What are the signs and symptoms of herpes simplex virus (HSV) infections?

Updated: Mar 17, 2020
  • Author: Sean P McGregor, DO, PharmD; Chief Editor: William D James, MD  more...
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Localized or disseminated eczema herpeticum is also known as Kaposi varicelliform eruption. Caused by HSV-1, eczema herpeticum is a variant of HSV infection that commonly develops in patients with atopic dermatitis, burns, or other inflammatory skin conditions. Atopic dermatitis is associated with a breakdown in the skin barrier and immune dysregulation, which can lead to cutaneous infections, such as, eczema herpeticum. Cutaneous infections in patients with atopic dermatitis lead to increased emergency department utilization, and both pediatric and adult patients have higher odds of an HSV infection. [35] Children are most commonly affected by eczema herpeticum, and it is more commonly associated with younger age and black or Asian race. [36] Eczema herpeticum can be diagnostically challenging, and the mean time to diagnosis is approximately 4 days. [37] Both primary and secondary HSV infections can lead to eczema herpeticum, and there is a 26.5% recurrence rate observed. [37] A retrospective study of 180 hospitalized patients with atopic dermatitis found that fever on admission, a rash on the neck, and a vesicular eruption were the clinical features associated with eczema herpeticum and these patients had a longer hospital length of stay. [38]

Additionally, HSV infection can complicate other cutaneous diseases associated with a breakdown in the skin barrier, such as pemphigus vulgaris. A hospital-based study of 60 patients with pemphigus vulgaris found that the presence of hemorrhagic crusting and linear erosions were associated with HSV infection. [39]

Herpetic whitlow, characterized by vesicular outbreaks on the hands and the digits, was most commonly due to infection with HSV-1. It usually occurred in children who sucked their thumbs and, prior to the widespread use of gloves, in dental and medical health care workers. The occurrence of herpetic whitlow due to HSV-2 is increasingly recognized, probably due to digital-genital contact.

Herpes gladiatorum is caused by HSV-1 and is seen as papular or vesicular eruptions on the face, arms, or torsos of athletes in sports involving close physical contact (classically associated with wrestling).

Disseminated HSV infection can occur in females who are pregnant and in individuals who are immunocompromised. These patients may present with atypical signs and symptoms of HSV, and the condition may be difficult to diagnose.

Herpetic sycosis, a follicular infection with HSV, may present as a vesiculopustular eruption on the beard area. This infection often results from autoinoculation after shaving through a recurrent herpetic outbreak. Classically caused by HSV-1, there have been rare reports of relapsing beard folliculitis caused by HSV-2. [40]

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