Allergy

A father brings his 8-month-old daughter to your office because her eczema is “out of control” and is causing her to feel bad and have fever. He is following your recommendations of bathing her with gentle soaps, using topical emollients and steroids, and oral antihistamines. The examination reveals a lethargic child with an oral temperature of 103°F (39.4°C). The child’s cheeks are red and contain numerous red, punched-out, and umbilicated vesicles; some lesions are pustular. What is the best course of action at this point?

  1. Prescribe oral corticosteroids and have the child return in the morning.
  2. Initiate outpatient tacrolimus.
  3. Admit immediately to the hospital for intravenous acyclovir.
  4. Prescribe oral antibiotics.
  5. Prescribe outpatient topical acyclovir.

A. Certain atopic infants may develop the rapid onset of diffuse cutaneous herpes simplex. The disease is most common in areas of active or recently healed atopic dermatitis, particularly the face. High fever and adenopathy occur 2 to 3 days after the on­set of vesiculation. Viremia with infection of internal organs can be fatal. Eczema herpeticum of the young infant is a medical emergency. The child should be admitted immediately for intra­venous acyclovir.