Laboratory Studies

Consider the following laboratory studies:

Complete blood cell count to investigate constitutional symptoms
Measurement of EBV DNA; best detected with whole blood rather than serum or plasma: EBV DNA in peripheral blood mononuclear cells (PBMCs) provides a diagnostic indicator of hydroa vacciniform (HV) ^[29]
Cell free EBV DNA in plasma, as it may be related to serious complications like hemophagocytic lymphohistiocytosis ^[29]
Viral culture of blister fluid to rule out herpes virus infection
Erythrocyte sedimentation rate and antinuclear antibody, anti-Ro, and anti-La antibody tests to rule out bullous lupus erythematosus
Plasma or serum porphyrin assay to exclude cutaneous porphyrias
DNA repair studies to rule out xeroderma pigmentosum

Imaging Studies

Imaging studies are not routinely obtained as part of the workup of hydroa vacciniforme (HV).

Other Tests

Repetitive, broad-spectrum, UV-A phototesting may be warranted. Repetitive, broad-spectrum, low-dose UV-A irradiation can elicit lesions clinically and histologically identical to those produced by natural UV exposure, although results are inconsistent. The minimal erythemal dose of UV-B and UV-A in these patients is reduced.^[30]

Histologic Findings

Early lesions reveal an epidermal, multilocular vesicle with reticular degeneration and demonstrate EBV RNA (EBER positive) in lymphocytes.^[31] A dense, perivascular, lymphohistiocytic infiltrate with vessel hemorrhage may occur in the dermis. Late lesions show epidermal and dermal necrosis with a surrounding, chronic, inflammatory infiltrate. Direct immunofluorescence study results are usually normal, except for rare reports (2 patients) of C3 deposits at the dermoepidermal junction and in the small dermal vessels.

Treatment & Management

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Media Gallery

Characteristic vesicular lesions occur on sun-exposed skin and heal with varioliform scarring.

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Author

Gregory Toy, MD Resident Physician, Department of Internal Medicine, University of Utah School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Marjon Vatanchi, MD Board Certified Dermatologist, Board Certified Micrographic Dermatologic Surgeon

Marjon Vatanchi, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Dermatologic Society of Greater New York, Medical Dermatology Society, National Psoriasis Foundation, New England Dermatological Society, Society for Pediatric Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Jeannette Rachel Jakus, MD, MBA Clinical Assistant Professor, Director of Clinical Research, Assistant Program Director, Department of Dermatology, SUNY Downstate Medical Center; Dermatologist, Brody Dermatology

Jeannette Rachel Jakus, MD, MBA is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, American Skin Association, Society for Pediatric Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Maureen B Poh-Fitzpatrick, MD Professor Emerita of Dermatology and Special Lecturer, Columbia University College of Physicians and Surgeons

Maureen B Poh-Fitzpatrick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, New York Dermatological Society

Disclosure: Nothing to disclose.

Quynh L Sebastian, MD Clinical Instructor, Division of Dermatology, UCLA David Geffen School of Medicine

Quynh L Sebastian, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Raul Del Rosario, MD Consulting Staff, Dermatopathology, Mission Hospital at Laguna Beach

Raul Del Rosario, MD is a member of the following medical societies: American Society for Clinical Pathology

Disclosure: Nothing to disclose.

Hydroa Vacciniforme Workup

Laboratory Studies

Imaging Studies

Other Tests

Histologic Findings

References

Tables

Contributor Information and Disclosures

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