Eczema Herpeticum - Symptoms, Causes & Treatment
Medically reviewed by Dr. Anand S. Urhekar, MD, MD Pathology, Clinical Advisor · Last updated July 2026
A potentially serious widespread herpes simplex infection of skin already affected by eczema. It causes a rapid eruption of clustered, painful, punched-out blisters and erosions with fever and malaise, and can lead to sepsis, eye involvement or organ complications if untreated.
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Quick Answer
Eczema herpeticum is a medical emergency in which herpes simplex virus infects eczema-affected skin. Look for a rapid crop of painful, clustered, punched-out sores of uniform size, worsening eczema that suddenly turns painful rather than itchy, plus fever and feeling unwell. It requires same-day medical assessment and urgent oral or intravenous aciclovir.
Symptoms
- Clusters of small, uniform, punched-out erosions or blisters
- Pain rather than the usual itch
- Rapid spread over 24–48 hours
- Fever, shivering and feeling unwell
- Eczema that suddenly deteriorates and fails to respond to usual treatment
Causes & Risk Factors
- Herpes simplex virus type 1 or 2
- Pre-existing atopic eczema with a damaged skin barrier
- Recent contact with a cold sore
- Immunosuppression
Treatment & Management
- Urgent oral aciclovir, or intravenous if severe or extensive
- Same-day dermatology or emergency assessment
- Antibiotics if bacterial superinfection is present
- Ophthalmology review if near the eyes
- Careful resumption of eczema treatment during recovery
When to See a Doctor
Seek same-day medical care. Go to emergency care if there is high fever, lesions near the eyes, rapid spread, or if the person is drowsy, a young infant or immunosuppressed.
Frequently Asked Questions
How do I tell eczema herpeticum from a bad eczema flare?
The key differences are pain instead of itch, uniform punched-out round sores, fever, and deterioration over hours to a couple of days despite normal eczema treatment. If in doubt, get seen the same day.
Can I keep using steroid cream?
Not without medical advice. Topical steroids alone can allow the viral infection to spread. Antiviral treatment must be started first, then eczema therapy resumed under guidance.
Medical References
Information on this page is sourced from and verified against reputable medical resources:
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Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. The content on this page should not be used to diagnose or treat any health problem. Always consult with a qualified healthcare professional for proper medical evaluation, diagnosis, and treatment of your condition.