Kaposi Varicelliform Eruption: An Overview

What Is Kaposi Varicelliform Eruption?

Kaposi varicelliform eruption, also called eczema herpeticum, is a disseminated skin infection caused by the herpes simplex virus. Kaposi varicelliform eruption was initially thought to be secondary to a fungal infection. However, later the finding of cytoplasmic inclusion bodies in the histological examination indicated a viral origin.

It mainly occurs in people with atopic dermatitis or eczema (an inflammatory skin disorder characterized by skin dryness and itching). However, it is thought to be associated with other skin conditions, including Hailey-Hailey disease, pemphigus foliaceus, ichthyosis vulgaris, bullous pemphigoid, Darier disease, dyskeratosis follicularis, mycosis fungoides, psoriasis, pityriasis rubra pilaris, rosacea, Sezary syndrome, seborrheic dermatitis, contact dermatitis, second-degree burns, and skin grafts. Although rare, it is a potentially life-threatening condition.

What Causes Kaposi Varcelliform Eruption?

Kaposi varicelliform eruption is mainly caused by direct contact with herpes simplex virus (HSV) type 1. However, other viral agents like herpes simplex virus type 2, vaccinia, varicella zoster, Coxsackie A16, and smallpox can also be involved in pathogenesis. Often, Kaposi varicelliform eruption presents 5 to 12 days after the first contact with the herpes simplex virus.

What Are the Risk Factors for Kaposi Varicelliform Eruption?

The risk factors for Kaposi varicelliform eruption are listed below:

• Non-eczematous disorders that disrupt the continuity of the skin can increase a person's vulnerability to localized herpes infections. These skin conditions include burns, irritant contact dermatitis, environmental changes or exposure to chemicals, Hailey-Hailey disease (a rare genetic disease typically presents with blisters and erosions near skin folds), and Darier disease (a rare inherited disease that causes dry, crusted papules, or small elevations of the skin, to form under the breasts or on the neck).

• Topical creams such as Tacrolimus and Pimecrolimus may alter the skin's immune system.

• Kaposi varicelliform eruption can occur less commonly in people with psoriasis treated with immunosuppressive medications.

How Common Is Kaposi Varicelliform Eruption?

Kaposi varicelliform eruption is a rare disease first described in 1887 by Moritz Kaposi. It most often affects infants and children, but people of all ages can develop this condition. The condition's incidence is not precisely known due to its rarity and the need for large case series. The disease affects men and women equally without specific ethnic predominance.

Is Kaposi Varicelliform Eruption Contagious?

Eczema herpeticum is a highly contagious skin infection that can transmit through direct skin-to-skin contact with an infected person, even if the infected person does not have a current outbreak. In addition, infected people can infect other body parts through self-infection or autoinoculation.

What Are the Clinical Features of Kaposi Varicelliform Eruption?

Kaposi varicelliform eruption begins with clusters of itchy and painful blisters. It may affect any site, but the most frequently involved locations are the trunk, neck, and head. Blisters can occur in normal skin or areas actively or previously affected by atopic dermatitis or other skin conditions. It may take up to two weeks for symptoms to appear after the first contact with the herpes simplex virus. Various symptoms are listed below:

Skin Manifestations of Kaposi Varicelliform Eruption Include:

• Monomorphic blisters (blisters appearing similar to each other).

• Blisters often appear red, purple, or black.

• Blisters filled with clear yellow fluid or thick purulent material. They ooze-filled when broken open.

• A cluster of small blisters that are itchy and painful.

• Blisters may weep or bleed.

• New blisters with central dimples (umbilication).

• Older blisters may crust over and form sores.

Systemic Symptoms of Kaposi Varicelliform Eruption Include:

• High-grade fever and chills.

• Malaise.

• Swollen lymph glands.

• Overall not feeling well.

• Secondary bacterial infection with Staphylococci or Streptococci may result in impetigo and cellulitis.

In addition, Kaposi varicelliform eruption can be complicated by multiple organ involvements, including the brain, eyes, liver, lungs, gastrointestinal tract, and adrenal glands. However, it can rarely be fatal.

How Is Kaposi Varicelliform Eruption Diagnosed?

Because Kaposi varicelliform eruption is potentially severe, it is essential to see a healthcare professional if one experiences symptoms. The diagnosis of Kaposi varicelliform eruption is based mainly on a clinical examination, although several laboratory tests can be helpful, including:

• Tzanck Smear: It involves scraping the floor of an opened blister and staining the material with Wright-Giemsa stain, demonstrating multinucleated giant cells. It is an inexpensive, reliable, easily applicable, and quick technique to perform. It can also confirm the diagnosis of Kaposi varicelliform eruption and distinguish other potential diagnoses.

• Skin Biopsy: A skin biopsy or polymerase chain reaction (PCR) may be performed in case of atypical, equivocal, or old lesions.

Other viruses and bacteria can also cause similar-appearing skin lesions, so thorough examination and proper diagnostic testing of the person are necessary to receive an accurate diagnosis.

How Is Kaposi Varicelliform Eruption Treated?

Treatment for Kaposi varicelliform eruption should start as soon as possible with no delay since it is a potentially life-threatening disease. The treatment often includes the following:

• Antiviral drugs are effective in reducing morbidity and preventing complications. Nucleoside analogs are the most commonly used antiviral agents, inhibiting viral (deoxyribonucleic acid) DNA replication.

• Oral antiviral drugs, such as Acyclovir or Valacyclovir, are widely prescribed to reduce the risk of complications and prevent progression to severe disease. High-dose intravenous Acyclovir is often required for disease control.

• Most mild cases can be successfully treated with oral antiviral medications within 7-21 days.

• Additional treatment depends on the severity of the lesions. In severe cases, particularly when the person's immune system is weakened due to other conditions (human immunodeficiency virus or HIV, prolonged diabetes, leukemia, undernutrition) or specific treatments (corticosteroids and other immunosuppressant medications, chemotherapy, radiation therapy), hospitalization should be considered for intravenous (IV) administration of the antiviral medication and supportive care of other symptoms.

• Prophylactic treatment with systemic antibiotics is recommended to prevent secondary bacterial infection.

• Critically ill people may need additional fluids, pain relievers, and wound care to help with healing. Furthermore, individuals must be monitored for the development of secondary bacterial infection; if infection occurs, they may need treatment with systemic antibiotics.

How Is Kaposi Varicelliform Eruption Prevented?

Individuals with Kaposi varicelliform eruption should be educated about self-infection to prevent the spread of the infection. In addition, preventive measures, such as wearing gloves and frequently washing hands, are often recommended when herpes simplex infections are suspected.

Conclusion

Kaposi varicelliform eruption is a disseminated viral skin infection usually characterized by localized vesicular eruptions. The herpes simplex virus mainly causes it, particularly type 1 (HSV-1). The disease is highly contagious among both symptomatic and asymptomatic people. Therefore, seeing a healthcare professional is vital if one experiences symptoms. Treatment of Kaposi varicelliform eruption must be initiated with no delay since it is a life-threatening disease. Treatment generally involves antiviral medication, administered in doses depending on the severity of the case.