A skin rash to rememberBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6625 (Published 08 October 2012) Cite this as: BMJ 2012;345:e6625
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I would like to commend the authors of “A skin rash to remember” for their presentation of a patient with eczema herpeticum. Although this is a rare skin rash, it is one which I have encountered recently in clinical practice and one which presented similarly to the case described.
I would just like to highlight the complication of herpetic keratitis, which we encountered with our case of eczema herpeticum.
Although rare, patients may develop severe bilateral herpetic ocular disease.1 If left untreated this can cause severe visual disturbances to the affected eye.2
This keratitis has complications of; stromal scarring and slow epithelial healing.3 However, if treated early with combination of topical trifluridine and systemic aciclovir antivirals, outcome can be very good and often healing takes places without any residual scarring.2,3
Therefore, the diagnosis of herpetic keratitis should be considered in all patients presenting with eczema herpeticum and urgent ophthalmology review should be sought, with a view to initiating early treatment.
1) Feye F, Halleux CD, Gillet J, Vanpee D. Exacerbation of atopic dermatitis in the emergency department. Eur J Emerg Med,2004;11(6):360-362.
2) Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database Sys Rev,2010;(12):CD002898.
3) Margolis TP, Ostler HB. Treatmentof ocular disease in eczema herpeticum. Am J Opthalm,1990;110(3):274-279.
Competing interests: No competing interests