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Herpetic Whitlow Or Dyshidrotic Eczema

Complications Of Dyshidrotic Eczema

Herpetic Whitlow or Dyshidrotic Eczema

The main complication of dyshidrotic eczema is usually the discomfort from itching and the pain from the blisters.

This discomfort can sometimes become so severe during a flare that youre limited in how much you use your hands, or even walk. Theres also the possibility of getting an infection in these areas from over-scratching.

In addition, your sleep may be disrupted if the itching or pain is severe.

Can You Put Your Finger On The Diagnosis

DISCUSSIONThe lesion on this childs finger is a herpetic whitlow. Patients with atopy are often susceptible to all types of skin infections: bacterial, fungal, and viral. In fact, human papillomavirus infection manifesting as multiple warts is not uncommon in this population. Nor is herpes simplex virus infection, of which this case represents 1 manifestation.

A culture could have been done to confirm the diagnosis, but that would entail opening a vesicle to collect the fluid and then waiting at least 2 weeks for the results. By then, this whitlow would have long since resolved.

As with all HSV infections in the immunocompetent, treatment with acyclovir must be started in the first 2 to 3 days to have any effectso such treatment in this case would be useless. If the herpetic whitlow were to recur in the same location, prompt treatment could be initiated, which would likely shorten the disease course and reduce symptoms.

Another HSV infection seen almost exclusively in atopic patients is eczema herpeticum . This diffuse infection comprises dozens of tiny papulovesicular lesions, mostly concentrated on the face but often spilling down onto the chest. Patients with Darier disease or seborrheic dermatitis can also acquire it.


Complications Of Eczema Herpeticum

Eczema herpeticum is potentially a very serious condition. Complications of this infection may include:

  • Scarring from blisters
  • Infection in the cornea of the eye known as herpetic keratitis, which left untreated, can lead to blindness
  • In rare cases, organ failure and death if the virus spreads to the brain, lungs and liver

Immediate treatment for eczema herpeticum can reduce the risk of complications from the virus.

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What Is Eczema Herpeticum

Herpes does not cause serious health problems for someone with a healthy immune system. However, if a person with eczema becomes infected with one of the herpes simplex viruses HSV-1 or HSV-2 they may develop eczema herpeticum.

Eczema herpeticum is a rare but potentially serious complication. It can happen when areas of the skin that eczema affects come into contact with the herpes virus.

It is most likely to result from contact with a cold sore and usually occurs on the:

  • head
  • neck
  • trunk

Symptoms of eczema herpeticum usually appear 512 days after exposure to sores from the herpes virus. The symptoms typically present as follows:

  • A cold sore may be an initial symptom.
  • A blistering rash can appear over 710 days. The blisters form a cluster and may cover a large area. They may break open, be itchy or painful, weep, bleed, or have pus or yellow fluid inside.
  • The person may feel unwell, with swollen lymph nodes, a fever, chills, and fatigue starting as the rash appears.

Eczema herpeticum is a medical emergency because it can lead to severe and sometimes life threatening complications, such as:

  • herpetic keratitis, an infection in the cornea of the eye that can lead to vision loss without treatment
  • organ failure and death, if the virus spreads to the brain, lungs, and liver
  • long-term scarring

Eczema herpeticum can occur in people with any condition or injury that involves damaged skin, such as:

  • contact dermatitis
  • other irritants or allergens

Herpes Simplex Virus Type 1

Healthool Dyshidrotic Eczema

HSV-1 commonly causes cold sores, known as oral herpes. HSV-1 is very contagious.

According to the World Health Organization , about 67% of people under the age of 50 have HSV-1, globally.

HSV-1 can spread through sexual contact from the mouth to the genitals, but it is not necessarily a sexually transmitted infection . Many people get HSV-1 through nonsexual contact, including kissing or sharing personal items, such as lip balm or utensils.

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Prevention And Control Of Outbreaks

Because the causes are unknown and the triggers are so personal, theres no one way to completely prevent or control outbreaks of dyshidrotic eczema.

But you can keep your symptoms from barreling out of control by understanding your specific triggers, strengthening your skin by applying moisturizer daily, keeping your stress in check , and staying hydrated.

Treatments Your Physician May Prescribe

Most herpes simplex virus infections are easy for physicians to diagnose. On occasion, however, a swab from the infected skin may be sent to the laboratory for viral culture, which takes a few days to grow. Blood tests may also be performed.Untreated HSV infections will go away on their own, but medications can reduce the symptoms and shorten the duration of outbreaks. There is no cure for herpes simplex virus infection.Although herpetic whitlow symptoms will eventually go away on their own, your physician may prescribe antiviral medications in order to help relieve symptoms and to prevent spread of the infection to other people:

  • Acyclovir pills
  • Topical acyclovir ointment

These medications are usually taken for 714 days.More severe herpetic whitlow may require oral antibiotic pills if the area are also infected with bacteria.Although it is rare, recurrent herpetic whitlow can be treated with the same oral antiviral medications:

  • Acyclovir pills
  • Famciclovir pills
  • Topical acyclovir ointment

People who experience early signs before recurrent infections may benefit from episodic treatment, by starting to take medication after the onset of tingling and burning but before the appearance of blisters and sores.Very rarely, individuals may have recurrent herpetic whitlow outbreaks that are frequent enough or severe enough to justify suppressive therapy, in which medications are taken every day in order to decrease the frequency and severity of attacks.

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Diagnosis Of Eczema Herpeticum

Your healthcare provider can sometimes diagnose eczema herpeticum just by looking at it, but often a skin sample helps confirm the diagnosis. He or she may begin by scraping the infected skin and looking at the contents of the blisters under the microscope . Also, viral cultures and polymerase chain reaction testing can help identify what is causing the infection .

Why is all of this necessary if the provider can tell by appearance? Sometimes eczema herpeticum resembles another skin infection called impetigo. Impetigo is a bacterial skin infection, usually with Staphylococcus aureus or Streptococcus pyogenes, which are common skin bacteria. People with atopic dermatitis are more susceptible to impetigo than those without eczema. Impetigo usually has redness, swelling, tenderness, and honey-yellow crusting of infected skin . The treatment of the two conditions is different, one being a viral infection and the other caused by bacteria. The additional testing mentioned can help differentiate between the two when necessary.

Causes Of Eczema Herpeticum

herpetic whitlow – Herpes whitlow

An eczema herpeticum happens when the herpes virus infects large areas of the skin. People with atopic dermatitis are more susceptible to skin infection in general, including eczema herpeticum. Eczema herpeticum can also appear in people who have contact dermatitis or seborrheic dermatitis. It is more common in infants and young children and those with severe atopic dermatitis.

The herpes simplex 1 virus is spread through skin-to-skin contact.

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What Is Herpes Simplex Virus

Most people refer to herpes simplex viruses as herpes. These viruses transmit from one person to another and can cause painful or itchy blisters or open sores.

When sores or blisters appear, this is called a herpes outbreak. Many people have herpes but do not have symptoms or outbreaks, so they are unaware that they have the virus.

There are several types of herpes, but the two common ones are herpes simplex virus types 1 and 2.

Treatment Options For Eczema Herpeticum

Since it is caused by a virus, the best treatment for eczema herpeticum is an antiviral medication, like acyclovir or valacyclovir . These drugs help fight off the current outbreak but do not prevent future flare-ups. Some people get bacterial skin infections on top of the viral infection and need antibiotics as well. If the eczema herpeticum is severe, you may require hospitalization until your condition improves.

If you have any form of eczema and you develop a different kind of rash, especially one that is painful or forms blisters, see your healthcare provider for an evaluation. You may have a skin infection. Most of the time, in healthy people, prompt recognition and treatment can lead to a mild disease with few long-term consequences.

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Things You Can Do To Ease Pompholyx

You should try to avoid contact with anything that might irritate your skin, including soaps, shampoos and other household chemicals.

Use an emollient as a soap substitute and wear cotton-lined gloves when you’re at risk of contact with other potentially irritating substances, such as when washing your hair or doing housework.

Do not burst the blisters. Let them heal on their own. If they’re particularly big, your GP may be able to drain them.

Who Is At Risk For Developing Dyshidrotic Eczema

Herpes Simplex Virus (HSV) Infections

There are a variety of factors that may dictate who develops dyshidrotic eczema.

If you are going to develop it, itll most likely begin between 20 and 40 years of age. Genetics may also play a role in dyshidrotic eczema. If you have one or more blood relatives with it, theres a higher chance you could also have it.

A few other factors that may contribute to its development are:

  • youre already living with another type of eczema
  • youve worked, or currently work, as a mechanic or metalworker
  • you have a history of working with cement
  • you already deal with seasonal allergies
  • youre living with asthma
  • you have occasional bouts of allergic sinusitis

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Treatment For Pompholyx From A Gp

The main treatments your GP may recommend to treat the symptoms of pompholyx are similar to those used when treating atopic eczema, including:

  • emollients use these all the time and instead of soap to stop your skin becoming dry
  • steroid cream this reduces the inflammation and irritation and helps the skin heal

Your GP will probably prescribe a strong steroid cream to use for a short period of time to minimise the risk of steroid side effects.

You may be advised to wear cotton gloves at night to help the cream sink into the skin.

You can also try:

  • soaking your hands in a dilute solution of potassium permanganate for 10 to 15 minutes once or twice a day for up to 5 days
  • antihistamines to relieve the itching and help you sleep if the itchiness is keeping you awake at night

These treatments are available from pharmacies without a prescription. Your pharmacist can advise whether they’re suitable for you and how you should use them.

Antibiotics may be prescribed if your skin becomes infected.

Signs And Symptoms Of Pompholyx

Pompholyx usually starts as intense itching and burning of the skin on the hands and fingers. The palms and sides of the fingers then erupt into tiny itchy blisters that may weep fluid.

In severe cases, the blisters may be quite large and may spread to the backs of the hands, feet and limbs.

The skin can sometimes become infected. Signs of an infection can include the blisters becoming very painful and oozing pus or becoming covered in a golden crust.

The blisters will usually heal within a few weeks. The skin tends to become dry and crack or peel as it starts to heal.

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Difference Between Herpes Whitlow And Eczema

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Who Gets Eczema Herpeticum

Herpetic Whitlow – Dermatology

Anyone with atopic dermatitis can get eczema herpeticum, but infants and young children are the ones most often affected, especially if they have moderate to severe eczema . Approximately 1020% of people with atopic dermatitis develop eczema herpeticum . We dont know why some people exposed to the herpes simplex virus simply get cold sores while others get full-blown eczema herpeticum. We do know that atopic dermatitis affects the health of the skin and skin barrierthis can make the skin more susceptible to infections. People with other skin conditions, like contact dermatitis or seborrheic dermatitis , can also get eczema herpeticum from a herpes simplex virus infection .

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Home Remedies For Dyshidrotic Eczema

While home remedies may not be as effective as a doctor-recommended medication, they can help ease symptoms.

You can start with cold compresses, soothing the area every 15 minutes. You can also soak the affected areas for 15 minutes your doctor may know some good inflammation-lowering medicated soaks.

Find ways to relieve stress. Since dyshidrotic eczema can be triggered by stress, using techniques like meditation can help provide a dose of calm for your mind and body.

If your hands are affected, make sure to remove rings and jewelry whenever you wash your hands so water doesnt linger on your skin. If you notice that a certain personal care product like a new bar of soap seems to have been the cause of your blisters, stop using it for a few weeks and see if the inflammation and itching die down.

Keep the affected area well moisturized at all times. Try to maintain your fingernails so theyre short enough to not break the skin if/when you scratch. This can help you avoid infection.

Symptoms Of Eczema Herpeticum

Symptoms of eczema herpeticum include red, fluid-filled blisters on the face and neck. Image courtesy of DermNet New Zealand

Eczema herpeticum usually appears on the face and neck. It can also appear on other places on the body such as the hands. It can take up to two weeks for symptoms to appear after the first contact with the herpes simplex virus.

Skin symptoms of eczema herpeticum include:

  • Cluster of small blisters that are itchy and painful
  • Blisters that look red, purple or black
  • Blisters that ooze pus when broken open

Other symptoms of eczema herpeticum include:

  • High fever and chills
  • Swollen lymph glands
  • Not feeling well overall

If you suspect you may have eczema herpeticum it is very important that you see a doctor immediately.

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Treatments For Mild Outbreaks

Pimecrolimus cream, tacrolimus ointment, or Eucrisa, are typically used to treat atopic dermatitis. But they have also been shown to be effective for dyshidrotic eczema.

For mild flare-ups, your doctor may recommend:

  • a moisturizer thats very emollient to help relieve the dryness
  • a prescription corticosteroid that helps heal the blisters and reduces inflammation
  • anti-itch medication in the form of a pill or cream

Dyshidrotic Eczema In Children

Dyshidrotic Eczema

Eczema, or atopic dermatitis, is more common in children and infants than in adults. About 10 to 20 percent have some form of eczema. But many will outgrow atopic dermatitis or eczema by adulthood.

Conversely, dyshidrotic eczema can also affect children, but its rare.

The first symptoms of a dyshidrotic eczema flare may be a burning, itching sensation without any visual clues.

Tiny, itchy blisters might then develop, most likely on your:

  • palms
  • feet

In severe cases, the blisters can expand to the back of hands, limbs, and feet.

These tiny blisters can grow together and form larger areas that are very itchy, red, and raised. If the skin becomes infected, the blisters can become painful and ooze pus.

Typically, dyshidrotic eczema heals on its own in 3 to 4 weeks, but as the blisters heal, they can cause your skin to become very dry and peel. Individuals with a darker skin tone may develop dark spots where the blisters have healed.

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How Is Dyshidrotic Eczema Diagnosed

If youve been dealing with red, itchy skin for more than a week, its a good idea to seek out your doctor or dermatologist, because many skin conditions can cause blisters.

During your visit, your doctor will most likely take a look at your skin and ask you if youve noticed a pattern around your blisters like if youve started using different products or have felt particularly stressed and if your jobs or hobbies include coming into contact with metals.

If your doctor believes your dyshidrotic eczema could be due to an allergy, they may do an allergy test.

If your case is severe or if the symptoms have been long-lasting, you may be prescribed medication.

The severity of your outbreak and other personal health factors determine which treatments your doctor might suggest. It also may be necessary to try more than one treatment before finding one that works.

Infective Causes Of Blistering

Herpes simplex and herpes zoster

Herpes simplex and herpes zoster cause painful blisters. Both start as a red macule, which soon becomes raised and forms a vesicle. Pain preceding the appearance of the skin lesions is a very important clue to this diagnosis.

Herpes simplex causes small, closely grouped vesicles on a red base and these can be located anywhere on the body, not just the most common sites .

Herpes zoster lesions are more linear and restricted to one side of the body following a dermatome. In immunosuppressed people or patients on chemotherapy, this condition can involve several dermatomes.

Herpes simplex can be treated with either topical or oral aciclovir. Frequent recurrences may need an extended course of oral aciclovir. In immunosuppressed patients, herpes simplex can become generalised and may be life-threatening. In this situation, hospital admission and IV antivirals will be necessary.

Treating herpes zoster with antivirals has been shown to reduce the acute pain, virus shedding, rash and the incidence and severity of post-herpetic neuralgia.2

Eczema herpeticum

Eczema herpeticum is a condition with a somewhat misleading name, as it suggests there has to be eczema, but any skin problem that breaches the skin barrier can be complicated by herpes simplex . Often mistaken for impetigo, it consists of small, very even, punched-out blisters, which look as if someone has tried to take shallow punch biopsies.

Herpetic whitlow



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