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)

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.

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.

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.

Eccema herpético por virus herpes simplex tipo 2: revisión de la literatura a propósito de un caso / Eczema herpeticum caused by herpes simplex virus type 2: review of the literature about one case

Eczema herpeticum is an extensive vesicular eruption caused by cutaneous dissemination of herpes simplex virus in patients who have underlying skin conditions or epidermal barrier disruption. Herpes simplex virus type 1 (HSV 1) is the most common etiology. This is the first report in Chile of a case of eczema herpeticum caused by HSV 2 in a patient with Darier' s disease, We review the literature and emphasize the use of sensitive and specific assays as real time polimerase chain reaction, that allow to initiate timely the correct treatment.

El eccema herpético es una erupción vesicular extensa causada por la diseminación cutánea del virus herpes simplex, en pacientes con trastornos cutáneos previos o daño de la barrera epidérmica. La etiología más frecuente es virus herpes simplex tipo 1 (VHS 1), aunque se han reportado casos de virus herpes simplex tipo 2 (VHS 2). Presentamos el primer reporte en Chile de eccema herpético por VHS 2 en un paciente con enfermedad de Darier. Realizamos una revisión de la literatura médica y destacamos la importancia del uso de técnicas sensibles y específicas como la reacción de polimerasa en cadena (RPC) en tiempo real, que posibilitan el inicio precoz de la terapéutica correcta.

Sepse por S. aureus em paciente com dermatite atópica e eczema herpético: relato de caso / Sepsis by S. aureus in a patient with atopic dermatitis and herpeticum eczema: a case report

O objetivo deste relato de caso foi apresentar uma paciente com dermatite atópica (DA) e que no primeiro ano de vida desenvolveu quadro infeccioso grave com eczema difuso em face pescoço e tórax, acompanhado de celulite periorbitária bilateral, febre alta, gemência, hipoatividade e acentuado comprometimento do estado geral. Pele xerótica com lesões vesículares, umbilicadas e com secreção purulenta. O isolamento de Staphy/occus aureus em hemocultura confirmou a suspeita de septicemia e o tratamento antimicrobiano efetivo (Ceftriaxona e Oxacilina) permitiu o seu controle e evidenciou a presença de Eczema herpeticum em face. O tratamento com Aciclovir intra-venoso e cuidados locais possibilitaram o seu controle. A infecção viral funcionou como porta de entrada para o S.aureus causando a septicemia, pouco comum em DA não complicada.

The aim of this report is to relate a one year-old female patient with atopic dermatitis (AD) that developed a severe infectious clinical picture associated with diffuse eczema in face, neck and thorax, bilateral per orbital cellulite, elevated fever, groaning, underactivity, and accentuated commitment of general condition. Pustule umbilicated vesicles over a xerotic skin were observed. Hemoculture reveals Growing of Staphy/occus aureus in hemoculture confirmed septicemia diagnose and specific antibiotic therapy (Ceftriaxona e Oxacilina) allowed its control and put in evidencethe presence of facial Herpeticum eczema. The intravenous treatment with Acyclovir associated with local care enable its control. Virus infection was the S. aureus entrance door causing septicemia, uncommon in no complicated DA patients.

A Case of Eczema Herpeticum with Hailey-Hailey Disease

Eczema herpeticum is the dissemination of herpes simplex virus in the setting of a preexisting skin disease. Hailey- Hailey disease [familial benign chronic pemphigus] is a blistering dermatosis that is inherited as an autosomal dominant trait and it usually presents itself around the third or fourth decades. Coexistence of eczema herpeticum and Hailey-Hailey disease is an infrequent occurrence. Four such cases have been reported in the English and German medical literature. We report here on an unusual case of eczema herpeticum that coexisted with Hailey-Hailey disease in a 47 years old man and we review the relevant literatures.

Eczema Herpeticum in Normal Skin of Two Siblings / 대한피부과학회지

Eczema herpeticum is a herpes simplex virus infection with disseminated skin involvement, which superimposes on a pre-existing dermatosis. Two siblings with simultaneous primary herpes simplex virus (HSV) infection on the normal skin of their backs, followed by their mother's herpes labialis. Eczema herpeticum was diagnosed on the basis of history, clinical feature, Tzanck test, histologic examination and a serologic test. Their skin lesions were healed by treatment with oral acyclovir and mupirocin ointment.

Clinical Features of Eczema Herpeticum in Comparison with Localized Herpes Simplex Virus Infection

No abstract available.

A Case of Darier's Disease Complicated by Eczema Herpeticum / 대한피부과학회지

Eczema herpeticum is a herpes simplex virus (HSV) infection with disseminated skin involvement superimposed on a pre-existing dermatosis such as atopic dermatitis, neurodermatitis, pemphigus vulgaris and Darier's disease. We report a case of eczema herpeticum by HSV-1 infection confirmed by polymerase chain reaction in a 20-year-old man associated with Darier's disease.

Disseminated Eczema Herpeticum Transmitted by Self-inoculation / 대한피부과학회지

Eczema herpeticum is a widespread Herpes simplex virus(HSV) infection, which usually develops in patients with atopic dermatitis. Because pruritus in patients with atopic dermatits leads them to scratch their bodies, it causes the dissemination of Herpes simplex virus. A delay in diagnosing this condition may result in intense and rapid spread of the cutaneous lesions. We report a patient who underwent a prolonged friction with a rough nylon towel while bathing and developed eczema herpeticum. We suspect a bath with a rough nylon towel as a possible route of spread.

Eczema Herpeticum in Darier's Disease

Eczema herpeticum is a herpes simplex virus infection with disseminated skin involvement superimposed on a pre-existing dermatosis. Dariers disease has been reported to be among the dermatoses susceptible to the sudden onset of a widespread vesicular eruption accompanied by high fever known as Kaposis varicelliform eruption. We report a case of eczema herpeticum in a 46-year-old woman associated with Dariers disease.

Pemphigus Foliaceus Complicating Eczema Herpeticum / 대한피부과학회지

Eczema herpeticum occurred in a patient with pemphigus foliaceus and esophageal cancer. The patient's initial skin lesions composed of large flaccid bullaes showed subcorneal bullae with typical acantholytic cells. Subsequent grouped small vesicles appeared widely on the erythematous base were diagnosed herpes simplex virus infection by Tzanck smear and histopathological findings. The patient died one week after the development of the widespread herpes virus infection.

Eczema herpeticum in a patient with Darier;s disease duringtreatment with etretinate / 대한피부과학회지

We report a case of eczema herpeticum associated with secondry staphylococcal infection in a 19 year-old male patient with Dariers disease during tratment with etretinate. Diagnosis was made by the history, clinical feature and histologic examination with light microscope & electron microscope. This patients condition was improved by the treatment with systemic and topical antibiotics within 1 week of admission.