Kaposi Varicelliform Eruption Clinical Presentation

  • Author: Kerry A Lavigne, MD; Chief Editor: William D James, MD   more...
 
Updated: May 24, 2012
 

History

Kaposi varicelliform eruption (KVE) begins as a sudden eruption of painful; edematous; often crusted or hemorrhagic vesicles, pustules, or erosions in areas of the preexisting dermatosis. A delay in diagnosis often occurs because the eruption is confused with the underlying disease. The eruption continues to spread over 7-10 days and may be associated with a high temperature, malaise, and lymphadenopathy

The primary episode of KVE runs its course and heals in 2-6 weeks. The average duration of illness is 16 days.

Transmission occurs through contact with a person who is infected or by dissemination of primary or recurrent herpes. Recurrent episodes may also occur but are milder and not usually associated with systemic symptoms. Some studies have shown a high frequency of HSV DNA in the oral cavity of patients with KVE.[19] In severe cases of KVE, lesions may heal with scarring.

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Physical

Umbilicated vesiculopustules that progress to punched-out erosions in the setting of a widespread dermatosis, as shown below, is virtually pathognomonic for Kaposi varicelliform eruption (KVE).

Infant with crusted, erythematous, umbilicated vesInfant with crusted, erythematous, umbilicated vesicles of eczema herpeticum and associated periorbital edema. Kaposi varicelliform eruption occurring with underKaposi varicelliform eruption occurring with underlying Darier disease. Characteristic umbilicated vesiculopustules on theCharacteristic umbilicated vesiculopustules on the thigh of a child with a preexisting atopic dermatitis.

The eruption is most commonly disseminated in the areas of dermatitis, with a predilection for the upper body and the head. Localized forms also exist.[20] The vesicles often become hemorrhagic and crusted and can evolve into extremely painful erosions with a punched-out appearance. These erosions may coalesce to form large denuded areas that frequently bleed and can become secondarily infected with bacteria.

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Causes

Kaposi varicelliform eruption (KVE) is caused primarily by HSV-1, but can also be caused by HSV-2, coxsackievirus A16, or vaccinia virus infecting a preexisting dermatosis. Most commonly, it is caused by a disseminated HSV infection in patients with AD. For this reason, it is also referred to as EH.

KVE has also been associated with the following:

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Contributor Information and Disclosures
Author

Kerry A Lavigne, MD  Resident Physician, Department of Dermatology, Geisinger Medical Center

Kerry A Lavigne, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Pennsylvania Academy of Dermatology, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Eric W Hossler, MD  Staff Physician, Departments of Dermatology and Dermatopathology, Geisinger Medical Center

Eric W Hossler, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Medical Dermatology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Kathleen David-Bajar, MD  Former Consultant to the Army Surgeon General, Department of Dermatology, Brooke Army Medical Center

Kathleen David-Bajar, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Jeffrey K McKenna, MD, and Paul Krusinski, MD, to the development and writing of this article.

References

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  2. Oyoshi MK, Elkhal A, Kumar L, et al. Vaccinia virus inoculation in sites of allergic skin inflammation elicits a vigorous cutaneous IL-17 response. Proc Natl Acad Sci U S A. Sep 1 2009;106(35):14954-9. [Medline]. [Full Text].

  3. Howell MD, Gallo RL, Boguniewicz M, et al. Cytokine milieu of atopic dermatitis skin subverts the innate immune response to vaccinia virus. Immunity. Mar 2006;24(3):341-8. [Medline].

  4. Kawakami Y, Tomimori Y, Yumoto K, et al. Inhibition of NK cell activity by IL-17 allows vaccinia virus to induce severe skin lesions in a mouse model of eczema vaccinatum. J Exp Med. Jun 8 2009;206(6):1219-25. [Medline]. [Full Text].

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  8. Gao PS, Rafaels NM, Hand T, et al. Filaggrin mutations that confer risk of atopic dermatitis confer greater risk for eczema herpeticum. J Allergy Clin Immunol. Sep 2009;124(3):507-13, 513.e1-7. [Medline].

  9. Rinaldo CR Jr, Torpey DJ 3rd. Cell-mediated immunity and immunosuppression in herpes simplex virus infection. Immunodeficiency. 1993;5(1):33-90. [Medline].

  10. Bin L, Howell MD, Kim BE, Streib JE, Hall CF, Leung DY. Specificity protein 1 is pivotal in the skin's antiviral response. J Allergy Clin Immunol. Feb 2011;127(2):430-438.e1-2. [Medline].

  11. Gao PS, Leung DY, Rafaels NM, Boguniewicz M, Hand T, Gao L, et al. Genetic variants in interferon regulatory factor 2 (IRF2) are associated with atopic dermatitis and eczema herpeticum. J Invest Dermatol. Mar 2012;132(3 Pt 1):650-7. [Medline]. [Full Text].

  12. Howell MD, Gao P, Kim BE, Lesley LJ, Streib JE, Taylor PA, et al. The signal transducer and activator of transcription 6 gene (STAT6) increases the propensity of patients with atopic dermatitis toward disseminated viral skin infections. J Allergy Clin Immunol. Nov 2011;128(5):1006-14. [Medline]. [Full Text].

  13. De Benedetto A, Slifka MK, Rafaels NM, Kuo IH, Georas SN, Boguniewicz M, et al. Reductions in claudin-1 may enhance susceptibility to herpes simplex virus 1 infections in atopic dermatitis. J Allergy Clin Immunol. Jul 2011;128(1):242-246.e5. [Medline]. [Full Text].

  14. Kawakami Y, Tomimori Y, Yumoto K, et al. Inhibition of NK cell activity by IL-17 allows vaccinia virus to induce severe skin lesions in a mouse model of eczema vaccinatum. J Exp Med. Jun 8 2009;206(6):1219-25. [Medline]. [Full Text].

  15. Wheeler CE Jr, Abele DC. Eczema herpeticum, primary and recurrent. Arch Dermatol. Feb 1966;93(2):162-73. [Medline].

  16. Wollenberg A, Zoch C, Wetzel S, Plewig G, Przybilla B. Predisposing factors and clinical features of eczema herpeticum: a retrospective analysis of 100 cases. J Am Acad Dermatol. Aug 2003;49(2):198-205. [Medline].

  17. Lubbe J, Sanchez-Politta S, Tschanz C, Saurat JH. Adults with atopic dermatitis and herpes simplex and topical therapy with tacrolimus: what kind of prevention?. Arch Dermatol. May 2003;139(5):670-1. [Medline].

  18. Aronson PL, Yan AC, Mittal MK, Mohamad Z, Shah SS. Delayed acyclovir and outcomes of children hospitalized with eczema herpeticum. Pediatrics. Dec 2011;128(6):1161-7. [Medline].

  19. Yoshida M, Amatsu A. High frequency of detection of herpes simplex virus DNA in the oral cavity of patients with eczema herpeticum. Dermatology. 2004;209(2):101-3. [Medline].

  20. Fivenson DP, Breneman DL, Wander AH. Kaposi's varicelliform eruption. Absence of ocular involvement. Arch Dermatol. Aug 1990;126(8):1037-9. [Medline].

  21. Monsalvez V, Polo I, Fuertes L, Zarco C, Vanaclocha F. [Eczema herpeticum in cutaneous T-cell lymphomas]. Actas Dermosifiliogr. Jun 2009;100(5):431-3. [Medline].

 
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Erythematous vesicles characteristic of eczema herpeticum with associated impetiginous crust.
Infant with crusted, erythematous, umbilicated vesicles of eczema herpeticum and associated periorbital edema.
Kaposi varicelliform eruption occurring with underlying Darier disease.
Characteristic umbilicated vesiculopustules on the thigh of a child with a preexisting atopic dermatitis.
 
 
 
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