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Cold sores: Should I keep a child with eczema away?

For anyone who has eczema, the virus that causes cold sores can lead to a rare infection that can be life threatening. This infection develops when the virus that causes cold sores, the Herpes simplex virus, finds its way to open skin and spreads. If this happens, a person can develop eczema herpeticum.

Infants and young children who have moderate or severe eczema can be more susceptible to this infection. 

3 ways to reduce your child’s risk 

You can reduce your child risk of developing a serious infection by following these dermatologists’ tips:

  1. Make sure your child avoids skin-to-skin contact with a person who has a cold sore, or any outbreak caused by herpes virus. Skin-to-skin contact is often how someone who has eczema gets this virus. If you have a child with eczema, be sure to look at the pictures in the slideshow, which show various ways that herpes simplex virus can appear on the face.

  2. Teach your child not to share things that touch another person’s mouth. Your child can catch the virus by eating from another person’s fork, sharing lip balm or lipstick, drinking from the same glass, or getting a kiss from someone who has a cold sore on the mouth.

  3. Wash your hands. You can also pick up the virus without knowing it. The virus could be on a doorknob, card-swiping machine, or another object that you touched. Frequent hand washing hands can prevent your child from getting the virus.

Finding eczema herpeticum on your child

If your child becomes infected with the Herpes simplex virus, eczema herpeticum can develop. Early medical care can prevent a serious complication, so it’s import to know what to look for.

Signs and symptoms of eczema herpeticum

These tend to appear within 5 to 12 days of coming into contact with the virus. You’ll notice that your child has one or more of the following signs or symptoms:

  • Rash with itchy, watery blisters

  • Rash may spread quickly and your child may be in pain

  • Flu-like symptoms, including a fever, fatigue, and swollen lymph nodes

  • Without treatment, the blisters may bleed, crust over, and look like open sores. By this stage, the pain is extreme.

A cold sore appears above the upper lip

The cold sore virus can cause a serious infection in anyone who has eczema.

cold sore on upper lip

Herpes simplex outbreak

This 8-year-old boy has a herpes simplex outbreak near his mouth.

herpes simplex outbreak

Cold sore outbreak

Sometimes cold sores develop on a lip.

cold sore on lip

Herpes simplex

Sores can appear on a person's nose.

Herpes simplex on nose

Healing cold sore

Even when the cold sore looks dry, avoid skin-to-skin contact.

healing cold sore

Anyone who might have eczema herpeticum needs immediate medical care.

How does a doctor find eczema herpeticum?

A doctor scrapes the infected skin to get a sample, also called a smear. The smear will be examined under a microscope.

How is eczema herpeticum treated?

This infection is treated with an anti-viral medicine like acyclovir. A doctor prescribes this medicine to stop the herpes virus from spreading inside the body. Pain medicine may also be necessary.

If the rash appears near an eye, the dermatologist may also send your child to an ophthalmologist (medical doctor who diagnoses and treats the eyes). This appointment is important because the doctor will check to see if the virus is affecting the eyes.

Related AAD resources

Herpes simplex outbreak: Photo used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

All other photos on this page from GettyImages.

Arkwright PD, Motala C et al. “Management of difficult-to-treat atopic dermatitis.” J Allergy Clin Immunol Pract. 2013 Mar;1(2):142-51.

Atherton DJ, Harper JI. “Correspondence: Management of eczema herpeticum.” J Am Acad Dermatol 1988 Apr; 18(4):575-8.

Pride HB, Tollefson M, et al. “What new in pediatric dermatology?” Part II. Treatment. J Am Acad Dermatol 2013 Jun; 68(6):899.e1–899.e11.