An 18-month-old boy with severe atopic dermatitis develops fever and numerous painful, monomorphic punched-out erosions and vesicles over eczematous areas of the face, neck, and trunk within 48 hours. What is the most appropriate immediate next step?

• A Reassure the parents as this represents a self-limiting flare of atopic dermatitis
• B Increase the potency of topical corticosteroid and add topical antibiotics
• C Start oral acyclovir and refer for urgent dermatological assessment ✓
• D Start oral fluconazole for candidal superinfection

Explanation

Eczema herpeticum (Kaposi varicelliform eruption) is disseminated HSV infection spreading through compromised skin barrier in atopic dermatitis. It is a medical emergency because it can progress to viremia with visceral dissemination and death if untreated. Systemic acyclovir must be started promptly. Escalating steroids worsens viral replication, and this is not a routine eczema flare given its acute monomorphic punched-out morphology.

Reference: Fitzpatrick's Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.