eMedicine Specialties > Dermatology > Photo-Related Diseases

Hydroa Vacciniforme: Differential Diagnoses & Workup

Author: Quynh L Sebastian, MD, Clinical Instructor, Division of Dermatology, UCLA David Geffen School of Medicine
Coauthor(s): Raul Del Rosario, MD, Consulting Staff, Surgical Pathology and Dermatopathology, South Coast Medical
Contributor Information and Disclosures

Updated: Jul 24, 2008

Differential Diagnoses

Actinic Prurigo
Polymorphous Light Eruption
Chickenpox
Porphyria Cutanea Tarda
Epidermolysis Bullosa
Pseudoporphyria
Epidermolysis Bullosa Acquisita
Urticaria, Solar
Erythropoietic Protoporphyria
Hartnup Disease
Herpes Simplex

Other Problems to Be Considered

Hydroa aestivale
Lymphoproliferative disorders7,8,9,10,11,12

Workup

Laboratory Studies

  • CBC count to investigate constitutional symptoms
  • Viral culture of blister fluid to rule out herpes virus infection
  • Erythrocyte sedimentation rate and antinuclear antibody, anti-Ro, and anti-La antibody tests to rule out bullous lupus erythematosus
  • Plasma or serum porphyrin assay to exclude cutaneous porphyrias
  • DNA repair studies to rule out xeroderma pigmentosum

Imaging Studies

  • Imaging studies are not routinely obtained as part of the workup of HV.

Other Tests

  • Repetitive, broad-spectrum, UV-A phototesting
    • Repetitive, broad-spectrum, low-dose UV-A irradiation can elicit lesions clinically and histologically identical to those produced by natural UV exposure, although results are inconsistent.
    • The minimal erythemal dose of ultraviolet B (UV-B) and UV-A in these patients is usually normal.

Histologic Findings

Early lesions reveal an epidermal, multilocular vesicle with reticular degeneration. A dense, perivascular, lymphohistiocytic infiltrate with vessel hemorrhage and thrombosis may occur in the dermis. Late lesions show epidermal and dermal necrosis with a surrounding, chronic, inflammatory infiltrate. Direct immunofluorescence study results are usually normal, except for rare reports (2 patients) of C3 deposits at the dermoepidermal junction and in the small dermal vessels.

More on Hydroa Vacciniforme

Overview: Hydroa Vacciniforme
Differential Diagnoses & Workup: Hydroa Vacciniforme
Treatment & Medication: Hydroa Vacciniforme
Follow-up: Hydroa Vacciniforme
Multimedia: Hydroa Vacciniforme
References
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References

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  2. Jeng BH, Margolis TP, Chandra NS, McCalmont TH. Ocular findings as a presenting sign of hydroa vacciniforme. Br J Ophthalmol. Nov 2004;88(11):1478-9. [Medline].

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  4. Kim WS, Yeo UC, Chun HS, Lee ES. A case of hydroa vacciniforme with unusual ear mutilation. Clin Exp Dermatol. Mar 1998;23(2):70-2. [Medline].

  5. Halasz CL, Leach EE, Walther RR, Poh-Fitzpatrick MB. Hydroa vacciniforme: induction of lesions with ultraviolet A. J Am Acad Dermatol. Feb 1983;8(2):171-6. [Medline].

  6. Annamalai R. Hydroa vacciniforme in three alternate siblings. Arch Dermatol. Feb 1971;103(2):224-5. [Medline].

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  8. Iwatsuki K, Ohtsuka M, Harada H, Han G, Kaneko F. Clinicopathologic manifestations of Epstein-Barr virus-associated cutaneous lymphoproliferative disorders. Arch Dermatol. Sep 1997;133(9):1081-6. [Medline].

  9. Magaña M, Sangüeza P, Gil-Beristain J, Sánchez-Sosa S, Salgado A, Ramón G, et al. Angiocentric cutaneous T-cell lymphoma of childhood (hydroa-like lymphoma): a distinctive type of cutaneous T-cell lymphoma. J Am Acad Dermatol. Apr 1998;38(4):574-9. [Medline].

  10. Tokura Y, Ishihara S, Ohshima K, Hidano A, Koide M, Seo N, et al. Severe mosquito bite hypersensitivity, natural killer cell leukaemia, latent or chronic active Epstein-Barr virus infection and hydroa vacciniforme-like eruption. Br J Dermatol. May 1998;138(5):905-6. [Medline].

  11. Iwatsuki K, Satoh M, Yamamoto T, Oono T, Morizane S, Ohtsuka M, et al. Pathogenic link between hydroa vacciniforme and Epstein-Barr virus-associated hematologic disorders. Arch Dermatol. May 2006;142(5):587-95. [Medline].

  12. Yamamoto T, Tsuji K, Suzuki D, Morizane S, Iwatsuki K. A novel, noninvasive diagnostic probe for hydroa vacciniforme and related disorders: detection of latency-associated Epstein-Barr virus transcripts in the crusts. J Microbiol Methods. Feb 2007;68(2):403-7. [Medline].

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  16. Omenn GS, Goodman GE, Thornquist MD, Balmes J, Cullen MR, Glass A, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med. May 2 1996;334(18):1150-5. [Medline].

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  27. Gu H, Chang B, Qian H, Li G. A clinical study on severe hydroa vacciniforme. Chin Med J (Engl). Aug 1996;109(8):645-7. [Medline].

  28. Gupta G, Man I, Kemmett D. Hydroa vacciniforme: A clinical and follow-up study of 17 cases. J Am Acad Dermatol. Feb 2000;42(2 Pt 1):208-13. [Medline].

  29. Raza N, Bari AU, Farooq M. Hydroa vacciniforme in an adolescent girl. J Coll Physicians Surg Pak. Jun 2007;17(6):359-61. [Medline].

  30. Ruiz-Maldonado R, Parrilla FM, Orozco-Covarrubias ML, Ridaura C, Tamayo Sanchez L, Duran McKinster C. Edematous, scarring vasculitic panniculitis: a new multisystemic disease with malignant potential. J Am Acad Dermatol. Jan 1995;32(1):37-44. [Medline].

  31. Sato K, Taguchi H, Maeda T, Minami H, Asada Y, Watanabe Y, et al. The primary cytotoxicity in ultraviolet-a-irradiated riboflavin solution is derived from hydrogen peroxide. J Invest Dermatol. Oct 1995;105(4):608-12. [Medline].

  32. Taylor CR, Duke D. Blistering, scarring, and photosensitivity in a male teenager. Arch Dermatol. Oct 1999;135(10):1267, 1270. [Medline].

  33. Yoon TY, Kim YG, Kim JW, Kim MK. Nodal marginal zone lymphoma in association with hydroa vacciniforme-like papulovesicular eruption, hypersensitivity to mosquito bites and insect bite-like reaction. Br J Dermatol. Jul 2005;153(1):210-2. [Medline].

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Further Reading

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Keywords

Bazin hydroa vacciniforme, HV, photodermatosis

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Contributor Information and Disclosures

Author

Quynh L Sebastian, MD, Clinical Instructor, Division of Dermatology, UCLA David Geffen School of Medicine
Quynh L Sebastian, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Raul Del Rosario, MD, Consulting Staff, Surgical Pathology and Dermatopathology, South Coast Medical
Raul Del Rosario, MD is a member of the following medical societies: American Society for Clinical Pathologists
Disclosure: Nothing to disclose.

Medical Editor

Maureen B Poh-Fitzpatrick, MD, Professor Emerita of Dermatology and Special Lecturer, Columbia University; Professor of Medicine (Dermatology), University of Tennessee
Maureen B Poh-Fitzpatrick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Van Perry, MD, Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center
Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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