Erupción variceliforme de Kaposi y enfermedad de Darier / Kaposi's varicelliform rash and Darier's disease

La erupción variceliforme de Kaposi es una infección cutánea diseminada, causada en la mayor parte de los casos por el virus Herpes simple tipo 1. Se suele presentar en pacientes con alteraciones preexistentes de la barrera cutánea, especialmente en niños con dermatitis atópica. Se comunica el caso de un paciente de 84 años, quien negaba enfermedades cutáneas previas, que consultó por lesiones dolorosas y pruriginosas, en la piel del tórax y el abdomen, de 3 semanas de evolución. Con sospecha de una enfermedad infecciosa viral, bacteriana, ampollar o neutrofílica, se realizó inmunofluorescencia directa para herpes, cultivo y biopsia de piel para estudio histológico. La inmunofluorescencia fue positiva para Herpes simple tipo 1 y el estudio histopatológico mostró cambios compatibles con infección herpética y enfermedad de Darier. La enfermedad de Darier es una genodermatosis infrecuente que se suele manifestar en la adolescencia. Si bien su diagnóstico en la ancianidad es excepcional, este caso ilustra que se debe considerar en todos los pacientes que presenten erupción variceliforme. (AU)

Kaposi's varicelliform rash is a disseminated cutaneous infection, caused by Herpes virus 1. It usually presents in patients with pre-existing skin barrier disorders, especially in children with atopic dermatitis. We report the case of an 84-year-old patient, who reported having no previous skin diseases, who consulted for painful, itchy, 3-week-old skin lesions. As we suspected viral, bacterial, bullous or neutrophilic disease, direct immunofluorescence, culture, and skin biopsy for histological study were performed. Immunofluorescence was positive for Herpes simplex type 1 and the histopathological study showed changes compatible with herpetic infection and Darier's disease. Darier's disease is a rare genodermatosis that usually manifests in adolescence. Although its diagnosis in old age is anecdotal, it should be considered in patients with a varicelliform rash. (AU)

Recurrent Kaposi Varicelliform Eruption: Investigation of Clinical Characteristics and Predisposing Factors / 대한피부과학회지

BACKGROUND: Kaposi varicelliform eruption (KVE) is a disseminated viral infection primarily caused by the herpes simplex virus in the setting of an underlying chronic skin disease. Few studies have reported the clinical characteristics and predisposing factors for recurrent KVE.OBJECTIVES: To characterize the clinical features and predisposing factors for recurrent KVE.METHODS: This retrospective comparative study of recurrent vs. single-episode KVE was performed at the Pusan National University Hospital between 2004 and 2017.RESULTS: A total of 84 episodes occurred in 60 patients, and of these, 13 patients developed recurrence (21.7%). No statistically significant intergroup difference was observed in the mean age and sex distribution. The face was the most common site of involvement in both groups, followed by the trunk and the upper and lower extremities. Atopic dermatitis was the most common pre-existing disease in both groups; however, Darier's disease was more common in the recurrent KVE group, and this difference was statistically significant. Most patients with KVE (66.7%) showed aggravation of the underlying skin disease within 3 months of KVE onset. This finding was more prominent in patients with recurrent episodes (91.7%) than in those with single-episode KVE (58.3%), (p=0.040).CONCLUSION: This study can contribute to a better understanding of recurrent KVE and guide clinicians in treating patients with conditions predisposing to KVE.

Severe Eczema Herpeticum in an Adult Patient with Atopic Dermatitis Following Herbal Medicine and Acupuncture / 대한피부과학회지

Atopic dermatitis is a common chronic, relapsing skin disorder, and many patients with atopic dermatitis use complementary and alternative medicine instead of consulting a certified dermatologist. Herein, we report the case of a 38-year-old woman with severe eczema herpeticum who had been treated with herbal medicine and acupuncture for her atopic dermatitis. Herbal medicine and acupuncture are the most frequent types of alternative medicine that Korean patients rely on. However, the effectiveness of these treatments in atopic dermatitis remains unclear as there is a great lack of scientific evidence supporting it. As atopic dermatitis can cause potentially fatal secondary infections such as eczema herpeticum, dermatologists should put great effort into communicating with and educating the patients and in guiding them to choose the most appropriate treatment plan for managing their atopic dermatitis.

Comparison of Clinical Features according to FLG Mutation in Korean Atopic Dermatitis Patients / 대한피부과학회지

BACKGROUND: Mutation in the gene encoding filaggrin (FLG) is a major predisposing factor for atopic dermatitis (AD), in association with distinct features such as increased allergic sensitization, higher severity, and frequent skin infections. Genetic diversity in FLG mutations exists across ethnicities. OBJECTIVE: This study aimed to investigate the clinical features of AD according to the presence of FLG mutation in Korean individuals. METHODS: We performed reverse blot hybridization assay to detect FLG mutation in Korean patients with AD. Classifying subjects into AD with or without FLG mutation, clinical features of AD and patch test results were compared between the two groups. RESULTS: Among a total of 281 subjects, 39 (13.9%) were found to have FLG mutation. AD with FLG mutation was associated with higher risk of impetigo and eczema herpeticum but lower risk of prurigo nodularis. In the patch test, there was no difference in positive reactions of major contact allergens between the groups. CONCLUSION: In Korean patients with AD, FLG mutation was associated with more frequent skin infections but not with personal or family history of atopic diseases, allergic sensitization, contact allergy, and protracted course. It is important to consider other skin-barrier-related genes, such as KLK7 and SPINK5, and immune response-related genes in conjunction.

Clinical features of eczema herpeticum in atopic dermatitis in a single center

PURPOSE: This study evaluated the clinical characteristics and risk factors associated with atopic dermatitis patients complicated by eczema herpeticum. METHODS: This study included 45 patients under the age of 18 with atopic dermatitis complicated by eczema herpeticum in the disease group (ADEH+), and 50 patients under the age of 18 with atopic dermatitis without any episode of eczema herpeticum in the control group (ADEH−). We retrospectively reviewed the clinical features, treatment and prognosis of the 2 groups. RESULTS: In this study, eczema herpeticum occurred in 2.7% of the AD patients. No significant difference in percentage of boys or mean age was found between the ADEH+ and ADEH− groups. In the ADEH+ group, eczema herpeticum occurred more frequently in the head and neck. Severe atopic dermatitis, recurrent impetigo, IgE−mediated atopic dermatitis and food allergy were identified as the risk factors of eczema herpeticum. The mean white blood cell count, erythrocyte sedimentation rate, percent of eosinophils and total serum IgE were higher in the ADEH+ group than in the ADEH− group. More than 2 recurrences were confirmed in 12 patients (26.7%). CONCLUSION: In the ADEH+ group, skin lesions were dominant on the head and neck. We revealed that severe atopic dermatitis, frequent impetigo, IgE-mediated atopic dermatitis, and food allergy are risk factors for eczema herpeticum.

Common features of atopic dermatitis with hypoproteinemia / 소아과

PURPOSE: The purpose of this study was to identify the causes, symptoms, and complications of hypoproteinemia to prevent hypoproteinemia and provide appropriate treatment to children with atopic dermatitis. METHODS: Children diagnosed with atopic dermatitis with hypoproteinemia and/or hypoalbuminemia were retrospectively reviewed. The patients’ medical records, including family history, weight, symptoms, treatment, complications, and laboratory test results for allergies and skin cultures, were examined. RESULTS: Twenty-six patients (24 boys) were enrolled. Seven cases had growth retardation; 7, keratoconjunctivitis; 6, aural discharges; 5, eczema herpeticum; 4, gastrointestinal tract symptoms; and 2, developmental delays. In 21 cases, topical steroids were not used. According to the blood test results, the median values of each parameter were elevated: total IgE, 1,864 U/mL; egg white-specific IgE, 76.5 kU(A)/L; milk IgE, 20.5 kU(A)/L; peanut IgE, 30 kU(A)/L; eosinophil count, 5,810/μL; eosinophil cationic protein, 93.45 μg/L; and platelet count, 666.5×10³/μL. Serum albumin and total protein levels decreased to 2.7 g/dL and 4.25 g/dL, respectively. Regarding electrolyte abnormality, 10 patients had hyponatremia, and 12, hyperkalemia. Systemic antibiotics were used to treat all cases, and an antiviral agent was used in 12 patients. Electrolyte correction was performed in 8 patients. CONCLUSION: Hypoproteinemia accompanying atopic dermatitis is common in infants younger than 1 year and may occur because of topical steroid treatment continuously being declined or because of eczema herpeticum. It may be accompanied by growth retardation, keratoconjunctivitis, aural discharge, and eczema herpeticum and can be managed through skin care and topical steroid application without intravenous albumin infusion.

Síndrome de Ramsay Hunt tipo II en mujer mayor de 90 años / Ramsay Hunt Syndrome type II in women older than 90 years of age

El Síndrome de Ramsay Hunt o Herpes Zóster Ótico, se define por la asociación de parálisis facial periférica con la presencia de erupción eritemato-vesicular en el oído externo, por el virus de la Varicela-Herpes Zóster. Objetivo: Establecer la evolución de la reactivación del virus de la varicela en personas mayores de 90 años. Presentación del Caso clínico: paciente femenina de 91 años, con antecedente de artritis reumatoide e hipertensión arterial no controlada; inicia con erupción maculo papular en hemicara izquierda que evoluciona a vesículas, acompañada de fiebre y mal estado general; concomitante presenta otalgia. Es ingresada por el servicio de Medicina Interna al Hospital Escuela Universitario donde se instaura tratamiento: Aciclovir 500mg intravenoso cada 8 horas, Pregabalina 1 cápsula vía oral cada 12 horas y Prednisona 50mg vía oral cada día, con buena respuesta terapéutica; se da de alta con mejoría de sus síntomas y resolución de lesiones faciales. Conclusión: Para la aparición del síndrome de Ramsay Hunt II en esta paciente, el principal factor de riesgo fue la edad; su evolución fue favorable y sin secuelas al instaurarse el tratamiento en forma oportuna...(AU)

A Case of Endothelial Keratitis Associated with Immunosuppressant in Kaposi's Varicelliform Eruption

PURPOSE: To report a case of endothelial keratitis occurred after reactivation of herpes simplex virus following immunosuppressant therapy for Kaposi's varicelliform eruption. CASE SUMMARY: A 23-year-old female was referred for ocular pain and blurred vision. She had atopic dermatitis and was diagnosed with Kaposi's varicelliform eruption on her face after using an immunosuppressant. Slit lamp examination revealed central corneal edema in the right eye. She was initially diagnosed with contact lens-induced keratitis. Subsequently, the contact lens was removed and topical antiviral agent used for prevention of ocular involvement. Four days after treatment, Wesseley immune ring of deep stromal haze and cells in the anterior chamber were present. She was diagnosed with endothelial keratitis caused by reactivation of herpes simplex virus after using an immunosuppressant. Topical steroid, hypertonic saline eye drops and cycloplegic eye drops were added to the treatment for the progression of endothelial keratitis. Corneal edema was decreased 2 weeks after treatment and anterior chamber cells decreased 1 month after treatment. There was no recurrence during the follow-up period. CONCLUSIONS: Patients diagnosed with Kaposi's varicelliform eruption after using immunosuppressants should have an ophthalmic examination to confirm ocular involvement; use of appropriate eye drops is necessary for the treatment of corneal involvement.

Kaposi's Varicelliform Eruption due to Varicella Zoster Virus in a Patient with Atopic Dermatitis / 대한피부과학회지

No abstract available.

A Descriptive Epidemiologic Study of Pediatric Infectious Skin Diseases in the Ansan and Southwestern Area of Gyeonggi-do over a Ten-year Period (2003~2013) / 대한피부과학회지

BACKGROUND: Pediatric infectious skin diseases are different from their counterparts in adults, since the sources of infection and disease progressions are distinct. To our knowledge, there have been no reports of epidemiologic studies of pediatric infectious skin diseases in Korea. OBJECTIVE: The purpose of this study was to evaluate the distribution of pediatric infectious skin diseases in the Ansan and Southwestern area of Gyeonggi-do, and to compare the results with previous reports about general pediatric dermatoses. METHODS: The authors retrospectively evaluated 4,366 cases of pediatric infectious skin diseases from July 2003 to June 2013 in the Department of Dermatology at Korea University Ansan Hospital. The monthly, seasonal, and annual incidences, as well as the ages and genders of the patients were evaluated. RESULTS: The study included 2004 (45.0%) girls and 2362 (55.0%) boys. The most frequent age of infection was 4 to 6 years old (range 0~15 years), and the peak incidences occurred in July, August, and January. The most common infectious dermatoses were viral (76.0%), bacterial (11.5%), fungal (8.3%), and parasitic (4.0%). The 10 most common pediatric infectious skin diseases were viral wart (45.8%), molluscum contagiosum (20.9%), impetigo (10.3%), tinea (7.1%), scabies (3.8%), herpes zoster (2.5%), varicella (1.6%), herpes simplex (1.5%), eczema herpeticum (1.1%), and cellulitis (0.9%). CONCLUSION: Compared to previously published reports, the distribution of pediatric infectious skin diseases has changed and was different from general pediatric dermatoses.

Macrophage Activation Syndrome Triggered by Herpes Viral Infection as the Presenting Manifestation of Juvenile Systemic Lupus Erythematosus

Macrophage activation syndrome (MAS) is a rare complication in systemic lupus erythematosus (SLE) that can be triggered by infections. Due to the fact that MAS may mimic clinical features of underlying rheumatic disease, or be confused with an infectious complication, its detection can prove challenging. This is particularly true when there is an unknown/undiagnosed disease; and could turn into an even greater challenge if MAS and SLE are combined with a viral infection. A-14-year-old female came to the hospital with an ongoing fever for 2 weeks and a painful facial skin rash. Hepatomegaly, pancytopenia, increased aspartate aminotransferase, elevated serum ferritin and lactate dehydrogenase were reported. No hemophagocytic infiltration of bone marrow was reported. The patient was suspected for hemophagocytic lymphohistiocytosis. Her skin rashes were eczema herpeticum, which is usually associated with immune compromised conditions. With the history of oral ulcers and malar rash, positive ANA and low C3, C4 and the evidence of hemolytic anemia, she was diagnosed as SLE. According to the diagnostic guideline for MAS in SLE, she was diagnosed MAS as well, activated by acute HSV infection. After administering steroids and antiviral agent, the fever and skin rash disappeared, and the abnormal laboratory findings normalized. Therefore, we are reporting a rare case of MAS triggered by acute HSV infection as the first manifestation of SLE.

A Case of Kaposi's Varicelliform Eruption in a Patient with Psoriasis Receiving Cyclosporine Therapy

No abstract available.

A Clinical Study of Inpatients with Eczema Herpeticum / 대한피부과학회지

BACKGROUND: Eczema herpeticum (EH) is caused by viral infection, usually with the herpes simplex virus (HSV), and most often occurs in patients with atopic dermatitis (AD). Although EH is a common dermatosis, predisposing factors are largely unknown, and there have been few clinical and epidemiologic studies in Korea. OBJECTIVE: This study evaluated the clinical characteristics of inpatients diagnosed with EH over the last 10 years. METHODS: We reviewed the medical records of 62 patients who were diagnosed with EH and were hospitalized at the Chonnam National University Hospital in Gwangju from January 2004 to July 2014. RESULTS: The ratio of male to female patients with EH was about 2:1, and the mean age at onset of EH was 25.3 (+/-17.3) years. In this study, AD (67.7%) was the most common preceding skin disorder, followed by nummular eczema (6.5%), and seborrheic dermatitis (3.2%). Patients with EH had other systemic symptoms such as fever (22.6%), headache (4.8%), and lymphadenopathy (4.8%). Patients with recurrent infection of HSV had longer hospitalizations compared to those with primary infection (9.35 vs. 6.49 days), but the difference was not significant (p=0.269). There was no significant difference in the number of hospitalized days between patients receiving antiviral agents vs. antibiotics (p=0.153). Systemic steroids were administered in 66.1% patients, which had no correlation with the number of hospitalized days (p=0.203). CONCLUSION: The present retrospective analysis contributes to our understanding of the clinical characteristics of EH.

Two Cases of Widespread Eczema Herpeticum with Low Serum Vitamin D Levels / 대한피부과학회지

Eczema herpeticum is a disseminated herpes simplex virus infection mainly in atopic individuals. Low expression of cathelicidin in atopic dermatitis contributes to the lack of defense capability against viral infection. Serum vitamin D level, which is essential for cathelicidin induction, is reported to be low in patients with severe atopic dermatitis. However, serum vitamin D level has not been studied in patients with eczema herpeticum. The mainstay of treatment of eczema herpeticum is systemic antiviral therapy. In atopic individuals with eczema herpeticum, intravenous immunoglobulin is less likely to enhance cutaneous viral susceptibility than other immunomodulators. Herein, we report two pediatric cases of widespread eczema herpeticum, both accompanied by high fever and low serum vitamin D levels. The patients were successfully treated with intravenous acyclovir and intravenous immunoglobulin. Serum 25-hydroxyvitamin D3 level was even less than 4.0 ng/ml in one patient, and no more repeated episodes of eczema herpeticum occurred, after supplementation of vitamin D.

Herpes Simplex Virus Infection after Corrective Rhinoplasty through External Approach: Two Case Reports

PURPOSE: Eczema herpeticum, caused by herpes simplex virus, is an infectious disease involving skin and internal organs. Varieties of physiologic, psychosocial, or environmental stress reactivate reservoir virus which exists in the trigeminal nerve ganglia. Authors report rare cases of nasal eczema herpeticum following corrective rhinoplasty. METHODS: First case, 22-year-old female underwent corrective rhioplasty through an external approach in a local clinic. She developed progressive and painful erythema, nodules and vesicles on nose on the 9th day postoperatively. This unfamiliar lesion lead to a misdiagnosis as a bacterial infection, and had accelerated its progress to the trigeminal innervation of the nasal unit. Second case, a 23-year-old female underwent corrective rhinoplasty by external lateral osteotomy. Ten days after the surgery, disruption occurred on the external osteotomy site, and the ulceration gradually worsened. The surgeon misdiagnosed it as secondary bacterial infection and only an antibacterial agent was applied. RESULTS: Both cases were healed effectively without any complication with proper wound dressing and antiviral therapy, and show no sequelae during an 8-month follow-up period. CONCLUSION: Eczema herpeticum is rare in the field of plastic surgery, but it should be kept in mind that secondary bacterial infections may lead to serious complications such as full-thickness skin loss. Thus, acknowledgement of the patient's past history regarding perioral or intraoral lesion may provide the surgeon with the possible expectancy of eczema herpeticum. Thus, if anyone develops eczema herpeticum, following facial plastic surgery, early diagnosis and immediate proper antiviral therapy will allow fast recovery without serious complications.

Herpes Simplex Virus Infection after Corrective Rhinoplasty through External Approach: Two Case Reports

PURPOSE: Eczema herpeticum, caused by herpes simplex virus, is an infectious disease involving skin and internal organs. Varieties of physiologic, psychosocial, or environmental stress reactivate reservoir virus which exists in the trigeminal nerve ganglia. Authors report rare cases of nasal eczema herpeticum following corrective rhinoplasty. METHODS: First case, 22-year-old female underwent corrective rhioplasty through an external approach in a local clinic. She developed progressive and painful erythema, nodules and vesicles on nose on the 9th day postoperatively. This unfamiliar lesion lead to a misdiagnosis as a bacterial infection, and had accelerated its progress to the trigeminal innervation of the nasal unit. Second case, a 23-year-old female underwent corrective rhinoplasty by external lateral osteotomy. Ten days after the surgery, disruption occurred on the external osteotomy site, and the ulceration gradually worsened. The surgeon misdiagnosed it as secondary bacterial infection and only an antibacterial agent was applied. RESULTS: Both cases were healed effectively without any complication with proper wound dressing and antiviral therapy, and show no sequelae during an 8-month follow-up period. CONCLUSION: Eczema herpeticum is rare in the field of plastic surgery, but it should be kept in mind that secondary bacterial infections may lead to serious complications such as full-thickness skin loss. Thus, acknowledgement of the patient's past history regarding perioral or intraoral lesion may provide the surgeon with the possible expectancy of eczema herpeticum. Thus, if anyone develops eczema herpeticum, following facial plastic surgery, early diagnosis and immediate proper antiviral therapy will allow fast recovery without serious complications.

Cyclosporin Treatment of Atopic Dermatitis: Is It Really Associated with Infectious Diseases?

BACKGROUND: Patients with severe atopic dermatitis (AD) can benefit from cyclosporin (CSA) treatment. Some studies reported that CSA can cause infectious diseases as side effects. OBJECTIVE: To investigate the possible association of CSA treatment in AD patients with infectious diseases. METHODS: We performed a case-controled study on 202 patients with AD, 101 of whom were taking CSA and 101 who were not. Retrospective medical record review was held, and the incidence of infectious disease in both groups was compared. RESULTS: The total number of infectious diseases in the CSA group was slightly lower than in control group but that was not statistically significant. Similarly, the incidence density was almost the same in the two groups. In both groups, eczema herpeticum was the most common infection. CONCLUSION: Our results suggest that CSA therapy in AD does not increase the incidence of infectious disease.

Dermatologic Diseases Associated with Atopic Dermatitis in Koreans: Multicenter Study / 대한피부과학회지

BACKGROUND: Dermatological diseases can occur with atopic dermatitis. OBJECTIVE: The purpose of this study was to analyze diseases associated with atopic dermatitis in Koreans. METHODS: From November, 2007, to May, 2008, 948 patients with atopic dermatitis who visited the department of dermatology at 19 hospitals were evaluated for associated diseases. RESULTS: Of 948 patients, 53.8% (510) had symptoms associated with other dermatological diseases. In order of frequency, diseases associated with atopic dermatitis included acne, hand/foot eczema, seborrheic dermatitis, urticaria, warts, and recurrent herpes simplex. The number of associated diseases did not change significantly with the severity of atopic dermatitis. However, the incidence of hand/foot eczema and eczema herpeticum correlated significantly with the severity of atopic dermatitis. CONCLUSION: There is a distinct pattern of diseases associated with atopic dermatitis in Koreans.