Why Eczema and Cold Sores are a High-Risk Combo

If you or someone in your family has eczema, you’re probably used to avoiding a long list of things that can cause flare-ups, everything from soaps to itchy fabrics to certain types of jewelry.

But you may not be aware of one particularly dangerous trigger: the virus that causes cold sores, the herpes simplex virus (HSV).

Direct contact with another person’s cold sore, especially when eczema symptoms are flaring, can lead to a very serious complication called eczema herpeticum.

Infants and children with moderate to severe eczema are most susceptible to this skin infection, but eczema herpeticum can also affect adults, says the American Academy of Dermatology (AAD).

However, it can be life-threatening, especially if the infection spreads over wide areas of skin or involves organs, such as the brain, lungs, or liver, says the National Eczema Association (NEA).

For this reason, it is vital for people with eczema and parents of children with eczema to understand how to prevent an infection with HSV, as well as how to recognize symptoms of eczema herpeticum as soon as they arise, in order to seek prompt medical treatment.

What Is Eczema Herpeticum?

Eczema herpeticum is a painful, blistery rash that occurs when eczema-damaged skin is infected with herpes simplex virus type 1 (HSV-1) through skin-to-skin contact, says the NEA.

The most common symptom of HSV-1 is a cold sore on the lip or around the mouth that takes a week or two to heal. Occasionally, HSV-1 can cause genital herpes, often through oral-genital contact, according to the Centers for Disease Control and Prevention (CDC).

Although not typical, another herpes simplex virus, HSV-2, which causes most cases of genital herpes, can also trigger eczema herpeticum.

“Patients with eczema have a compromised skin barrier that puts them at a higher risk of skin infections in general, including eczema herpeticum,” says Nika Finelt, MD, director of pediatric dermatology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New Hyde Park, New York. Eczema causes breaks in the skin, which allows the herpes virus in.

In kids and young adults with eczema, wrestling and other contact sports can increase the risk of coming into direct contact with the herpes simplex virus and developing eczema herpeticum.

People who have other conditions that cause cracking in the skin’s surface, such as contact dermatitis or seborrheic dermatitis, can also develop eczema herpeticum, notes the NEA.

Once the herpes virus gains a foothold, the infection can spread rapidly over the body, affect vital organs, and even become life-threatening, says Carol Cheng, MD, a pediatric dermatologist at UCLA Health in Santa Monica. Because of this, eczema herpeticum is considered a medical emergency.

How to Spot Early Symptoms of Eczema Herpeticum

The first signs of eczema herpeticum occur about 5 to 12 days after exposure to HSV, says the AAD. At that point, it can be easy to think that changes in the skin are simply a particularly bad flare-up of eczema.

However, symptoms of eczema herpeticum — which include painful red, purple, or black blisters — tend to be more dramatic in appearance than eczema, says the NEA.

These blisters typically occur on the face and neck, but they can appear anywhere on the body where there is eczema and the skin has been in contact with the herpes virus.

In addition to a painful, blistery rash, eczema herpeticum can cause more general body-wide effects, says Sruthi Renati, MD, an assistant professor of dermatology at the University of Michigan–Michigan Medicine in Ann Arbor.

“Some patients develop high fevers, a general feeling of discomfort or feeling unwell, and enlarged lymph nodes,” she explains. These symptoms often start as the blisters are appearing.

Due to the potential for severe complications, you should call your doctor or dermatologist right away if you or a family member who has eczema develop any of the following symptoms:

  • A cluster of small, itchy, painful blisters
  • Blisters that are around the same size and have a punched-out look (like a hole puncher was used across the affected skin)
  • Blisters that are red, purple, or black
  • Crust that forms over older blisters
  • Blisters that ooze pus when broken
  • A cold sore above the upper lip
  • High fever and chills
  • Swollen lymph glands
  • Not feeling well overall

How Is Eczema Herpeticum Diagnosed?

Often, a doctor can diagnose eczema herpeticum through a physical evaluation, says the NEA.

A physician may also take a sample of skin scraped from the infected area (also known as a smear) to confirm the diagnosis. The smear is sent to a lab to be examined under a microscope, says the AAD.

How Is Eczema Herpeticum Treated?

Eczema herpeticum is typically treated with antiviral medications, such as acyclovir (Zovirax), which work by stopping the herpes virus from spreading inside the body, says the AAD.

Because early treatment is best, your doctor may begin this medication even before a lab confirms the diagnosis.

Depending on the severity of the infection, these drugs may need to be given in a hospital through an intravenous line into the bloodstream, says Dr. Finelt.

“The patient may also need IV hydration and may need to be treated for a secondary bacterial infection [with an antibiotic],” she adds. Topical medication may be used to treat the eczema as well.

Usually patients start to see improvement within a few days and can have a complete resolution of symptoms within a few weeks, although this can vary depending on how severe the condition is when it is diagnosed and treated.

Potential Complications of Eczema Herpeticum

It’s important to seek care for eczema herpeticum as soon as possible to prevent complications.

“If untreated, eczema herpeticum can be associated with a secondary bacterial infection, often with staph aureus,” Dr. Cheng says. This type of infection can be severe and may require hospitalization and treatment with intravenous antibiotics.

It’s also possible for the virus to spread to the eye, leading to a condition called herpetic keratitis, which can cause scarring of the cornea, vision loss, and even blindness, says the American Academy of Ophthalmology.

To avoid this complication, “patients with lesions on the face near or on the eyelids may require an ophthalmology consult,” says Cheng.

In rare cases, eczema herpeticum can spread to the brain and spinal cord. “In children, infants, and people with a compromised immune system, and in severe cases, there is a risk of developing meningitis, which is inflammation of the brain and spinal cord, and encephalitis, which is inflammation of the brain,” says Dr. Renati.

5 Ways to Reduce Your Risk of Eczema Herpeticum

If you or one of your family members has eczema, you can help reduce the risk of developing eczema herpeticum by following (and teaching your children to follow) these protective measures.

  1. Manage the eczema. “One of the best ways to prevent infection is to improve the background skin condition,” says Renati. When eczema is well controlled, there is less inflammation and fewer breaks in the skin. That leads to a better barrier and less chance that the herpes virus can find a way in, she explains.
  2. Avoid close contact with cold sores. A cold sore first appears as a red bump, then evolves into a fluid-filled blister that will ooze and crust over. These sores can appear anywhere, but they typically crop up around the lips and mouth, and sometimes on or in the nose, according to the Mayo Clinic. If someone with signs of a cold sore wants to kiss you hello, offer a hug instead.
  3. Don’t share things that touch another person’s mouth. You or your child can catch the herpes virus by eating from another person’s utensil, sharing lip balm or lipstick, and/or drinking from the same glass.
  4. Wash your hands frequently. You can also come into contact with the virus inadvertently. The herpes simplex virus could be on a doorknob, card-swiping machine, or other object that someone who is infected has touched. Frequent handwashing can help prevent you from being exposed to HSV, says the AAD.
  5. If you’re sexually active, avoid exposure to genital herpes. If your partner has genital herpes, using condoms and avoiding sexual activity when herpes lesions or other symptoms of herpes are present can reduce (but not eliminate) your risk of coming in contact with the herpes simplex virus, says the CDC.

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