Treatment of Eczema Herpeticum in Children

Immediate Management

The American Academy of Dermatology recommends immediate treatment with systemic antiviral therapy, specifically acyclovir, which has transformed eczema herpeticum from a potentially fatal disease with 10-50% mortality to one with zero mortality when treated appropriately, in children with suspected eczema herpeticum 1, 2
Initiate acyclovir as early as possible upon clinical suspicion, as earlier initiation directly correlates with shorter hospital stays and better outcomes, in children with eczema herpeticum 2
Intravenous acyclovir is preferred for ill, febrile patients or those with severe, widespread disease, according to the BMJ, in children with eczema herpeticum 3
Oral acyclovir is appropriate for less severe cases and outpatient management, in children with eczema herpeticum, as per the BMJ 3

Add antibiotics only if there is clinical evidence of concurrent bacterial infection, such as purulent exudate or pustules, in children with eczema herpeticum, as recommended by the American Academy of Dermatology 1, 2
Flucloxacillin is first-line for Staphylococcus aureus co-infection, in children with eczema herpeticum, according to the BMJ 3