Eczema Herpeticum — SCE Dermatology MCQ

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ModerateInflammatory DermatosesEczema HerpeticumSCE Dermatology

A 22-year-old woman with atopic eczema develops widespread vesicles and pustules over areas of active eczema after contact with a friend who had cold sores. PCR confirms HSV-1. She is systemically unwell with fever. In addition to systemic Aciclovir, what topical treatment should be AVOIDED?

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Correct answer: B — Topical corticosteroids on actively infected skin

In eczema herpeticum, topical corticosteroids should be WITHHELD from actively HSV-infected skin as they may facilitate viral replication and spread. Systemic Aciclovir (oral or IV depending on severity) is the cornerstone of treatment. Once the viral infection is controlled (no new vesicles, existing lesions crusting), topical corticosteroids can be cautiously reintroduced to manage the underlying eczema. Emollients should be continued throughout. Topical antibiotics or antiseptic washes may be needed if secondary bacterial infection is suspected. The key teaching point: topical immunosuppression on active viral infection is contraindicated.

Reference: NICE CG57; BAD AD Guidelines