Abstract
A 20-year-old man with a history of atopic dermatitis presented with a 3-week history of a rash affecting his antecubital fossae. Examination revealed punched out monomorphic papules on an erythematous base.
Dear Editor, An immunocompetent 20-year-old man with atopic dermatitis presented with a bilateral antecubital fossa rash. Examination revealed punched-out monomorphic papules on an erythematous base (Figure 1). A clinical diagnosis of eczema herpeticum was made. Polymerase chain reaction assay of the skin confirmed herpes simplex virus type-1 (HSV-1). He was treated with 14 days of oral valaciclovir, with scarring evident at follow-up (Figure 2).
Figure 1.
(a) Right antecubital fossa (pretreatment) showing erythematous papules coalescing into an ulcerated plaque. (b) Left antecubital fossa (pretreatment) showing punched out monomorphic eroded papules.
Figure 2.
Right antecubital fossa (post-treatment) showing scarring and postinflammatory erythema.
Eczema herpeticum presents as disseminated monomorphic vesicles and erosions1 resulting from HSV-1. Prevalence is 3% in patients with atopic dermatitis.2 There is a risk of HSV encephalitis, which has a mortality rate of >70% without antiviral medication.2 Recognition is of utmost importance to minimize the risk of disseminated HSV-1 infection.
Contributor Information
Claudine Howard-James, Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland.
Emma Shudell, Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland.
Author contributions
Claudine Howard-James (Data curation, Investigation, Methodology [equal], Writing—original draft, Writing—review & editing [lead]), and Emma Shudell (Conceptualization, Supervision [lead], Data curation [supporting], Visualization, Writing—review & editing [equal])
Funding sources
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Conflicts of interest
The authors declare no conflicts of interest.
Data availability
Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
Ethics statement
Not applicable.
Patient consent
All patients in this manuscript have given written informed consent for participation in the study and the use of their de-identified, anonymized, aggregated data and their case details (including photographs) for publication.
References
- 1. Traidl S, Roesner L, Zeitvogel J, Werfel T. Eczema herpeticum in atopic dermatitis. Allergy 2021; 76:3017–27. [DOI] [PubMed] [Google Scholar]
- 2. Damour A, Garcia M, Seneschal J et al. Eczema herpeticum: clinical and pathophysiological aspects. Clin Rev Allergy Immunol 2020; 59:1–18. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.