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Eczema herpeticum (EH), historically known as Kaposi varicelliform eruption, is a severe, rapidly progressing, infection of eczematous skin with herpes simplex (HSV). Lesions are sometimes atypical and lead to delayed diagnosis, increasing mortality due to viremia, vision loss, and organ involvement. A 24-year-old male with a history of atopic dermatitis presented to the emergency department with diffuse erythema, edema, full thickness sloughing, and yellow exudate on the face, ears, neck, and upper chest with sparing of the mucosa. Hyperpigmented excoriated vesicular lesion remnants on the hand, elbow, upper arm, and shoulder were also present. He had previously contacted teledermatology to treat a supposed eczema flare via two visits that ended in recommendations of hydrocortisone and doxycycline. Laboratory results were significant for low WBCs, low absolute lymphocyte count, high lactate, and positive culture of Staphylococcus aureus. He was started on IV vancomycin for assumed septic cellulitis secondary to eczema. Infectious disease was consulted after no improvement on antibiotics, raising concerns for Steven Johnson Syndrome. Lastly, dermatology was consulted to obtain an inpatient impression, immediately revealing recent HSV exposure from his girlfriend and vesicular lesions of EH on arm and shoulder. The patient was started on IV acyclovir and PCR confirmed HSV infection. The patient was slowly transitioned to oral acyclovir once no new lesions appeared and discharged to follow up outpatient. This represents a delay in diagnosis that may be attributed to teledermatology practices and unfamiliarity, which was ultimately resolved by an inpatient dermatology consult highlighting its utility in emergent conditions.

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