eMedicine Specialties > Dermatology > Viral Infections
Kaposi Varicelliform Eruption: Treatment & Medication
Updated: Dec 3, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Consultations
Consultation with an ophthalmologist is indicated when eye involvement is suspected. Herpetic keratitis can lead to scarring. Fortunately, ocular herpetic infection in the setting of Kaposi varicelliform eruption (KVE) is rare.
Medication
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Antivirals
Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit HSV polymerase with 30-50 times the potency of human alpha-DNA polymerase.
Acyclovir (Zovirax)
Synthetic acyclic guanosine analogue that inhibits viral DNA polymerase. Remains the treatment of choice for Kaposi varicelliform eruption. Systemic and/or topical antibiotics can be used for secondary bacterial infections.
Adult
15 mg/kg/d IV divided tid for 5 d or until lesions heal
Alternatively, 200-400 mg PO 5 times/d for 10-14 d or until lesions heal
Pediatric
Administer as in adults
Concomitant use of probenecid or zidovudine prolongs half-life and increases CNS toxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in renal failure or when using nephrotoxic drugs
Foscarnet (Foscavir)
For immunocompromised host with HSV infection and acyclovir-resistant HSV infection. Inhibits viral replication at 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.
Adult
40 mg/kg IV q8h until lesions heal
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Coadministration with potentially nephrotoxic drugs (eg, aminoglycosides, amphotericin B, IV pentamidine) may increase nephrotoxicity (do not administer unless potential benefits outweigh risks); coadministration with IV pentamidine may cause hypocalcemia
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause decline in renal function; for correct dosing, obtain 24-h serum creatinine at baseline and continue to monitor (discontinue if serum creatinine level <0.4 mL/min/kg); hydration may reduce nephrotoxicity; carefully monitor electrolytes (eg, calcium, magnesium); assess for electrolyte and mineral level abnormalities if mild perioral numbness, paresthesia symptoms, or seizures occur; granulocytopenia and anemia may occur (regularly monitor CBC count); infuse into veins with adequate blood flow to avoid local irritation; to avoid toxicity, do not administer by rapid or bolus IV injection
Trifluridine (Viroptic)
Inhibits viral replication by incorporating into viral DNA in place of thymidine. If no response in 7-14 d, consider other treatments.
Adult
Prophylaxis: 1 gtt OU 5 times/d
Ocular involvement: 1 gtt OU 8 times/d
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause mild, local irritation of conjunctiva and cornea upon instillation
Vidarabine (Vira-A)
Topical idoxuridine that interferes with early steps of viral DNA synthesis. If no signs of improvement after 7 d or incomplete reepithelialization in 21 d, consider alternative therapy. Severe cases may require longer treatment. After reepithelialization occurs, treat bid for another 7 d to prevent recurrence.
Adult
Prophylaxis: Apply 0.5-inch ribbon into lower conjunctival sacs tid
Ocular involvement: Apply 0.5-inch ribbon into lower conjunctival sacs 5 times/d
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Viral resistance to vidarabine is possible but none reported
Valacyclovir (Valtrex)
Prodrug rapidly converted to the active drug acyclovir. More expensive but has a more convenient dosing regimen than acyclovir.
Adult
First episode herpes simplex: 1 g PO bid for 10 d, preferably beginning within 48 h of onset
Suppressive dosage for herpes simplex: 500 mg to 1 g PO qd
Herpes zoster: 1 g PO tid for 7 d
Pediatric
Not established
Probenecid, zidovudine, or cimetidine coadministration prolongs half-life and increases CNS toxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in renal failure (decrease dose) and coadministration of nephrotoxic drugs; associated with onset of hemolytic uremic syndrome
More on Kaposi Varicelliform Eruption |
| Overview: Kaposi Varicelliform Eruption |
| Differential Diagnoses & Workup: Kaposi Varicelliform Eruption |
 Treatment & Medication: Kaposi Varicelliform Eruption |
| Follow-up: Kaposi Varicelliform Eruption |
| Multimedia: Kaposi Varicelliform Eruption |
| References |
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References
Howell MD, Wollenberg A, Gallo RL, et al. Cathelicidin deficiency predisposes to eczema herpeticum. J Allergy Clin Immunol. Apr 2006;117(4):836-41. [Medline].
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].
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].
Bork K, Brauninger W. Increasing incidence of eczema herpeticum: analysis of seventy-five cases. J Am Acad Dermatol. Dec 1988;19(6):1024-9. [Medline].
Lübbe 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].
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].
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].
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].
Brook I, Frazier EH, Yeager JK. Microbiology of infected eczema herpeticum. J Am Acad Dermatol. Apr 1998;38(4):627-9. [Medline].
Cesario T, Fife LT, Rayhan S, Emmons R. Cutaneous dissemination of herpes simplex virus in individuals fifteen years of age and older. Am J Med Sci. May-Jun 1977;273(3):345-53. [Medline].
David TJ, Longson M. Herpes simplex infections in atopic eczema. Arch Dis Child. Apr 1985;60(4):338-43. [Medline].
Erlich KS. Management of herpes simplex and varicella-zoster virus infections. West J Med. Mar 1997;166(3):211-5. [Medline].
Fivenson DP, Breneman DL. A rapidly progressive papulovesicular eruption. Eczema herpeticum/Kaposi's varicelliform eruption. Arch Dermatol. Nov 1989;125(11):1570, 1572-3. [Medline].
Fivenson DP, Breneman DL, Wander AH. Kaposi's varicelliform eruption. Absence of ocular involvement. Arch Dermatol. Aug 1990;126(8):1037-9. [Medline].
Goodyear HM, McLeish P, Randall S, et al. Immunological studies of herpes simplex virus infection in children with atopic eczema. Br J Dermatol. Jan 1996;134(1):85-93. [Medline].
Kohl S. The role of antibody in herpes simplex virus infection in humans. Curr Top Microbiol Immunol. 1992;179:75-88. [Medline].
Kramer SC, Thomas CJ, Tyler WB, Elston DM. Kaposi's varicelliform eruption: a case report and review of the literature. Cutis. Feb 2004;73(2):115-22. [Medline].
Lee SY, Laibson PR. Medical management of herpes simplex ocular infections. Int Ophthalmol Clin. Spring 1996;36(2):85-97. [Medline].
Pereira FA. Herpes simplex: evolving concepts. J Am Acad Dermatol. Oct 1996;35(4):503-20; quiz 521-2. [Medline].
Rinaldo CR Jr, Torpey DJ 3rd. Cell-mediated immunity and immunosuppression in herpes simplex virus infection. Immunodeficiency. 1993;5(1):33-90. [Medline].
Schmid DS, Rouse BT. The role of T cell immunity in control of herpes simplex virus. Curr Top Microbiol Immunol. 1992;179:57-74. [Medline].
Shillitoe EJ, Wilton JM, Lehner T. Sequential changes in T and B lymphocyte responses to Herpes simplex virus in man. Scand J Immunol. 1978;7(5):357-66. [Medline].
Vestey JP, Howie SE, Norval M, Maingay JP, Neill WA. Immune responses to herpes simplex virus in patients with facial herpes simplex and those with eczema herpeticum. Br J Dermatol. Jun 1988;118(6):775-82. [Medline].
Vestey JP, Howie SE, Norval M, Maingay JP, Neill WA. Severe eczema herpeticum is associated with prolonged depression of cell-mediated immunity to herpes simplex virus. Curr Probl Dermatol. 1989;18:158-61. [Medline].
Wheeler CE Jr, Abele DC. Eczema herpeticum, primary and recurrent. Arch Dermatol. Feb 1966;93(2):162-73. [Medline].
Further Reading
Keywords
Kaposi varicelliform eruption, KVE, eczema herpeticum, eczema vaccinatum, atopic dermatitis, herpes simplex virus type 1, HSV-1, herpes simplex virus type 2, HSV-2, coxsackievirus A16, vaccinia virus
