Eczema herpeticum (EH) is a superimposed cutaneous viral infection that occurs in the context of preexisting dermatoses, most commonly atopic dermatitis (AD). It typically involves the face, neck, and upper trunk. Although ocular involvement is relatively uncommon, it may present diagnostic and therapeutic challenges and pose a significant risk to vision. We report a pediatric case of EH with severe ocular involvement in a young child with underlying AD. Despite early oral antiviral and antibiotic therapy, the condition progressed rapidly to orbital cellulitis. Clinical improvement was observed following escalation to intravenous antiviral therapy, addition of topical antiviral treatment, and broadening of antibiotic coverage, with subsequent full recovery. This case highlights the importance of early recognition, close monitoring, and timely escalation of treatment in EH with ocular involvement to prevent sight‐threatening complications.

Kaposi's varicelliform eruption presenting with thick facial crusting.

Targeted systemic therapies for atopic dermatitis (AD), including biologics and Janus kinase (JAK) inhibitors, are increasingly used. However, comparative post-marketing evidence on herpetic infection-related safety signals across these therapies remains limited. To compare safety signals of herpetic infections associated with targeted AD therapies using the Food and Drug Administration Adverse Event Reporting System (FAERS). FAERS reports (Q2 2017 to Q1 2025) involving dupilumab, abrocitinib, baricitinib, or upadacitinib were included if these agents were designated as the primary suspect drug and the indication was AD. Disproportionality analyses using four algorithms were performed to detect signals for overall and virus-specific herpetic events. Subgroup analyses by age and sex and time-to-onset (TTO) analyses were conducted. All therapies demonstrated positive signals for herpetic infections. Baricitinib and abrocitinib showed the strongest signals, followed by upadacitinib, whereas dupilumab showed comparatively lower signals overall. Notably, dupilumab demonstrated a herpes simplex virus (HSV) signal comparable to abrocitinib and higher than upadacitinib, and a signal for eczema herpeticum (EH) was also identified. Signals were generally higher in females, except for upadacitinib. Age-stratified analyses showed varying signal patterns across age groups. Median TTO differed between therapies, with an earlier onset for upadacitinib. Herpetic infection reporting patterns differ across targeted AD therapies. Disproportionate reporting of HSV and EH with dupilumab warrants further investigation. Differences across sex, age groups, and TTO suggest potential heterogeneity in reporting patterns, which may reflect underlying patient characteristics and reporting behaviours.

Eczema Herpeticum Following Topical Ruxolitinib Use: A Report of Two Cases

Individuals with atopic dermatitis (AD) are at increased risk for skin infections, including eczema herpeticum (EH), a severe condition caused by herpes simplex virus type 1 (HSV-1). While AD skin is often colonized by Staphylococcus aureus (S. aureus), its role in EH susceptibility remains unclear. Here we aim to investigate differences in the skin microbiome of AD patients with (ADEH+) and without (ADEH-) EH and examine the impact of S. aureus and S. epidermidis on HSV-1 infection in an invitro keratinocyte model. 16S microbiome sequencing was performed on skin samples from ADEH+, ADEH-, and healthy controls. To investigate microbial effects on HSV-1 infection, keratinocytes were pre-incubated with heat-killed S. aureus (HKSA) or S. epidermidis (HKSE), followed by HSV-1 infection in the presence or absence of the Th2 cytokines IL-4 and IL-13, simulating the conditions of AD lesional skin. Infection rates and transcriptomic changes were analyzed. ADEH+ patients showed a reduced microbial diversity compared to ADEH-, with increased S. aureus and S. epidermidis colonization. HKSA, but not HKSE, protected keratinocytes from HSV-1 infection and reduced the release of infectious progeny virus. Transcriptome analysis of keratinocytes revealed HKSA-induced upregulation of interferon pathways and antimicrobial peptides, and downregulation of HSV-1 entry factors. Pre-incubation with S. aureus set basal keratinocytes into an alarmed state, restricting HSV-1 infection presumably via downregulation of receptors important for viral entry and activation of antiviral pathways.

Eczema herpeticum (Kaposi’s varicelliform eruption) is a disease characterized by an intoxication syndrome associated with a viral infection in children with atopic dermatitis. The most common etiological agent of eczema herpeticum is herpes simplex virus type 1 (HSV-1), less frequently herpes simplex virus type 2 (HSV-2), and, in rare cases, Coxsackievirus A16 or the vaccinia virus. The disease is typical for children aged 6 months to 2 years. This article presents a clinical case of eczema herpeticum in a 14-year-old adolescent with a burdened premorbid background, infected with several human herpesviruses simultaneously (Epstein-Barr virus (EBV), HSV-1, HHV-7) and an active infection caused by herpes simplex virus type 2. The etiological verification of the diagnosis using molecular genetic methods and enzyme immunoassay is described. The patient received systemic therapy, which included antiviral agent (acyclovir 500 mg IV 3 times daily for 5 days), infusion (0.9% sodium chloride 250 ml 2 times daily for 3 days), systemic anti-inflammatory agent (prednisolone 60 mg 2 times daily for 3 days), desensitizing agent (chloropyramine 25 mg 2 times daily for 5 days); local treatment with anti-inflammatory and antifungal/antibacterial agents (hydrocortisone + natamycin + neomycin 15 g 3 times daily for 7 days); drying and anti-inflammatory agent (zinc oxide 25 mg 2 times daily for 5 days), antibacterial eye drops (sulfacetamide 0.1 ml 4 times daily for 5 days). The treatment resulted in a significant improvement of the patient’s condition. The presented case of a typical clinical course of Kaposi’s varicelliform eruption has a scientific and practical significance in terms of the atypical age of disease manifestation and the etiology of the infectious process associated with patient’s burdened pre-comorbidities anamnesis. The presented case of a typical clinical course of eczema herpeticum is of scientific and practical interest due to the atypical age of disease manifestation and the etiology of the infectious process associated with the patient’s burdened premorbid background. The presented data are intended to increase awareness among practicing physicians regarding the clinical and laboratory diagnosis of herpes skin infections in older pediatric age groups.

Molluscum contagiosum (MC) is a viral infection that primarily affects pediatric patients, sexually active young adults, and immunocompromised individuals of all ages. Clinically, MC presents as firm, rounded, pink, or skin-colored papules with a shiny and umbilicated surface. Microscopic histological findings include a crateriform invagination of the hyperplastic epithelium composed of enlarged keratinocytes containing inclusion bodies known as Henderson-Patterson bodies. In some patients, including immunocompetent children, the morphology of MC lesions can vary. Giant MC lesions can mimic cysts, abscesses, or condylomas. Erosive MC lesions can mimic eczema vaccinatum. The papules may also be pearly white or reddish in color. Here, we report a case of a Molluscum contagiosum infection complicated by an epidermal cyst.

Comparing Food Allergies in Eczema Herpeticum vs Atopic Dermatitis Pediatric Patients

ObjectivesDupilumab and tralokinumab are FDA-approved biological agents for the treatment of atopic dermatitis (AD). This study analyzed tralokinumab-related adverse events (AEs) reported by healthcare professionals, utilizing data mined from the FDA Adverse Event Reporting System (FAERS). Furthermore, we compared the frequency of reports for common AEs with dupilumab or tralokinumab as the primary suspect, focusing on injection-site reactions, conjunctivitis, and keratitis.MethodsDisproportionality analysis methods, including the reporting odds ratio (ROR), the Medicines and Healthcare products Regulatory Agency (MHRA) comprehensive method, the Bayesian confidence propagation neural network (BCPNN), and the Multi-item gamma Poisson shrinker (MGPS), were employed to quantify tralokinumab-associated AE signals. Then, the occurrence risk of common AEs between dupilumab and tralokinumab was further compared.ResultsAmong 1,591,367 AE reports, 1,770 identified tralokinumab as the primary suspect. Tralokinumab-related AEs affected 25 System Organ Classes (SOC), with 49 significant disproportionality primary terms (PTs) consistently detected across all four algorithms. Notable potential AEs included eczema herpeticum, generalized exfoliative dermatitis, alopecia, skin exfoliation, and blepharitis. Most tralokinumab-related AEs occurred within the first month of treatment, with a median onset time of 37 days (interquartile range [IQR]: 13–111 days). The reporting proportion of injection site reactions was significantly higher with dupilumab than with tralokinumab (p < 0.001). In contrast, tralokinumab was associated with a substantially higher reporting proportion of conjunctivitis (p = 0.001) and keratitis (p = 0.039).ConclusionThis study identified potential AE signals that could aid clinical monitoring and risk identification for tralokinumab. Additionally, close monitoring is warranted for dupilumab-associated injection site reactions and tralokinumab-associated conjunctivitis and keratitis throughout treatment.

BACKGROUND Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare pediatric condition that can present with rapidly progressive glomerulonephritis and is characterized by necrotizing crescentic glomerulonephritis. While there are no specific pediatric treatment guidelines, rituximab has shown promising benefits in the management of pediatric AAV. This report presents a case of AAV in a 6-year-old girl treated with rituximab and mycophenolate mofetil, resulting in remission that was maintained at 5-year follow-up. CASE REPORT A 6-year-old girl with eczema herpeticum presented with progressive bilateral lower extremity pain, weakness, and intermittent fever and later developed microscopic hematuria. Initial workup revealed proteinuria, elevated inflammatory markers, and renal biopsy findings of pauci-immune crescentic glomerulonephritis, with positive perinuclear ANCA and myeloperoxidase antibodies, confirming AAV. She was initially treated with corticosteroids without improvement, but subsequent rituximab induction followed by mycophenolate mofetil maintenance resulted in clinical improvement. At 5-year follow-up, she remained in remission while receiving enalapril and annual rituximab therapy. CONCLUSIONS This report presents a rare occurrence of AAV in a pediatric patient and demonstrates the challenges in treating this condition given the lack of pediatric-specific treatment protocols. Further research and case reports are essential in the development of standardized and evidence-based treatment strategies tailored to the pediatric population. This case highlights that AAV, while rare in children, can be effectively managed with rituximab and mycophenolate mofetil to achieve long-term remission.

Eczema Herpeticum in a Young Boy

Hand-foot-and-mouth disease, commonly caused by Coxsackievirus A16, can manifest in atypical and severe forms associated with the CVA6 serotype, termed "eczema coxsackium," which may mimic serious pathologies. This report describes the case of a 10-year-old boy with a diffuse maculopapular rash, targetoid and bullous lesions, and systemic compromise, initially diagnosed as erythema multiforme major. The discussion focuses on the differential diagnostic challenge with eczema herpeticum, highlighting that despite the alarming clinical presentation, etiological confirmation via PCR for CVA6 was crucial to rule out other infections, discontinue unnecessary acyclovir, and focus treatment on supportive care, leading to a favorable outcome. In conclusion, eczema coxsackium due to CVA6 should be considered in severe vesiculobullous rashes, with PCR being essential for an accurate diagnosis and proper management, as its prognosis is generally benign.

A 35-year-old male farmer developed drug-induced erythroderma following disulfiram therapy, leading to generalized skin dryness and scaling. Treated with systemic and topical corticosteroids, he later presented with facial vesiculopustular lesions, which progressed to erosions due to manipulation. A Tzanck smear revealed multinucleated giant cells, confirming herpes simplex virus (HSV) infection and diagnosing Kaposi varicelliform eruption (KVE). He was treated with oral acyclovir (800 mg, five times daily for seven days), showing marked improvement. KVE, commonly caused by HSV-1 or HSV-2, may also result from vaccinia virus or Coxsackievirus A16. It is vital to differentiate KVE from similar conditions like eczema coxsackium and eczema vaccinatum. In this case, erythroderma compromised the skin barrier, while corticosteroid-induced immunosuppression likely facilitated viral spread. KVE can also occur with conditions like HHD, Darier’s disease, burns, and psoriasis. Early diagnosis and antiviral therapy are crucial to prevent complications such as bacterial superinfections or systemic viremia.

Patient: Female, 8-year-oldFinal Diagnosis: Acrodermatitis enteropathicaSymptoms: Chronic dermatitis since infancy, featuring perioral and acral skin lesions, alopecia, and a recent diffuse vesiculobullous rash consistent with Kaposi’s varicelliform eruptionClinical Procedure: —Specialty: DermatologyObjective: Unusual clinical courseBackgroundAcrodermatitis enteropathica (AE) is a rare autosomal recessive disorder caused by solute carrier family 39 member 4 (SLC39A4) gene variants that impair zinc absorption. Although typically associated with bacterial or fungal superinfection, its concurrence with Kaposi’s varicelliform eruption (KVE) is exceptionally rare – only 1 case was previously reported. This report describes a case of KVE complicating AE in a patient with novel compound heterozygous SLC39A4 variants, highlighting the immunovirological implications of zinc deficiency.Case ReportAn 8-year-old girl who had chronic dermatitis since infancy presented with a diffuse vesiculobullous rash. Physical examination revealed perioral and acral dermatitis, alopecia, and crusted vesicles consistent with KVE. Laboratory testing showed normal serum zinc levels (76.13 μg/dL) but reduced alkaline phosphatase (32 U/L). Genetic analysis identified compound heterozygous SLC39A4 variants: a maternal frameshift variant (c.522_523dup) and 3 paternal variants (c.925T>C, c.1782C>T, and c.1843C>T). The patient received oral zinc gluconate and topical crisaborole ointment, achieving complete resolution within 2 weeks.ConclusionsThis case demonstrates that AE may present with normal zinc concentrations, underscoring the diagnostic value of alkaline phosphatase. Genetic confirmation remains essential in atypical presentations. These novel variants broaden the mutational spectrum of SLC39A4 and emphasize the importance of early zinc supplementation and antiviral prophylaxis in patients with AE who display KVE risk.

Kaposi's varicelliform eruption.

Background: Nemolizumab is approved for the treatment of moderate-to-severe atopic dermatitis in patients aged ≥12 years, combined with topical corticosteroids and/or calcineurin inhibitors, when the disease is not adequately controlled by topical prescription therapies. Given the limited duration of follow-up in clinical trials and the current lack of postmarketing surveillance data, further investigations to evaluate the long-term safety profile of nemolizumab are urgently needed. Methods: Adverse event (AE) signals were identified using disproportionality analysis with four algorithms: the reporting odds ratio (ROR), proportional reporting ratio, information component, and empirical Bayesian geometric mean. The data analyzed were from the FDA Adverse Event Reporting System, covering the period from the first quarter of 2024 to the second quarter of 2025. Results: The three most frequently reported AEs were pruritus, rash, and headache. The top three AE signals with ROR values were eczema herpeticum, pemphigoid, and dermatitis exfoliative generalized. Specific AEs included injection site hemorrhage, injection site discoloration, eyelid edema, and urticaria. Notably, sleep disorder and eosinophil count emerged as new AEs. Conclusion: These findings provide a comprehensive real-world safety overview of nemolizumab, highlighting both expected and emerging risks to inform clinical monitoring and risk management strategies during patient treatment.

BackgroundJanus kinase (JAK)-1 inhibitors have been approved for moderate-to-severe atopic dermatitis (AD). Despite favorable efficacy, their real-world infection risk profile requires further investigation.MethodsWe conducted a retrospective disproportionality analysis using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. Reports identifying upadacitinib or abrocitinib as primary suspect drugs for “Infections and Infestations” adverse events (AEs) in AD treatment from Q3 2019 to Q1 2025 were included. Four disproportionality methods were employed to detect infection-related safety signals.ResultsA total of 18 infection-related positive safety signals associated with abrocitinib were identified, which include known AEs (herpes zoster, eczema herpeticum, and herpes simplex) and unexpected signals (sepsis, appendicitis, and septic shock). Upadacitinib showed 64 infection-related signals, encompassing known AEs (herpes zoster, pneumonia, and influenza) and unexpected signals (sepsis, appendicitis, and septic shock). Herpes zoster was the most frequent infection-related AE for both drugs.ConclusionThis study confirms established infection risks of JAK-1 inhibitors in AD (particularly herpes zoster) and identifies novel potential safety signals (sepsis, appendicitis, and septic shock). These findings provide real-world insights into the risk of infections associated with JAK inhibitors.

Collagen XXIII (COL23A1): A novel risk factor for eczema herpeticum.

Eczema herpeticum (EH), also known as Kaposi's varicelliform eruption, is a viral skin infection caused by the herpes simplex virus in the setting of compromised skin, most often associated with atopic dermatitis (AD).An eighteen-year-old female patient with a longstanding history of AD presented with EH, confirmed by viral testing, and was treated with intravenous acyclovir and topical antibiotics.A potent topical corticosteroid, clobetasol propionate, was applied to manage the underlying AD.Within five days, significant improvement was observed in both the viral and eczematous lesions with no adverse effects.This case highlights the effectiveness of combining antiviral therapy with topical corticosteroids in EH and the role of corticosteroids in supporting skin recovery in patients with AD at risk of EH.

Eczema Herpeticum Secondary to Atopic Dermatitis: A Case Study