Figure 1: Initial evaluation in ED, 10/29/2022; A 22-year-old male with skin of color, and a pertinent past medical history of atopic dermatitis (AD), presented to the emergency department with a six day history of pruritic, painful hyperkeratotic plaques involving his face, chest, and extremities. Patient was given cephalexin, prednisone, and topical mupirocin.

Figure 2: Re-evaluation in ED, 11/02/2022; Patient returned four days later febrile with a temperature of 103?. His lesions evolved into erosive plaques with a punched-out appearance. Patient’s medications were switched to doxycycline and fluconazole.

Figure 3: Inpatient evaluation, 11/07/2022; Patient returned four days later without improvement and a 4mm punch excision was taken for H&E, as well as a viral culture swab with herpes simplex virus (HSV) polymerase chain reaction (PCR) testing. The patient was started on acyclovir 5mg/kg IV Q8H for empiric treatment of eczema herpeticum (EH) and was given mupirocin ointment due to clinical evidence of impetiginization around the periocular areas. For symptomatic relief, cool compresses, emollients, and topical corticosteroids were given. Clinical improvement was noted five days later as shown in the image. Viral culture was positive for HSV, and HSV PCR confirmed the presence of HSV type 1.