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Eczema Herpeticum — SCE Dermatology MCQ

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ModeratePaediatric DermatologyEczema HerpeticumSCE Dermatology

A 6-year-old boy with atopic eczema develops sudden onset of painful, grouped, monomorphic punched-out erosions and vesicles on his face and neck. He is febrile (39°C) and distressed. What is the most important immediate management step?

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Correct answer: C — Start systemic Aciclovir and refer for same-day specialist dermatological advice

This presentation is classic for eczema herpeticum (Kaposi varicelliform eruption) — a dermatological emergency caused by disseminated HSV in atopic eczema. NICE CG57 mandates immediate systemic Aciclovir (oral or IV depending on severity) and same-day specialist dermatology referral. Punched-out monomorphic erosions with systemic upset in an eczema patient are key diagnostic features. Topical antivirals alone are insufficient. Increasing topical corticosteroids may worsen viral dissemination. Secondary bacterial infection should be treated concurrently if suspected.

Reference: NICE 2007 CG57 Atopic eczema in under 12s (updated 2023)