Eczema Herpeticum — SCE Dermatology MCQ

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ModerateCutaneous InfectionEczema HerpeticumSCE Dermatology

A 40-year-old woman has eczema herpeticum that has been treated with IV Aciclovir. She improves clinically but her CRP remains elevated and she develops honey-coloured crusting on healing lesions. What should be suspected?

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Correct answer: B — Secondary bacterial infection (staphylococcal/streptococcal) superimposing on the resolving viral infection — swab and treat with antibiotics

Secondary bacterial infection (most commonly S. aureus or Group A Streptococcus) frequently complicates eczema herpeticum, especially during the recovery phase when the disrupted skin barrier is vulnerable to bacterial colonisation. Honey-coloured crusting and persistent/rising inflammatory markers despite improving viral disease suggest bacterial superinfection. Wound swabs for MC&S should be obtained and appropriate antibiotics started (Flucloxacillin for S. aureus, or broader coverage if MRSA suspected). The combination of antiviral and antibiotic therapy is often needed. Untreated bacterial superinfection can lead to sepsis in immunocompromised patients.

Reference: NICE CG57; BAD AD Guidelines