Painful erosions in dermatitis

THE sudden onset of painful erosions around the periocular skin in an individual with atopic dermatitis should alert you to the possibility of secondary herpes simplex infection.

The actual intact vesicles of herpes are seldom seen because of the atopic patient’s tendency to rub the skin. They usually have a herpes infection elsewhere.

In atopic individuals, the herpes simplex virus can rapidly spread to other areas of dermatitis, giving a condition called Kaposi’s herpetiform eruption, resulting in admission to hospital for intravenous antiviral therapy. In the periocular area, there is also the risk of transmission into the eye, resulting in corneal scarring.

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