GP and hospital practitioner Dr Andy Jordan presents the latest in his series on differentiating similar-looking skin conditions
Atopic eczema is an extremely common condition affecting about 20% of infants nowadays. The condition is characterised by the skin having defective barrier function and abnormal immune responses. This puts the patient at increased risk of infection with bacteria
(usually Staphylococcus aureus) and viruses (herpes simplex). It is important to differentiate impetiginised atopic eczema from eczema herpeticum.
Impetiginised atopic eczema
• Any age group may be affected but usually children and young adults
• May be recurrent
• Infection usually on face, neck or limbs
• Acute onset of eroded skin with leakage of serous yellow fluid and golden crusting
• No vesicles seen
• Treat with antibiotics
• Treat underlying eczema.
• Any age group but usually under 40
• May be recurrent (second and subsequent attacks are often less severe)
• Lesions usually occur on the face (often periorbitally) and neck but may rapidly become widespread
• Widespread crusted papules, vesicles and erosions are characteristic
• Monomorphic, punched-out lesions are very suggestive
• More likely than impetiginised atopic eczema to produce systemic symptoms such as raised temperature and malaise
• Rash is often painful
• Treatment is with antivirals such as oral aciclovir or, if severe, hospital admission might be needed for intravenous aciclovir
• Underlying eczema should be treated.
Always see a patient with acute flare-up of atopic eczema urgently, especially if the area affected is around the head and neck or there are systemic symptoms – it may be eczema herpeticum.
If the cause of a flare-up of atopic eczema is uncertain clinically, swab for both viruses and bacteria. If in doubt, either refer or treat with antivirals and antibiotics while awaiting swab results.
Dr Andy Jordan is a GP and hospital practitioner in dermatology in Chesham, Buckinghamshire
Eczema herpeticum Eczema herpeticum Impetiginised eczema Impetiginised eczema