Outpatient and Inpatient Management of Infants and Children With Eczema Herpeticum Diagnosed in the Emergency Department.

Background: There are no universally established guidelines for when pediatric EH warrants hospitalization or intravenous (IV) acyclovir over oral therapy. To address this lack of consensus, this study aimed to describe outcomes of outpatient oral acyclovir treatment in pediatric EH cases, including rates of disease exacerbation, hospitalizations, and complications.

Methods: We conducted a retrospective cohort review of pediatric patients under age 7 diagnosed with EH who presented to the pediatric emergency department (ED) between January 1, 2008, and December 31, 2022. Cases were identified via electronic medical record (EMR) query using ICD-9/ICD-10 diagnosis codes for EH, 054.0 and B00.0, respectively. All encounters were manually reviewed to confirm diagnosis, assess disease severity, identify complications, and document treatment. The primary outcome was clinical deterioration (e.g., return visits, hospitalization, or new complications). Secondary outcomes included length of stay and treatment modality. Descriptive statistics and subgroup comparisons were performed to assess associations with disposition.

Results: A total of 97 encounters among 87 unique patients were identified. Mean age was 2.05 years. Of 27 patients discharged from the ED, only one returned for hospitalization due to EH. Among 70 hospitalized patients, no intensive care, resuscitation, or deaths occurred. Hospitalization was more common in patients with more severe skin findings, concurrent cellulitis, and younger age. No systemic complications or keratitis were observed.

Conclusion: In this cohort, oral acyclovir outpatient management was not followed by disease progression or serious complications. These findings support that some mild EH cases may be managed without hospitalization, but further prospective studies are needed.