Eczema Herpeticum

Eczema herpeticum is a condition wherein the patient has a preexisting condition such as atopic dermatitis, and then suffers a herpetic outbreak, which subsequently seeds the inflamed, eroded skin with HSV.  This is such a case.  

This patient originally had a herpetic outbreak on the lips, which then quickly generalized to nearly all his skin.  Luckily, he was immunocompetent, otherwise this would have killed him.  He did very well on systemic (IV) Acyclovir.  

The clues to the diagnosis are history, especially the perioral history with the spread like wildfire, and also the primary lesions, which are vesiculopustular.  

Also known as Kaposi's Varicelliform Eruption, eczema herpeticum is a devastating disease that can be life threatening if not treated promptly.  The take home message is this, though:  In a patient with a chronic inflammatory condition such as atopic dermatitis or Darier's, if they also have a history of heprpes labialis (or genitalis) please ensure they are prophylaxed so as not to end up with the disseminated variety of their condition.