Kaposi Varicelliform Eruption Workup

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

Laboratory Studies

Viral cultures of fresh vesicular fluid and the direct observation of infected cells scraped from ulcerative lesions by direct fluorescent antibody (DFA) staining are the most useful and reliable diagnostic tests available for Kaposi varicelliform eruption (KVE). When cultures are taken, swabbing should be vigorous because herpes simplex virus (HSV) is cell associated and a paucity of extracellular virus particles may be present. DFA staining of scrapings from an early vesicular or crusted lesion is as accurate as viral culture in differentiating HSV-1, HSV-2, and varicella-zoster virus. Furthermore, the results from DFA staining can be available in a few hours.

A Tzanck smear of an opened vesicle or erosion can provide rapid diagnosis when it shows the characteristic epithelial multinucleated giant cells and acantholysis.

If the lesions are atypical, equivocal, or old, biopsy or the polymerase chain reaction (PCR) should be considered. A biopsy can establish a diagnosis that may not have been thought of clinically, whereas PCR can detect minute amounts of viral DNA in tissue through amplification.

Bacterial superinfection is common in KVE patients, and bacterial culture taken from a moist or crusted lesion often isolates Staphylococcus or Streptococcus.

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Procedures

As indicated above, biopsy of the affected area can aid in the diagnosis of Kaposi varicelliform eruption (KVE).

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Histologic Findings

Tissue biopsy in Kaposi varicelliform eruption (KVE) shows changes characteristic of herpes virus infection, notably ballooning degeneration of keratinocytes with multinucleated epithelial cells. A viral cytopathic effect occurs in the nucleus, which manifests as peripheral margination of the nucleoplasm creating a basophilic rim at the edge of the nucleus.

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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.

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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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