Eczema herpeticum
When Is Derm Discussion Reasonable for Eczema Herpeticum Concern?
A concise clinician guide for punched-out erosions, painful monomorphic vesicles, and herpes superinfection concern.
Quick answer
Herpes Superinfection Concern
- Derm or ID discussion is reasonable when painful monomorphic vesicles, punched-out erosions, atopic dermatitis/barrier disruption, fever, ocular involvement, immunocompromise, or rapid spread are present. *
- Ophtho may be important when eye involvement is suspected.
- Testing site, isolation, antiviral pathway, and disposition are the key decisions.
Derm discussion is reasonable when
Higher-Yield Consult Context
- Painful monomorphic vesicles or punched-out erosions on eczematous or barrier-disrupted skin.
- Disseminated HSV/VZV concern, ocular symptoms, fever, immunocompromise, or rapid spread.
- Testing site, antiviral pathway, isolation, or disposition is unclear.
Workup or other service first when
Better First Step
- The rash is localized, stable, and clearly routine without ocular/systemic features or immunocompromise.
- The immediate concern is sepsis, airway, or another emergency stabilization pathway.
- There are no images, distribution, morphology, immune status, or exposure details available yet.
Common pitfall
Keep the Question Specific
Eczema herpeticum can be mislabeled as an eczema flare. Painful monomorphic vesicles or punched-out erosions should raise the stakes.
FAQ
Clinician Questions
What should be described?
Pain, monomorphic vesicles, punched-out erosions, distribution, ocular symptoms, immune status, fever, and rapidity of spread.
Who else may need involvement?
ID may help with antiviral and infection strategy; Ophtho may be important when ocular involvement is suspected.
Should SIC interpret photos?
No. Use chart photos and reference images for clinician review; SIC does not analyze uploaded patient images.
References
Educational tool only. SIC provides clinician-facing educational consult-triage references. SIC does not diagnose, treat, prevent, cure, or mitigate disease and is not a substitute for clinical judgment, local guidelines, institutional referral pathways, or recommendations from your dermatology department. See disclaimer.