Ep 8. Atopic Dermatitis Management with Dr. Peter Lio Part 2 | Eczema Herpeticum/Kaposi’s Varicelliform Eruption, Infection Management, and the Atopic March

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Atopic Dermatitis Cases & Board Pearls: Eczema Herpeticum/Kaposi’s Varicelliform Eruption, Infection Management, and the Atopic March | The Derm Resident

Host dermatology resident Jonny Hatch and Dr. Peter Leo finish an atopic dermatitis episode with cases and board-focused pearls. They review recognition and urgent management of eczema herpeticum (crusted, punched-out lesions), emphasizing HSV PCR/culture, considering bacterial coinfection, empiric antivirals (valacyclovir/acyclovir) and when IV acyclovir/hospitalization is warranted, plus Tzanck smear and biopsy findings (three Ms). They discuss Kaposi’s varicelliform eruption etiologies including eczema coxsackium (supportive care, possible empiric antiviral while ruling out HSV, and onychomadesis) and a life-threatening eczema vaccinatum story. They cover the atopic march, transcutaneous sensitization, LEAP study implications, and why most eczema doesn’t improve with dietary restriction. Practical guidance includes treating impetiginized AD with drying compresses and topical mupirocin, limited oral antibiotics, updated views on bleach baths, bathing frequency, topical steroid potency by vehicle, dupilumab-associated conjunctivitis theories, IL-31-mediated itch, TSLP signaling, site-specific steroid absorption, and why JAK1 selectivity matters.

00:00 Podcast Intro
00:19 Eczema Herpeticum Case
02:04 Testing and Swabs
03:09 Empiric Treatment Plan
04:05 When to Hospitalize
05:27 Tzanck Smear Basics
06:53 Eczema Coxsackium Overview
07:33 Kaposi Varicelliform Story
10:21 Differentiating Coxsackium
11:32 Atopic March Explained
13:56 Diet and Food Allergy Myths
18:13 Bacterial Superinfection Case
20:11 Topicals and Tea Compresses
21:13 Bleach Baths Reality Check
22:01 Topicals Over Orals
23:50 Bleach Baths and Bathing
27:23 Eczema Herpeticum Drill
28:20 Steroid Potency Vehicles
29:11 Dupilumab Eye Effects
31:22 Itch Pathways Explained
32:22 Eczema Coxsackium Care
34:58 Atopic March TSLP
36:42 Steroid Absorption Sites
37:30 Genital Itch Strategy
39:49 JAK STAT6 and Future
41:41 Wrap Up and Thanks

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