ABSTRACT
This chapter provides a case study of a 6-year-old boy. He is brought to the accident and emergency department by his parents with a 5-day history of worsening eczema associated with malaise and lethargy. He quantifies the level of pain as 8 out of 10. His flare is not responding to diligent application of his usual eczema treatments according to his ‘step-up’ management plan. He looks unwell and is febrile at 38.5 °C. Systemic examination is normal except for widespread lymphadenopathy. He has a superimposed monomorphic eruption over his lower face, chest and forearms. The eruption is composed of multiple 23-mm monomorphic ‘punched-out’ erythematous lesions in various stages of evolution. Diagnosis can be confirmed by viral swab of a blister or eroded area. He has generalized moderate to severe eczema with erythema, dryness, excoriation and lichenification. Herpes simplex infection in patients with eczema can lead to widespread lesions and an associated risk of superimposed bacterial infection and sepsis.
