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Eczema Herpeticum

The first time I learned about eczema herpeticum was when I was 20 years old. Prior to that, despite having eczema since birth, I wasn't aware that there could possibly be any other complications. I grew up watching eczema being treated by medical professionals as "that annoying but not fatal" condition.

Therefore, it came as a surprise that there are two possible complications that could result in death if not treated right away: eczema vaccinatum, which is a rare but serious adverse reaction to small pox vaccine, and eczema herpeticum, which I have had the displeasure of experiencing first-hand.

I first read about eczema herpeticum in Sue Armstrong-Brown's book, The Eczema Solution. She described it as a foul variation of cold sore virus that infected the eczematous skin and spread quickly by the inevitable scratching. I didn't think it would ever happen to me, though. I had never had cold sores before. So when I started having a rash problem that just wouldn't go away for a few days on the lower back of my right side, I didn't think much of it. I scratched it a bit, put on the topical steroid, and waited it to go away. I think what made the situation worse was the fact that the location of the rash wasn't easily visible.

When the rash didn't go away after a few days, I started suspecting something but I wasn't sure what to do. I put an antibiotic bandage over the area and hoped it would go away on its own, but then the pain started.

It wasn't so unusual to have pain on the site of eczema since the skin would often be raw and the clothes could brush it, but this was another level of pain. It started as a light throbbing that just got stronger over time, until I couldn't handle it anymore. It felt as if my nerve roots were exposed and someone was hacking away at them with a machete.

When I looked at the rash in the mirror, it didn't seem like normal eczema. It was very red and virulent and seemed like several blisters that had popped and started crusting over. My husband dragged me to the urgent care unit that night and the doctor in charge diagnosed it as herpes zoster, also known as "shingles."

Herpes zoster is basically a reactivated chicken pox virus that erupts into a painful skin rash. I wasn't sure why I would come down with shingles since I had heard that it usually occurs to elderly people with depressed immune system.

Then I realized that I was on azathioprine (also known as Imuran), which was an immune system suppressing drug used to reduce organ rejection. One of the side effects that I was warned about was that I could be at a higher risk for infections, but I didn't think it would happen so soon since I had only been on the drug for 3 weeks. At any rate, I got a shot of morphine to calm down the pain and was put in acyclovir which is an antiviral drug.

The next day, I made an appointment with a nurse practitioner at another facility because I knew that she would probably consult a specialist. When she saw my skin, she didn't believe it was shingles and brought in the head of the dermatology department. He promptly diagnosed it as eczema herpeticum, which sounded credible given my history of eczema.

It really didn't matter whether it was shingles or eczema herpeticum though, because all I cared about was alleviating the horrific pain. Also, the drug used to treat both conditions is the same - acyclovir. Armed with more painkillers (Vicodin), I was on my way to be in pain for another few days until my skin cleared up.

In a way, I guess this could be my failed encounter with azathioprine. Having such a painful rash on my skin gave me a big scare and I got off the drug right away. It probably was a ridiculous idea to try that drug to control my eczema, but at the time, I just wanted to try something. But I concluded that it wasn't worth the pain and additional risks of getting some other awful infection. 


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