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)

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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)

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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)

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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)

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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.

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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.

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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.