Eczema herpeticatum kaposi

Eczema herpeticum is also called Kaposi's varicelliform eruption or pustulosis vacciniformis. It develops in an eczematous child three to seven days after contact with a person who has herpes simplex. The clinical manifestations of the dermatosis are similar to those of disseminated herpes simplex. Disseminated grouped small uniloculated vesicles with an umbilicate depression in the centre and papulovesicular and pustular lesions form here and there on an erythematous and edematous area of the skin. Superficial scars remain after resolution of the vesicles. The mucous membranes of the genitals and oral cavity are often involved. The eruptions occur suddenly with severe toxicosis, sharp elevation of body temperature (up to 39-40° C), confused consciousness, and enlargement of the liver and lymph nodes. Pneumonia, meningeal phenomena and encephalitis, otitis, keratoconjunctivitis sometimes with corneal ulceration, and gastro-intestinal disorders may develop.

In some cases the prognosis is unfavourable. The outcome may be fatal if the child is weak and asthenic and the viscera and nervous system are involved in the process.

Prevention. Individuals with herpes simplex are not allowed to take care of children.

Treatment. Patient education is an important first step in the management of patients with HSV infection. Particularly for genital HSV infection, counseling should be given regarding the natural history of herpes sexual and perinatal transmission, and methods to reduce such transmission. Patients should be informed that the lesions may recur, usually in the same location. They should be instructed that lesional contact should be avoided from prodrome until complete reepithelialization Since asymptomatic shedding of intact viral particles commonly occurs, this topic should be addressed clearly with patients. Additionally, condom use to prevent the transmission of genital HSV infection is prudent even between clinical recurrences, because of the possibility of asymptomatic shedding of the virus. Orolabial HSV frequently is triggered by intense sun exposure, and patients should use sunscreen on the face and lip balm containing a sunscreen.

Treatment of herpetic infections is suppressive, not curative. Systemic treatment is clearly much more effective than is topical treatment. However, if systemic treatment is contraindicated or refused, topical treatment may play a minor role in viral suppression.

Systemic Therapy

Treatment of acute infection

For patients with primary HSV infection, whether orofacial or genital, the best studied treatment is acyclovir 200 mg five times daily for 7 to 10 days. This treatment has been shown to decrease pain, new lesion formation, the duration of viral shedding, and the time to crusting and resolution. Since acyclovir is poorly absorbed and requires administration five times per day, it is no longer a treatment of choice.

Treatment option that is superior to acyclovir include valacyclovir 500 mg orally twice a day for 7 to 10 days. Valacyclovir is better absorbed than is acyclovir and probably is more effective because of the need for less frequent dosing. The only patient groups for which acyclovir remains appropriate are children. Valacyclovir should be used with extreme caution in immunocompromised patients because of occurrences of thrombotic thrombocytopenic purpura in some patients during clinical trials. None of these treatments has been found to decrease the chance of future recurrences.