Herpes simplex is the virus that causes cold sores. Most people come into contact with this virus during childhood and have antibodies against it, even if they do not recall ever having a cold sore. Children and adults with atopic eczema are susceptible to a more severe infection with Herpes simplex, especially if they have not previously had a cold sore and have no immunity against this virus. It is therefore advisable to avoid direct contact between anyone with eczema and a person who has a cold sore.
Rather than getting a single painful sore, eczema sufferers may develop a widespread rash with hundreds of small painful ulcers. This is called ‘eczema herpeticum’. The most commonly affected sites are the head and neck, but it can also spread over the chest and body.
Sufferers usually feel unwell and may have a fever. Unlike a typical eczema flare that feels intensely itchy, sufferers normally complain of soreness and pain. Eczema herpeticum is a potentially serious condition and needs urgent treatment with antiviral medication. It can be difficult to diagnose in someone who has a lot of eczema because the viral sores are more difficult to see. If this diagnosis is suspected, a specialist should be seen urgently. Viral skin swabs can confirm the diagnosis, but treatment with antiviral medication should be started immediately without waiting for the results of these tests.
Viral Warts And Molluscum Contagiosum
Warts and Molluscum contagiosum are common childhood infections. Both are caused by viruses, which are tiny germs that are too small to see with an ordinary microscope. Warts are extremely common and mainly affect the hands and feet (verrucas). They sometimes spread to the face, especially around the nose and lips. The wart virus makes the epidermis overgrow, causing the raised, thickened bumps on the skin surface that we recognize as warts. These may have tiny finger-like projections and black dots.
Molluscum contagiosum are usually more widespread than warts and appear as small, smooth, red or flesh-coloured bumps, each with a tiny dimple in the centre. They often develop on eczema-prone areas such as the skin folds behind the knees. Many children get warts or Molluscum contagiosum, but these may be slightly more common in atopic eczema sufferers.
Unlike bacterial infections which can be cleared with antibiotics, there are no specific medicines which kill these viruses. It is ultimately up to the body’s own immune system to get rid of these infections, and this can take many months. Treatments such as freezing with liquid nitrogen (cryotherapy), may encourage the immune system to fight the infection, but they do not guarantee a cure, and can be painful. Young children do not usually tolerate freezing treatment, unless a local anaesthetic cream is applied to the skin beforehand. Wart paints are a useful alternative for the hands and feet, but it may be simplest to just wait for the infection to clear naturally.
Molluscum contagiosum often become red and crusted when the body’s immune system is starting to fight against them. This can look alarming especially if surrounded by eczema, however, it is generally a good sign and means that they are going to clear up soon.