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Year : 2002  |  Volume : 68  |  Issue : 5  |  Page : 306-308

Eczema herpeticum in two elderly patients

Department of Skin, St.Johns Hospital, Bangalore, India

Correspondence Address:
Department of Skin, St.Johns Hospital, Bangalore, India


Two elderly patients with eczema herpeticum are being reported. The First patient did not respond to the conventional dose of acyclovir. The second case was seen in a patient with air borne contact dermatitis.

How to cite this article:
Gupta N, Augustine M, Jayaseelan E. Eczema herpeticum in two elderly patients. Indian J Dermatol Venereol Leprol 2002;68:306-8

How to cite this URL:
Gupta N, Augustine M, Jayaseelan E. Eczema herpeticum in two elderly patients. Indian J Dermatol Venereol Leprol [serial online] 2002 [cited 2020 Aug 3];68:306-8. Available from:

   Introduction Top

Eczema herpeticum or Kaposi's varicelliform eruption refers to a widespread cutaneous infection of herpes simplex virus in a patient with pre - existing skin disease. It is commonly seen between second to third decade of life[1] complicating diseases like atopic dermatitis,[2] Darier's disease[3] pemphigus foliaceous,[4] ichthyosis vulgaris.[5]

   Case 1 Top

A 53 - year -old woman presented with blisters and erosions all over the body of two weeks duration. The lesions were painful but non itchy. There were normal lesions or constitutional symptoms. There was no previous history of herpes infection. The Nikolsky's sign was positive. Haematological parameters and liver function tests were normal. Urine showed the presence of white blood cells, granular casts and bacteria. Acantholytic cells were seen in the Tzanck smear. Skin biopsy showed a cleft in the stratum granulosum and Direct immunofloresence was positive to IgG. [Figure - 1], [Figure - 2]
A diagnosis of pemphigus foliaceous was made and the patient was started on antibiotics, cyclophoshamide and steroids (50 mg daily). Within two weeks the lesions started healing. At the end of the second week fresh vesicles, which were larger and centrally umbilicated appeared on the face and the lesions eczematized and later spread to the rest of the body. These lesions appeared on the dermatitis involved skin. Repeat Tzanck smear from these lesions revealed multinucleated giant cells along with the acantholytic cells. Eczema herpeticum was thought of and acyclovir 200 mg 5 times a day was started. The lesions however continued to worsen. The dose of acyclovir was increased to 800mg 5 times a day and at the end of 7 days there was compete clearence of the lesions.

   Case 2 Top

A 56 year old woman, a known case of air borne contact dermatitis due to parthenium presented with multiple vesicular eruptions on the chin, peri - oral region, forehead and rest of the face of one week duration.The lesions on the chin were larger. There was associated scaling and hyperpigmentation over the dorsa of both hands. The rest of the body was spared. There were no constitutional symptoms. Atzanck smear was done from the vesicles and multinucleated giant cells were seen. She was on topical clobetasol propionate for her dermatitis. A diagnosis of eczema herpeticum was made and acyclovir 200mg 5 times a day was started. The lesions cleared within a week.

   Discussion Top

Eczema herpeb ticum appear as vesicles which are umbilicated. These are confined to eczematized skin. Costitutional symptoms like fever, malaise which may become severe are seen and there is associated lymphadenopathy. The vesicles rapidly become pustular, later erorions from and which can get secondarily infected. New crops may continue to appear for 7 to 10 day S: the fever however subsides in 4 to 5 days. The face when involved may become odematous. The pustules crust and heal slowly leaving little scarring. In non responding persistent eczematous lesions we should suspect eczema herpeticum and investigate. Vesicles should be sought for and a simple tzanck smear would be helpful. The punched out appearance of the erosions is diagnostic' and presence of multinucleated giant cells in the tzanck smear confirmatory. Milder infections are usually self limiting. Most patients respond well to oral acyclovir[7] whereas the severly ill may need intravenous acyclovir.[8] 

   References Top

1.Bork K, bra uninger W. Increasing incidence of eczema herpeticum: analysis of 75 cases. J Am Acad Dermatol 1988; 19 : 1024 - 1029.  Back to cited text no. 1    
2.Leyden JJ, Baker DA. Localized herpes simplex infections atopic dermatitis. Arch Dermatol 1979; 115 : 311 - 312.  Back to cited text no. 2    
3.Fisher BK, Kibrick S. Primary herpes in adult with Darier's disease. Arch Dermatol 1963; 87 : 729 - 731.  Back to cited text no. 3    
4.Silverstein EH, Burnett JW. Kaposi's varicelliform eruption complicating pemphigus foliaceous. Arch Dermatol 1967; 95 : 214 - 216.  Back to cited text no. 4    
5.Verbov J, Munro DD, Miller A. Recurrent eczema herpeticum associated with ichthyosis vulgaris. BrJ Dermatol 1972; 86 : 638 - 640.  Back to cited text no. 5    
6.Fitzpatrick TB, Johnson RA, Klanswolff, et al. Herpes simplex viruswidespread cutaneous infection in underlying dermatoses. In: ColorAtlas and Synopsis of Clinical Dermatology, International edition/ 3rd edition.Pg 806.  Back to cited text no. 6    
7.Muelleman PJ, Doyle JA, House RE Eczema herpiticum treated with oral acyclovir. J Am Acad Dermatol 1989; 15 : 716 - 717.  Back to cited text no. 7    
8.Jawitz JC, Hines HC, Moshell AN. Treatment of eczema herpeticum with systemic acyclovir. Arch Dermatol 1985; 121: 274 - 275.  Back to cited text no. 8    


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