History and findings: In a 32-year-old 26-week pregnant woman with atopic eczema densely packed blisters, ca. 1 mm in diameter, developed within the eczema areas, typical of herpetic eczema. This diagnosis was confirmed by identifying the virus under the electronmicroscope and demonstrating herpes simplex virus DNA in the polymerase chain reaction.
Treatment and course: During intravenous aciclovir administration (5 mg/kg three times daily for 9 days) the blisters quickly healed. As a bacterial superinfection was suspected (later confirmed by culturing Staphylococcus aureus from a skin swab) the patient was also given erythromycin (500 mg four times daily by mouth for 7 days), as well as fusidic acid cream locally. She delivered a healthy child in the 37th week of pregnancy.
Conclusion: Herpetic eczema is a serious complication of chronic eczema. If it occurs during pregnancy, the risk or fetal damage by aciclovir must be balanced against the risk of intrauterine herpes simplex infection.