What is Kaposi Varicelliform Eruption?
Kaposi varicelliform eruption, also known as eczema herpeticum, is a widespread skin infection caused by a virus that usually results in localized, blister-like outbreaks in a person with an existing skin disease. Despite being uncommon, it can be extremely dangerous, even life-threatening. The prime cause is the herpes simplex virus.
This condition is most often seen in people with atopic dermatitis, which is a type of skin inflammation often colloquially referred to as eczema. However, it has also been observed in people with other skin conditions such as pemphigus foliaceus, ichthyosis vulgaris, bullous pemphigoid, Darier disease, Grover disease, Hailey-Hailey disease, dyskeratosis follicularis, mycosis fungoides, Sezary syndrome, psoriasis, pityriasis rubra pilaris, rosacea, seborrheic dermatitis, contact dermatitis, burns, and skin grafts.
Clinical features of Kaposi varicelliform eruption include widely scattered clusters of dimpled blisters and pus-filled spots that develop into crusted skin sores. The body parts most often affected are the trunk, neck, and head. Diagnosis is mainly based on the physical symptoms shown by the patient.
If there is some doubt about the diagnosis, a Tzanck smear (a test where cells are scraped from a blister and examined), viral cultures, skin biopsy, or detection of viral DNA through Polymerase Chain Reaction (a technique used to amplify small segments of DNA) might be useful. Antiviral therapy has proven to be an effective treatment, but it should be started as soon as possible after diagnosis to reduce the chance of serious health problems and death.
What Causes Kaposi Varicelliform Eruption?
Kaposi varicelliform eruption, a type of skin rash, is mainly caused by a virus called herpes simplex virus type 1. However, other viruses can also cause this rash including herpes simplex virus type 2, Coxsackie A16, vaccinia (a virus used in smallpox vaccines), varicella zoster (the virus that causes chickenpox and shingles), and smallpox.
Risk Factors and Frequency for Kaposi Varicelliform Eruption
Kaposi varicelliform eruption is a rare skin disorder that was first identified in 1887 by a person named Moritz Kaposi. It’s seen more often in children because it’s linked with a skin condition called atopic dermatitis. Still, there have been reported cases in adults. We don’t have an exact number of how often it occurs because it’s a rare condition and there haven’t been many large studies on it. This condition doesn’t favor any gender or ethnicity; it affects men and women equally and occurs in all ethnic groups.
herpeticum, refers to a disseminated skin infection due to a virus that usually
leads to localized vesicular eruptions that occur in a patient with an
underlying cutaneous disease. Although rare, it is a potentially
life-threatening disorder. Herpes simplex virus is considered the primary
causative agent.
Signs and Symptoms of Kaposi Varicelliform Eruption
Kaposi varicelliform eruption is a skin condition that appears suddenly as painful clusters of sores and bumps filled with pus (vesicles and pustules). Over time, the sores might become crusted, filled with blood, or even resemble eroded skin. These sores can grow larger and join together to create large areas of raw skin that are more susceptible to bacterial infection.
The location of the sores often shows where there was previous skin damage, as the eruption typically starts in areas with pre-existing skin conditions. This can sometimes lead to delayed diagnosis, as the eruption may be mistaken for the pre-existing condition.
Kaposi varicelliform eruption can also be accompanied by other body-wide symptoms, such as:
- Feeling unwell (malaise)
- High temperature (fever)
- Swollen lymph nodes
In some cases, the illness can even affect various organs, including:
- The brain and spinal cord (central nervous system)
- Liver
- Lungs
- Digestive system (gastrointestinal tract)
- Adrenal glands (small glands that produce hormones).
Testing for Kaposi Varicelliform Eruption
If your doctor suspects you might have an outbreak of a skin condition called Kaposi varicelliform eruption, they will primarily base this diagnosis on a thorough physical examination of your skin. However, to help make a more informed diagnosis, several lab tests might also be carried out.
One such test is a Tzanck smear, where a scraping from the bottom of a fluid-filled bump, or vesicle, is taken and stained with a dye, called Wright-Giemsa stain. This process often reveals the presence of large cells with multiple nuclei, acting as an indicator of the disease. This test is cost effective, straightforward to conduct, and can give results very quickly. However, it does have a couple of limitations. Firstly, the test is not always able to detect the disease, making it less reliable. Secondly, it can’t tell the difference between different types of herpes simplex viruses, nor can it distinguish between herpes and a condition called varicella-zoster virus.
If the results from the Tzanck smear are not clear, your doctor might order alternative tests such as a viral culture or direct fluorescence antibody staining on the Tzanck smear. These are currently the most accurate techniques to identify herpes simplex viruses.
In case your skin lesions are not typical, unclear, or old, there may be a need for a skin biopsy or a test called polymerase chain reaction (PCR). PCR testing basically looks for the presence of the virus’s DNA. Finally, a histological examination, which is a microscopic study of your tissue sample, might be ordered. This may confirm a diagnosis that might not have been considered initially based on your clinical examination.
Treatment Options for Kaposi Varicelliform Eruption
Kaposi varicelliform eruption is a serious skin condition that requires immediate treatment due to its potential to become a life-threatening disease. Antiviral medications are usually effective in reducing the harm caused by the disease and preventing further complications.
Nucleoside analogs are a common type of antiviral medication used in this situation. They work by blocking the process that viruses use to copy their DNA, which stops them from spreading.
Acyclovir is the most frequently used drug to treat Kaposi varicelliform eruption. This drug is often given at high doses through an IV, because it’s important to control the disease quickly. Most patients see the skin lesions clear up over a period of a few days.
To prevent an additional bacterial infection from developing, doctors usually recommend taking systematic antibiotics, which are drugs designed to kill bacteria or slow their growth, as a preventive measure.
What else can Kaposi Varicelliform Eruption be?
Kaposi varicelliform eruption is a skin condition that can sometimes be mistaken for other skin problems. Some of the conditions that it can be confused with are:
- Chickenpox
- Impetigo
- Allergic contact dermatitis
What to expect with Kaposi Varicelliform Eruption
Kaposi varicelliform eruption is a serious skin condition which can potentially have deadly consequences. This condition can occur either as a first-time infection or a repeat infection.
The first-time infection usually affects children, spreading widely across their body. It’s often associated with widespread symptoms and serious complications like bacterial sepsis (an extreme response by the body to a bacterial infection), viremia (presence of viruses in the blood), and multiple organ involvement. The recurring infection usually happens in adults with a milder form, more localized on the body and typically does not involve viruses in the bloodstream.
There’s also a higher risk of serious health complications when the skin lesions (damaged parts of the skin) get secondary bacterial infections which can make the disease worse and increase the chances of death. Some frequently seen bacteria in patients with Kaposi varicelliform eruption are Staphylococcus aureus, group A beta-hemolytic streptococcus, Peptostreptococcus, and Pseudomonas aeruginosa.
When the condition, associated with a herpes simplex virus, impacts the face, it could affect eyes too. Eye-related complications can include uveitis (inflammation of the middle layer of the eye), conjunctivitis (often called “pink eye,” an inflammation of the tissue covering the front of the eye), keratitis (inflammation of the clear front surface of the eye), and blepharitis (inflammation of the eyelids).
The most serious eye consequence is herpetic keratitis, which may lead to loss of vision resulting from scarring on the clear, front surface of the eye (cornea).