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Dear Editor, Eczema herpeticum (EH) is a dermatological emergency, which often affects the paediatric population because of the higher prevalence of eczema in children. Prompt initiation of antiviral therapy is indicated when EH is suspected, with the patient information leaflet from the British Association of Dermatologists recommending commencement of systemic antivirals 'as early as possible'. 1 Clear dosing information is always helpful when initiating treatment. However, neither the Summary of Product Characteristics for aciclovir/valaciclovir 2,3 or the British National Formulary 4 specify a recommended antiviral dose for EH in adults or children, nor does the National Institute for Health and Care Excellence guideline relating to EH in children. 5 The decision on dosing is easier in patients on systemic immunosuppressive treatment. However, the fact remains that the majority of patients with eczema are treated with topical medications only, while all still have a compromised skin barrier that makes them highly susceptible to opportunistic skin infections. Can this patient cohort be classed as immunocompetent?It is clear that recommendations need to be clarified. Correct prescribing in EH, when prompt treatment is essential, would be greatly helped by the presence of dosing information specifically for EH in the relevant literature. The absence of these recommendations may delay early initiation and adversely affect outcomes.

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