Treatment of Eczema Herpeticum with Fever

Diagnosis and Clinical Features

Eczema herpeticum is characterized by disseminated viral infection with herpes simplex virus on eczematous skin, presenting as grouped, punched-out erosions or vesiculation 3, 4
Deterioration in previously stable atopic dermatitis may indicate secondary viral infection 4

For a patient with eczema herpeticum presenting with fever, intravenous acyclovir should be administered immediately as the first-line treatment 1, 2
Intravenous acyclovir administration must be given early in the course of disease, specifically indicated for ill, febrile patients 1, 2
Antipyretics for fever management and sedating antihistamines may help with pruritus during acute phase 1, 2
If bacterial superinfection is suspected, flucloxacillin is the first-line antibiotic for Staphylococcus aureus, erythromycin should be used in penicillin-allergic patients, and phenoxymethylpenicillin if β-hemolytic streptococci are isolated 1
After resolution of the acute infection, maintenance therapy for underlying atopic dermatitis should be resumed 1