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Eczema herpeticum — RACP Paediatrics MCQ

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HardRheumatology and dermatologyEczema herpeticumRACP Paediatrics

A 2-year-old with eczema develops fever and rapidly spreading painful punched-out vesicles over the face and flexures. Some lesions are crusted and he is reluctant to open one eye. What is the most appropriate management?

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Correct answer: B — Urgent intravenous aciclovir with ophthalmology review if eye involvement is suspected

Eczema herpeticum is disseminated HSV infection in eczematous skin and can threaten vision, requiring urgent aciclovir and eye assessment when periocular disease is present. Impetigo alone does not usually cause painful monomorphic punched-out vesicles with systemic symptoms. The pearl is that eczema plus fever plus painful vesicles is an emergency, not just a flare.

Reference: RCH Clinical Practice Guidelines: Eczema; Therapeutic Guidelines (eTG): Antibiotic