Kaposi Varicelliform Eruption Differential Diagnoses

Updated: Dec 13, 2017
  • Author: David T Robles, MD, PhD, FAAD; Chief Editor: William D James, MD  more...
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DDx

Diagnostic Considerations

Also consider varicella-zoster virus and eczema vaccinatum.

In 2004, recognizing a need for greater understanding of the increased risk of disseminated viral infections in patients with atopic dermatitis (AD), the National Institute of Allergy and Infectious Disease developed the Atopic Dermatitis and Vaccinia Network (ADVN) to address the risk for eczema vaccinatum in patients with AD who are exposed to vaccinia virus (smallpox vaccine). This may occur either through vaccination of atopic individuals (which is contraindicated) or, more likely, as a consequence of inadvertent exposure from close contact with someone recently vaccinated.

A focus of the ADVN has been to develop a registry of patients with AD and eczema vaccinatum and to study whether these patients may have a unique phenotype, recognizable by clinical and/or laboratory findings.

This goal was accomplished when analysis of registry findings determined that patients with AD who had a prior history of eczema herpeticum (EH) demonstrated more severe atopic disease with a greater Th-2 cytokine predominance. In addition, these patients had greater allergen sensitization, greater frequency of food allergy and/or asthma, and had a much higher frequency of cutaneous infections with pathogens such as Staphylococcus aureus or molluscum contagiosum. [4]

Should the need for obligatory smallpox vaccination arise from a threat of bioterrorism, it is essential that medical personnel be able to more accurately recognize patients most at risk for eczema vaccinatum due to the significant associated morbidity and mortality.

Because of the risk for eczema vaccinatum, the US Department of Health and Human Services recommends that patients with AD avoid contact with recent vaccinees and not receive vaccinia immunization.

Differential Diagnoses