Kaposi Varicelliform Eruption Medication

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

Medication Summary

The goals of pharmacotherapy in Kaposi varicelliform eruption (KVE) are to reduce morbidity and to prevent complications.

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Antivirals

Class Summary

Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit HSV DNA polymerase with 30-50 times the potency of human alpha-DNA polymerase.

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Acyclovir (Zovirax)

 

Indicated in genital herpes simplex, mucocutaneous herpes simplex in immunocompromised patients, herpes zoster, recurrent herpes simplex labialis, and varicella.

Synthetic acyclic guanosine analogue that inhibits viral DNA polymerase. Remains treatment of choice for KVE. Systemic and/or topical antibiotics can be used for secondary bacterial infections.

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Foscarnet (Foscavir)

 

For immunocompromised host with HSV infection and acyclovir-resistant HSV infection. Inhibits viral replication at the pyrophosphate-binding site on virus-specific DNA polymerases. Poor clinical response or persistent viral excretion during therapy may be due to viral resistance.

Patients who can tolerate foscarnet well may benefit from initiation of maintenance treatment at 120 mg/kg/d early in treatment. Individualize dosing based on renal function status.

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Trifluridine (Viroptic)

 

Approved for use in ophthalmic herpes simplex, primary keratoconjunctivitis, and recurrent epithelial keratitis due to HSV types 1 and 2.

Inhibits viral replication by incorporating into viral DNA in place of thymidine. If no response in 7-14 d, consider other treatments.

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Vidarabine (Vira-A)

 

Indicated for recurrent epithelial keratitis and acute keratoconjunctivitis. Topical idoxuridine that interferes with early steps of viral DNA synthesis. If no signs of improvement after 7 days or incomplete reepithelialization in 21 d, consider alternative therapy.

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Valacyclovir (Valtrex)

 

Prodrug rapidly converted to the active drug acyclovir. More expensive but has a more convenient dosing regimen than acyclovir.

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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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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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