Hydroa Vacciniforme Clinical Presentation

Updated: Jun 14, 2021
  • Author: Gregory Toy, MD; Chief Editor: Dirk M Elston, MD  more...
  • Print


Commonly, mild burning, itching, or stinging in exposed sites begins a few hours or days after sun exposure. Vesicles heal with varioliform scarring. [4] The initial onset of lesions occurs in spring, with recurrences in summer months.

Constitutional symptoms can occur but are uncommon. Oral and ocular symptoms can occur but are extremely rare.


Physical Examination

Skin and mucous membranes [13] are the primary sites affected by hydroa vacciniforme (HV). Ocular involvement is uncommon and usually occurs along with an HV outbreak of the face. [14]

Skin findings are as follows:

  • Tense, edematous papules progress to clear, then, cloudy discrete vesicles.

  • Lesions become umbilicated, necrotic papules on an erythematous base.

  • Papules heal with hypopigmented depressed scars.

Eye findings are as follows [14, 4] :

  • Mild keratoconjunctivitis

  • Corneal clouding and stellate keratotic precipitates in the cornea, indicating an inflammatory keratitis (one report [15] )

  • Conjunctivitis and vesicular eruptions of the conjunctiva

  • Corneal infiltration with vascularization

  • Keratouveitis

Other symptoms are as follows:

  • Photo-onycholysis

  • Limited partial absorption of bone and cartilage in severe HV

  • Earlobe mutilation and flexion contracture of a digit (reported in 1 patient) [16]

Severe HV may present with the following [17] :

  • High-grade fever
  • Liver damage

  • Ulcerative indurated lesions

  • Edematous swelling of the cheeks, ears, lips, and eyelids



Complications are rare in hydroa vacciniforme (HV). The most common severe sequela is the varioliform scarring.