Sections

Medication

Medication Summary

The goals of pharmacotherapy in Kaposi varicelliform eruption (KVE) are to reduce morbidity and to prevent complications.

Class Summary

Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit HSV DNA polymerase with 30-50 times the potency of human alpha-DNA polymerase.

Acyclovir (Zovirax)

View full drug information

Acyclovir is indicated in genital herpes simplex, mucocutaneous herpes simplex in immunocompromised patients, herpes zoster, recurrent herpes simplex labialis, and varicella. It is a synthetic acyclic guanosine analogue that inhibits viral DNA polymerase. Acyclovir remains the treatment of choice for KVE. Systemic and/or topical antibiotics can be used for secondary bacterial infections.

Foscarnet (Foscavir)

View full drug information

Foscarnet is for immunocompromised hosts with HSV infection and acyclovir-resistant HSV infection. It inhibits viral replication at the 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.

Trifluridine (Viroptic)

View full drug information

Trifluridine is approved for use in ophthalmic herpes simplex, primary keratoconjunctivitis, and recurrent epithelial keratitis due to HSV types 1 and 2. It inhibits viral replication by incorporating into viral DNA in place of thymidine. If no response occurs in 7-14 days, consider other treatments.

Valacyclovir (Valtrex)

View full drug information

Valacyclovir is prodrug that is rapidly converted to the active drug acyclovir. It is more expensive but has a more convenient dosing regimen than acyclovir.

Zhuang K, Wu Q, Ran X, Ran Y, Ding L, Xu X, et al. Oral treatment with valacyclovir for HSV-2-associated eczema herpeticum in a 9-month-old infant: A case report. Medicine (Baltimore). 2016 Jul. 95 (29):e4284. [QxMD MEDLINE Link].
Lee EJ, Yoon YJ. A case of generalized varicelliform eruption after herpes zoster oticus. Otol Neurotol. 2014 Jan. 35(1):e57-9. [QxMD MEDLINE Link].
Xu XL, Huang YX, Lin L, Zhang ML, Jiang YQ, Sun JF. Bullous mycosis fungoides: report of a case complicated by Kaposi's varicelliform eruption. J Dermatol. 2013 Oct. 40(10):844-7. [QxMD MEDLINE Link].
Molinelli E, Ricotti F, Campanati A, Cataldi I, Ganzetti G, Liberati G, et al. Kaposi-Juliusberg varicelliform eruption in patients suffering from Darier-White Disease: a case report and review of the literature. G Ital Dermatol Venereol. 2016 Oct. 151 (5):558-61. [QxMD MEDLINE Link].
Beck LA, Boguniewicz M, Hata T, et al. Phenotype of atopic dermatitis subjects with a history of eczema herpeticum. J Allergy Clin Immunol. 2009 Aug. 124(2):260-9, 269.e1-7. [QxMD MEDLINE Link].
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. 2009 Sep 1. 106(35):14954-9. [QxMD MEDLINE Link]. [Full Text].
Howell MD, Gallo RL, Boguniewicz M, et al. Cytokine milieu of atopic dermatitis skin subverts the innate immune response to vaccinia virus. Immunity. 2006 Mar. 24(3):341-8. [QxMD MEDLINE Link].
Darling AR, Freyschmidt EJ, Burton OT, Koleoglou KJ, Oyoshi MK, Oettgen HC. IL-10 suppresses IL-17-mediated dermal inflammation and reduces the systemic burden of Vaccinia virus in a mouse model of eczema vaccinatum. Clin Immunol. 2014 Feb. 150 (2):153-60. [QxMD MEDLINE Link].
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. 2009 Jun 8. 206(6):1219-25. [QxMD MEDLINE Link]. [Full Text].
Howell MD, Wollenberg A, Gallo RL, et al. Cathelicidin deficiency predisposes to eczema herpeticum. J Allergy Clin Immunol. 2006 Apr. 117(4):836-41. [QxMD MEDLINE Link]. [Full Text].
Peng WM, Jenneck C, Bussmann C, et al. Risk factors of atopic dermatitis patients for eczema herpeticum. J Invest Dermatol. 2007 May. 127(5):1261-3. [QxMD MEDLINE Link].
Kramer SC, Thomas CJ, Tyler WB, Elston DM. Kaposi's varicelliform eruption: a case report and review of the literature. Cutis. 2004 Feb. 73(2):115-22. [QxMD MEDLINE Link].
Gao PS, Rafaels NM, Hand T, et al. Filaggrin mutations that confer risk of atopic dermatitis confer greater risk for eczema herpeticum. J Allergy Clin Immunol. 2009 Sep. 124(3):507-13, 513.e1-7. [QxMD MEDLINE Link].
Rinaldo CR Jr, Torpey DJ 3rd. Cell-mediated immunity and immunosuppression in herpes simplex virus infection. Immunodeficiency. 1993. 5(1):33-90. [QxMD MEDLINE Link].
Bin L, Howell MD, Kim BE, Streib JE, Hall CF, Leung DY. Specificity protein 1 is pivotal in the skin's antiviral response. J Allergy Clin Immunol. 2011 Feb. 127(2):430-438.e1-2. [QxMD MEDLINE Link].
Bin L, Edwards MG, Heiser R, Streib JE, Richers B, Hall CF, et al. Identification of novel gene signatures in patients with atopic dermatitis complicated by eczema herpeticum. J Allergy Clin Immunol. 2014 Oct. 134 (4):848-55. [QxMD MEDLINE Link].
Lehman JS, el-Azhary RA. Kaposi varicelliform eruption in patients with autoimmune bullous dermatoses. Int J Dermatol. 2016 Mar. 55 (3):e136-40. [QxMD MEDLINE Link].
Mathias RA, Weinberg A, Boguniewicz M, Zaccaro DJ, Armstrong B, Schneider LC, et al. Atopic dermatitis complicated by eczema herpeticum is associated with HLA B7 and reduced interferon-γ-producing CD8+ T cells. Br J Dermatol. 2013 Sep. 169 (3):700-3. [QxMD MEDLINE Link].
Gao PS, Leung DY, Rafaels NM, Boguniewicz M, Hand T, Gao L, et al. Genetic variants in interferon regulatory factor 2 (IRF2) are associated with atopic dermatitis and eczema herpeticum. J Invest Dermatol. 2012 Mar. 132(3 Pt 1):650-7. [QxMD MEDLINE Link]. [Full Text].
Howell MD, Gao P, Kim BE, Lesley LJ, Streib JE, Taylor PA, et al. The signal transducer and activator of transcription 6 gene (STAT6) increases the propensity of patients with atopic dermatitis toward disseminated viral skin infections. J Allergy Clin Immunol. 2011 Nov. 128(5):1006-14. [QxMD MEDLINE Link]. [Full Text].
De Benedetto A, Slifka MK, Rafaels NM, Kuo IH, Georas SN, Boguniewicz M, et al. Reductions in claudin-1 may enhance susceptibility to herpes simplex virus 1 infections in atopic dermatitis. J Allergy Clin Immunol. 2011 Jul. 128(1):242-246.e5. [QxMD MEDLINE Link]. [Full Text].
Bin L, Malley C, Taylor P, et al. Whole genome sequencing identifies novel genetic mutations in patients with eczema herpeticum. Allergy. 2021 Aug. 76 (8):2510-2523. [QxMD MEDLINE Link]. [Full Text].
de Aquino Paulo Filho T, deFreitas YK, da Nóbrega MT, Lima CB, Carriço BL, Silva MA, et al. Hailey-Hailey disease associated with herpetic eczema-the value of the Tzanck smear test. Dermatol Pract Concept. 2014 Oct. 4 (4):29-31. [QxMD MEDLINE Link].
Russo R, Labate L, Cozzani E, et al. Kaposi-Juliusberg Varicelliform Eruption complicating Darier disease: May cannabinoid abuse be an underestimated risk factor?. Clin Case Rep. 2021 Aug. 9 (8):e04589. [QxMD MEDLINE Link]. [Full Text].
Monsalvez V, Polo I, Fuertes L, Zarco C, Vanaclocha F. [Eczema herpeticum in cutaneous T-cell lymphomas]. Actas Dermosifiliogr. 2009 Jun. 100(5):431-3. [QxMD MEDLINE Link].
Furuya K, Takemoto Y, Kurahashi H, et al. Eczema herpeticum subsequent to septic shock in early pregnancy: a first case report. BMC Infect Dis. 2021 Dec 14. 21 (1):1247. [QxMD MEDLINE Link]. [Full Text].
Schlievert PM, Roller RJ, Kilgore SH, et al. Staphylococcal TSST-1 Association with Eczema Herpeticum in Humans. mSphere. 2021 Aug 25. 6 (4):e0060821. [QxMD MEDLINE Link]. [Full Text].
Hong S, Kim EH, Cho SB, Rha SY. Kaposi's Varicelliform-Like Eruption in a Patient Treated with Everolimus for Metastatic Renal Cell Carcinoma: Report of a Rare Case. Case Rep Oncol. 2014 May. 7(2):337-42. [QxMD MEDLINE Link]. [Full Text].
Ajith C, Dogra S, Handa S. Kaposi's varicelliform eruption in a patient with phenytoin-induced drug rash. Int J Dermatol. 2006 Dec. 45 (12):1452-3. [QxMD MEDLINE Link].
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. 2009 Jun 8. 206(6):1219-25. [QxMD MEDLINE Link]. [Full Text].
Hsu DY, Shinkai K, Silverberg JI. Epidemiology of eczema herpeticum in hospitalized US children: Analysis of a nationwide cohort. J Invest Dermatol. 2017 Sep 16. [QxMD MEDLINE Link].
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. 2003 Aug. 49(2):198-205. [QxMD MEDLINE Link].
Wheeler CE Jr, Abele DC. Eczema herpeticum, primary and recurrent. Arch Dermatol. 1966 Feb. 93(2):162-73. [QxMD MEDLINE Link].
Lubbe 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. 2003 May. 139(5):670-1. [QxMD MEDLINE Link].
Aronson PL, Yan AC, Mittal MK, Mohamad Z, Shah SS. Delayed acyclovir and outcomes of children hospitalized with eczema herpeticum. Pediatrics. 2011 Dec. 128(6):1161-7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Fivenson DP, Breneman DL, Wander AH. Kaposi's varicelliform eruption. Absence of ocular involvement. Arch Dermatol. 1990 Aug. 126(8):1037-9. [QxMD MEDLINE Link].
Shin D, Lee MS, Kim do Y, Lee MG, Kim DS. Increased large unstained cells value in varicella patients: A valuable parameter to aid rapid diagnosis of varicella infection. J Dermatol. 2015 Aug. 42 (8):795-9. [QxMD MEDLINE Link].

Media Gallery

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.

of 4

Author

David T Robles, MD, PhD, FAAD Director, Dermatology Division, Chaparral Medical Group

David T Robles, MD, PhD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Jacquiline Habashy, DO, MSc Resident Physician, Department of Dermatology, Western University of Health Sciences College of Osteopathic Medicine of the Pacific

Jacquiline Habashy, DO, MSc is a member of the following medical societies: American Osteopathic College of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

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, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

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, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Acknowledgements

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.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Disclosure: Nothing to disclose.

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.

Jeffrey K McKenna, MD Associate, Mohs Surgeon, Soderstrom Dermatology Center, SC

Disclosure: Nothing to disclose.

Kaposi Varicelliform Eruption Medication

Medication Summary

Antivirals

Class Summary

Acyclovir (Zovirax)

Acyclovir (Zovirax)

Foscarnet (Foscavir)

Foscarnet (Foscavir)

Trifluridine (Viroptic)

Trifluridine (Viroptic)

Valacyclovir (Valtrex)

Valacyclovir (Valtrex)

Kaposi Varicelliform Eruption Medication

Medication Summary

Antivirals

Class Summary

Acyclovir (Zovirax)

Acyclovir (Zovirax)

Foscarnet (Foscavir)

Foscarnet (Foscavir)

Trifluridine (Viroptic)

Trifluridine (Viroptic)

Valacyclovir (Valtrex)

Valacyclovir (Valtrex)

References

Tables

Contributor Information and Disclosures

What would you like to print?