The best questions often stem from the inquisitive learner. As educators, we love—and are always humbled—by those moments when we get to say, “I don’t know.” For some of these questions, you may already know the answers. For others, you may never have thought to ask the question. For all, questions, comments, concerns, and critiques are encouraged. Welcome to the Kids Korner.

Eczema herpeticum (EH), sometimes called Kaposi Varicelliform Eruption (KVE), is a disease that can affect both children and adults—particularly those with chronic skin conditions that impair skin barriers—and has been reported in some of the literature to have a mortality rate as high as 10 to 50 percent.^1,2 Although this mortality rate is still quoted in present-day studies, it also preceded the use of acyclovir for this disease which was developed in the late 1970s.³

In children, the most common chronic skin disease leading to EH is atopic dermatitis.² With this highly reported mortality, a common management of EH has been admission for IV acyclovir. But is this mortality rate really true in children?

Most studies on this topic have been published within the past 15 years. A 2011 multi-center retrospective study by Aronson et al., evaluated the timing of administration of acyclovir on hospital length-of-stay (LOS) and mortality.⁴ These pediatric patients (n=1,331) ranged from 2 months to 17 years of age and data were evaluated from the Pediatric Health Information System that included 42 children’s hospitals over a 10-year period. All children were admitted to a children’s hospital.

Regarding mortality, no patient died, so the reported 10 percent mortality mentioned above does not appear to be consistent with the findings of this study. Regarding the time to initiation of acyclovir on hospitalization length of stay, the authors found that a delay in the initiation of acyclovir was associated with an increased LOS, suggesting early initiation of acyclovir was associated with a faster hospital discharge. Some of these hospitalized patients received IV acyclovir and some received oral acyclovir. The specific number of patients who received IV versus oral acyclovir was not stated in this study except to say, “The increase in LOS does not seem related to receipt of oral versus IV acyclovir.”

Another interesting finding from this study was that a superimposed S. aureus infection was diagnosed in 30 percent of the patients with EH, suggesting that we should have a high suspicion for a superimposed bacterial infection as well. Although the mortality rate appears much lower than 10 percent, we cannot draw any conclusions regarding outpatient treatment with oral acyclovir since all patients were admitted pediatric patients.