Kaposi's herpetic eczema

Many dermatologists consider Kaposi's herpetic eczema (synonyms: Kaposi's syndrome, varicelliform rash, acute varicelliform pustulosis, acute vacciniform pustulosis) to be the result of the herpes virus joining a chronic dermatosis, most often diffuse neurodermatitis. In this case, disseminated skin lesions occur in the form of vesicles and erosions. Kaposi's herpetic eczema can be a manifestation of both primary herpes and its relapse.

Causes and pathogenesis of Kaposi's herpetic eczema

Etiological factors may be herpes simplex virus type I, less commonly herpes simplex virus type II.

Children become infected through contact with parents suffering from herpes of the face and mouth. Risk factors include diffuse neurodermatitis, especially complicated by exfoliative erythroderma. Much less frequently, herpetic Kaposi's eczema occurs in Darier's disease, thermal burns, pemphigus, bullous pemphigoid, ichthyosis vulgaris, mycosis fungoides, and Wiskott-Aldrich syndrome.

Symptoms of Kaposi's Herpetic Eczema

Herpetic Kaposi's eczema develops acutely, accompanied by high temperature (39-40°) with a severe general condition. On the skin altered by eczema and neurodermatitis, as well as on other edematous-erythematous areas (usually on the face, neck, chest, hands, forearms, etc.) there appear grouped abundant blisters the size of a millet grain to a lentil, quickly turning into pustules with a characteristic umbilical depression in the center and resembling chickenpox. As a result of the opening of the blisters, erosions with polycyclic outlines appear, covered with yellow-brown crusts, after which pink spots or secondary pigmentation remain, extremely rarely - superficial scars. With herpetic eczema, lesions of the mucous membrane of the oral cavity, conjunctiva and cornea are observed. Sometimes the disease is severe, with symptoms of meningitis, complicated by pneumonia and otitis, which leads to death.

Histopathology. The lesion shows vesiculopustules in the epidermis, ballooning degeneration of epithelial cells, and accumulation of neutrophilic leukocytes. Giant multinucleated cells and intracellular inclusions are found.

Differential diagnosis. The disease should be distinguished from chickenpox, vaccinia, pyoderma.

Treatment of Kaposi's herpetic eczema

Antibiotics, sulfonamides, corticosteroids, interferon (parenterally), antihistamines, tonics, and vitamins are prescribed for treatment. Of the antiviral drugs, acyclovir (ulkaril, gerpevir, etc.) is often used orally for 7 days. In severe cases (usually with primary infection), acyclovir is administered intravenously at a dose of 1.5 kg / day. The bioavailability of valacyclovir when taken orally is 4-6 times higher than that of acyclovir. In mild cases, antiviral drugs can be avoided. In case of superinfection caused by Staphylococcus aureus, erythromycin or other antibiotics are prescribed. Castellani's solution, ointments with antibiotics (heliomycin, lincomycin, etc.) are used externally. Patients should be isolated. In order to prevent viral complications, children suffering from itching; dermatoses, should not come into contact with people sick with herpes who have been vaccinated against smallpox.

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