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Kaposi Varicelliform Eruption Follow-up

  • Author: David T Robles, MD, PhD; Chief Editor: William D James, MD  more...
 
Updated: Aug 20, 2015
 

Further Outpatient Care

Patients with Kaposi varicelliform eruption (KVE) should return for follow-up care in approximately 2 weeks to assess treatment response and to monitor for sequela.

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Complications

Systemic viremia with multiple-organ involvement is the major cause of morbidity and mortality in Kaposi varicelliform eruption (KVE). The organ systems involved include the liver, lungs, brain, gastrointestinal tract, and adrenal glands.

Septicemia from secondary bacterial infections of skin lesions also contributes to the morbidity and mortality of patients. Staphylococcus aureus, alone or mixed with group A beta-hemolytic streptococci, Pseudomonas aeruginosa, and Peptostreptococcus species were found to be the major isolates from patients with secondary bacterial infections.

When KVE due to herpes simplex virus (HSV) involves the face, a risk of ocular involvement leading to blepharitis, conjunctivitis, keratitis, and uveitis exists. Herpetic keratitis can lead to blindness due to stromal scarring. Interestingly, very few reported cases of ocular herpetic disease in KVE have occurred, even when positive conjunctival HSV cultures are present.

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Patient Education

For patient education resources, see the Skin, Hair, and Nails Center, as well as Eczema.

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Prognosis

Significant morbidity and mortality can be associated with Kaposi varicelliform eruption (KVE) due to HSV infection. However, with the introduction of intravenous acyclovir, in addition to systemic/topical antibiotic treatment, the mortality rate from KVE has decreased from as high as 50% to less than 10%. Significant complications may arise from keratoconjuctivitis, and rare cases of multiple-organ involvement with meningitis and encephalitis have been reported.[28]

Corticosteroid treatment has been suggested as a risk factor for developing KVE. Yet, a retrospective analysis of 100 cases showed that greater than 75% of patients had not received corticosteroid treatment in the 4 weeks before the onset of KVE.[21] This seems to argue against a role for topical steroids in the development of KVE. However, KVE has been reported to occur in AD patients treated with topical calcineurin inhibitors, such as tacrolimus.[29] Whether this is causally related remains unknown.

A recent retrospective cohort study concluded that delay in treatment with acyclovir increased hospital length of stay (LOS), ranging from an 11% increase when treatment was delayed only 1 day to an 98% increase in LOS when started on day 4-7. The study noted that there were no associated deaths during the nearly 10-year study period.[30]

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Contributor Information and Disclosures
Author

David T Robles, MD, PhD Dermatologist, Chaparral Medical Group

David T Robles, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Jacquiline Habashy, MSc Western University of Health Sciences College of Osteopathic Medicine of the Pacific

Jacquiline Habashy, MSc is a member of the following medical societies: American Osteopathic College of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

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, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

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.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Disclosure: Nothing to disclose.

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.

Jeffrey K McKenna, MD Associate, Mohs Surgeon, Soderstrom Dermatology Center, SC

Disclosure: Nothing to disclose.

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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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