Quality standard

Quality statement 7: Treatment of eczema herpeticum

Quality statement 7: Treatment of eczema herpeticum

Quality statement

Children with atopic eczema who have suspected eczema herpeticum receive immediate treatment with systemic aciclovir and are referred for same-day specialist dermatological advice.

Rationale

Eczema herpeticum (widespread herpes simplex virus) is a serious under-recognised condition and, if not diagnosed promptly, the child's condition may deteriorate rapidly. Eczema herpeticum can be fatal or can lead to blindness if not treated, and should therefore be an indication for urgent referral.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that children with atopic eczema who have suspected eczema herpeticum receive immediate treatment with systemic aciclovir and are referred for same-day specialist dermatological advice.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from referral pathways.

Process

The proportion of children with atopic eczema who have suspected eczema herpeticum who receive immediate treatment with systemic aciclovir and are referred for same-day specialist dermatological advice.

Numerator – the number of children in the denominator who receive immediate treatment with systemic aciclovir and are referred for same-day specialist dermatological advice.

Denominator – the number of children with atopic eczema who have suspected eczema herpeticum.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers ensure that local arrangements are in place for children with atopic eczema who have suspected eczema herpeticum to receive immediate treatment with systemic aciclovir and to be referred for same-day specialist dermatological advice.

Healthcare practitioners ensure that children with atopic eczema who have suspected eczema herpeticum receive immediate treatment with systemic aciclovir and are referred for same-day specialist dermatological advice.

Commissioners ensure that they commission services with local arrangements to give children with atopic eczema who have suspected eczema herpeticum immediate treatment with systemic aciclovir and to refer them for same-day specialist dermatological advice.

Children with atopic eczema who have suspected eczema herpeticum (a rare but serious infection caused by the same virus that causes cold sores) receive immediate treatment with an antiviral drug (called systemic aciclovir), which can be given as medicine or an injection, and are referred immediately for same-day specialist advice.

Source guidance

Atopic eczema in under 12s: diagnosis and management. NICE guideline CG57 (2007, updated 2023), recommendations 1.5.1.42 to 1.5.1.44 and 1.7.1.1

Definitions of terms used in this quality statement

Suspected eczema herpeticum

Eczema herpeticum is a widespread herpes simplex virus. Signs of eczema herpeticum are:

  • areas of rapidly worsening, painful eczema

  • clustered blisters consistent with early-stage cold sores

  • punched-out erosions (circular, depressed, ulcerated lesions) usually 1 mm to 3 mm that are uniform in appearance (these may coalesce to form larger areas of erosion with crusting)

  • possible fever, lethargy or distress.

[Adapted from NICE's guideline on atopic eczema in under 12s, recommendation 1.5.1.44]

Specialist dermatological advice

The referral should be to a specialist dermatological unit dealing with paediatric patients, for example, a clinician with experience and qualifications in paediatric dermatology. This could include a specialist nurse or a GP with a specialist interest if they are working within a dermatological unit and trained in paediatric dermatology. If eczema herpeticum involves the skin around the eyes, the child should be referred for same-day ophthalmological and dermatological advice. [Adapted from NICE's guideline on atopic eczema in under 12s, recommendations 1.5.1.42, 1.5.1.43, 1.7.1.1 and expert opinion]

Systemic aciclovir

Oral or intravenous aciclovir can be given depending on the clinical situation. Aciclovir is likely to be given orally in primary care and intravenously in secondary care. NICE's full guideline on atopic eczema in under 12s recommends that if a child with atopic eczema has a lesion on the skin suspected to be herpes simplex virus, treatment with oral aciclovir should be started even if the infection is localised. [Adapted from NICE's guideline on atopic eczema in under 12s, recommendations 1.5.1.41 to 1.5.1.43 and expert opinion]