Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
Eczema herpeticum or invasive infection
Rapidly spreading painful monomorphic vesicles, punched-out erosions or crust with fever, lethargy or eye involvement suggests eczema herpeticum; rapidly advancing warmth, tenderness, purpura, systemic illness or shock suggests invasive bacterial disease rather than an ordinary flare.
Action: Arrange same-day urgent paediatric or dermatology care, obtain HSV PCR and bacterial samples without delaying systemic aciclovir or sepsis treatment, and obtain emergency ophthalmology advice for periocular or ocular symptoms.
Synopsis
Diagnose and grade childhood atopic eczema, teach families safe age- and site-specific topical treatment, recognise infection and allergy signals, and protect sleep, growth, education and wellbeing.
Atopic eczema is an itchy relapsing inflammatory disorder: itch is essential, while dryness, excoriation, sleep loss and age-specific distribution support the diagnosis.
Infants often have cheek, scalp and extensor disease with relative napkin sparing; mobile children increasingly develop flexural, hand, ankle and eyelid eczema.
In brown or black skin, active eczema may look violaceous, grey, deep brown or follicular rather than bright red; warmth, texture, swelling and excoriation show activity.
Key red flags
Painful monomorphic blisters or punched-out erosions, periocular disease, fever or lethargy, rapidly spreading cellulitis, poor feeding or dehydration, extensive skin failure, growth faltering, recurrent deep infection, treatment toxicity or a diagnosis that remains uncertain requires urgent specialist review.
Eczema herpeticum
Painful clusters of similar vesicles evolve into sharply punched-out erosions and may disseminate with fever; periocular involvement threatens vision.
Investigation priorities
01
Clinical diagnostic criteria and severity assessmentFirst step
Confirm itchy age-patterned eczema and quantify skin and life impact.
Management branches
First-line daily careRepair barrier and reduce irritant exposure
Atopic eczema is diagnosed at any severity.
Choose an acceptable fragrance-free leave-on emollient, prescribe a quantity sufficient for whole-body daily use and use it instead of soap and detergent washes.
Demonstrate smooth application in the direction of hair growth, decant tubs with a clean spoon or use a pump, and provide bedding and clothing fire-safety advice.
First-line flare controlMatch potency to site and severity
Itch, inflammation, excoriation or sleep disruption signals an active flare.
Key medicines
Unperfumed leave-on emollientApply generously to dry skin at least twice daily and whenever needed, including when eczema is clear; use a prescribed quantity appropriate to body size and wash with an emollient soap substitute rather than detergent cleanser.
Topical corticosteroidApply a fingertip-unit-calculated thin layer to active eczema once daily unless the specific product directs otherwise: mild potency for mild, moderate for moderate and potent for severe disease, with the site and age restrictions in the written plan.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.
NICE atopic eczema in under 12sDiagnosis, severity, age- and site-specific topical therapy, infection, food allergy, referral and education.
BAD atopic eczemaClinical features, emollients, topical anti-inflammatory treatment, infection and practical self-care.
BAD eczema herpeticumRecognition of painful monomorphic lesions, emergency antiviral treatment and ocular risk.
NICE shared decision makingAge-appropriate involvement, treatment choices, risk communication and decisions with children and families.