Granulomatous folliculitis at sites of herpes zoster scars: Wolf''s isotopic response

Cutaneous eruptions described on herpes zoster scars are variable. We present a case of granulomatous folliculitis occurring 4 weeks after an episode of herpes zoster infection in a woman with cutaneous T-cell lymphoma. The pathogenesis of the lesions remains unclear. The viral genome was detected only in early lesions.     

Successful differentiation of herpes zoster‐associated erythema multiforme from generalized extension of herpes by rapid polymerase chain reaction analysis

The polymerase chain reaction (PCR) assay for varicella zoster virus (VZV), herpes simplex virus (HSV)‐1 and HSV‐2 is available for use. Sometimes the differential diagnosis of the generalized herpes zoster (HZ), HSV1/2, and drug eruption is difficult. We report a case of HZ followed by the vesicular erythema multiforme (EM)‐like lesion. In this case the use of PCR was of great assistance. A 78‐year‐old Japanese man without any significant previous history of disease was admitted to our hospital complaining of zosteriform vesicle on an erythematous base from his right shoulder to the upper arm. We diagnosed him with HZ at the level of right Th2. In spite of the prompt start of antiviral therapy, a secondary new vesiculous erythema developed on his trunk. Clinically, it was quite difficult to differentiate the lesion from the generalized HZ. Rapid PCR assay of effusion and crust for VZV was performed. A PCR assay of VZV was positive for the crust taken from the primary lesion, while it was negative for the effusion and crust of the secondary widespread lesion. We diagnosed the secondary widespread lesion as an EM‐type drug eruption induced by acyclovir, or an EM associated with herpes zoster. We then stopped the use of acyclovir and applied steroid ointment of a very strong class for the secondary lesions, which improved after a few days. A PCR assay for VZV was useful for ruling out the generalized HZ in our case with secondary developed vesiculous lesions.     

Identification and characterization of 20 immunocompetent patients with simultaneous varicella zoster and herpes simplex virus infection

Background It has been shown that varicella zoster virus (VZV) and herpes simplex virus (HSV) can co‐localize to the same sensory ganglion. However, only a few case reports on VZV/HSV co‐infections exist. Objective To identify and characterize patients with concurrent VZV and HSV infection at the same body site. Subjects/Methods In 1718 patients, the presence of VZV and HSV in suspicious skin lesions was investigated by polymerase chain reaction analysis. Clinical characteristics of co‐infected patients were compared with matched control patients infected with either VZV or HSV. The data are discussed in the context of an extensive review of the literature. Results Twenty (1.2%) of 1718 patients were infected with both VZV and HSV at the same body site. The mean age was 54 years (range, 2–83). The clinical diagnosis was zoster in 65%, herpes simplex in 20%, varicella in 10% and erythema multiforme in 5% of cases. The trigeminus region was affected in 60% and the trunk in 25%. Involvement of the head was most commonly associated with a severe course of disease and with older age. Conclusion Simultaneous VZV/HSV infection is rare but can occur in immunocompetent patients, which is often overlooked. The majority of cases is localized to the trigeminus region and affects elderly people.     

Granulomatous folliculitis as a manifestation of post-herpetic isotopic response

We report a case of postherpetic granulomatous folliculitis in a 52-year-old female. The several cutaneous granulomatous eruptions following herpes zoster reported in the literature include annular, sarcoid and tuberculoid granuloma, granulomatous vasculitis and granulomatous folliculitis. The mechanism of granuloma formation is probably triggered by a delayed hypersensitivity response to the virus.     

Annual pattern and clinical characteristics of herpes zoster in immunocompetent children in a rural area

This study aims to investigate the clinical signs, symptoms, complications and seasonal distribution of herpes zoster for otherwise healthy children and to demonstrate the outcome of varicella vaccinations on the herpes zoster incidence in a pediatric population. A retrospective study was conducted by using the data of the pediatric patients who were referred to two rural cities of Turkey, clinically diagnosed as Herpes Zoster (HZ). All participants were evaluated for clinical‐epidemiological factors, signs, symptoms, complications and varicella vaccination status for HZ. This study was comprised of 69 pediatric patients (29 [42%] female and 40 [58%] male) who were diagnosed with HZ. The mean age was 10.57 (6 months‐17) years old. The rash of HZ mostly appeared on the thoracic dermatome as seen in 29 patients. The findings revealed that among 56 unvaccinated patients of all, 25 (44.6%) had a painful rash, in comparison among vaccinated patients none reported pain as the characterization of shingles (P = .001). Annual distribution of cases showed two peaks (March and September), whereas in August no cases were detected. Of all participants, one patient had postherpetic neuralgia, who also had ophthalmic dermatomal involvement, and this was the only complication observed in this study cohort. In immunocompetent children, the most common involvement site was the thoracic dermatome. Our findings show that varicella vaccination has a protective role in the herpes zoster clinic, both by decreasing the prevalence and by making the infection course less severe.     

Folliculitis decalvans including tufted folliculitis: clinical, histological and therapeutic findings

In a series of 18 patients with folliculitis decalvans attending the Oxford hair clinic, eight were found to have areas of tufted folliculitis either at presentation or follow-up. There was no difference between these two groups in their presentation, clinical course, growth of causative organism (Staphylococcus aureus) or investigations including histology. We suggest that these two entities form part of a spectrum of a single disease. We performed lymphocyte staining on affected scalp biopsies, including CD4: CD8 and T-cell/B-cell ratios, but found no evidence of local immune suppression or failure which would explain the abnormal host response to a common pathogen in this rare condition. We introduced a new treatment regimen for these patients, oral rifampicin and oral clindamycin together for 10 weeks. Ten of the 18 patients have responded well with no evidence of recurrence 2-22 months after one course of treatment, and 15 of the 18 responded after two or three courses.     

玫瑰糠疹与人类疱疹病毒-7型关系的研究

目的探讨玫瑰糠疹(PR)与人类疱疹病毒-7型(HHV-7)的关系。方法采用巢式PCR检测了22例PR急性期患者的血浆、外周血单核细胞(PBMC)、皮损、唾液、尿液,14例恢复期患者的唾液、血浆、外周血单核细胞,14例正常人的唾液、血浆、外周血单核细胞中的HHV-7特异性序列。结果急性期唾液与单核细胞中HHV-7DNA检出率(95.5%,45.4%)明显高于正常人(64.3%,21.4%),唾液中HHV-7DNA检出率亦明显高于恢复期(57.1%),但单核细胞中HHV-7DNA检出率与恢复期(28.6%)无明显差异。8例皮损组织(36.4%)检测到HHV-7DNA。1例血浆中检测到HHV-7DNA(4.54%),其外周血单核细胞、皮损、唾液中亦均检测到HHV-7DNA,其恢复期唾液、单核细胞中HHV-7DNA仍可检测到。恢复期HHV-7DNA在唾液和单核细胞中的检出率与正常人无明显差别。结论有一部分玫瑰糠疹的发生可能与潜伏的HHV-7活化感染有关。     

Significance of monocytosis in varicella and herpes zoster.

Percent ratios and absolute numbers of peripheral blood monocytes in patients with varicella and herpes zoster were determined and compared with those in patients with herpes simplex virus infection, measles and rubella. Monocytosis during the acute stage (p less than 0.01) was statistically significant in varicella and generalized and localized herpes zoster, compared with the levels in herpes simplex virus infection, measles and rubella. Absolute monocyte counts in varicella and HZ were significantly increased (p less than 0.02) beyond those of measles and rubella. The high % ratios of monocytes in varicella and herpes zoster during the acute stage decreased to normal ranges with cure.     

Early diagnosis of herpes zoster by polymerase chain reaction

BACKGROUND: Herpes zoster is a common disease caused by the varicella-zoster virus. The use of virostatic agents as early as possible is necessary in shortening zoster-associated pain. OBJECTIVES: Rapid diagnosis is necessary for the optimal efficacy of antiviral therapy. The diagnosis in the early stage of infection is often difficult. METHODS: In the present study skin biopsies of patients with herpes zoster and unclear skin changes were analysed by detecting viral DNA using the polymerase chain reaction (PCR) in order to amplify open reading frames (ORF) 14, 29 and 63. RESULTS: Varicella-zoster virus DNA could be detected with PCR of all three ORF not only from blisters but also from erythematous skin. CONCLUSIONS: PCR is the method of choice for the viral diagnosis in herpes zoster before blister eruption.     

酶联免疫吸附试验在检测生殖器疱疹病毒抗原中的应用

目的探讨酶联免疫吸附试验(ELISA)检测泌尿生殖道分泌物及皮损中单纯疱疹病毒(HSV)抗原在临床中的应用价值.方法用聚合酶链反应(PCR)和ELISA方法检测泌尿生殖道及皮损中HSV DNA和HSV抗原,并对两种方法的检测结果进行比较.结果118例标本中,PCR检出41例阳性,ELISA 42例阳性.在118例标本中,111例两种方法结果相符,7例不相符合.PCR阳性的41例中,ELISA阳性38例(敏感性92.68%);PCR阴性的77例标本中,ELISA阳性4例(特异性94.81%).结论ELISA检测HSV抗原的方法可直接检测出泌尿生殖道及皮损中HSV病原体,从而为生殖器疱疹诊断提供准确的实验依据,其敏感性、特异性高,方便,快速,值得临床推广应用.     

Prolonged herpes zoster in a patient infected with the human immunodeficiency virus.

In 1983, varicella zoster virus (VZV) disease was first recognized in the context of infection with the human immunodeficiency virus (HIV). Since that time, there have been many reports discussing the occurrence and clinical manifestations of hepes zoster in HIV-infected patients. We describe the development of prolonged herpes zoster in a patient with acquired immunodeficiency syndrome (AIDS) over the course of 104 days. Viral isolates at the three different clinical stages of the skin lesions were sensitive in vitro to acyclovir, and supposed to be a same strain by polymerase chain reaction (PCR) analysis. We also discuss an effective treatment for prolonged cases of zoster.     

Clinical and histopathological differential diagnosis of eosinophilic pustular folliculitis

Eosinophilic pustular folliculitis (EPF) is an inflammatory disease characterized by repeated pruritic follicular papules and pustules arranged in arcuate plaques, and folliculotropic infiltration of eosinophils. The diagnosis of EPF is occasionally difficult and problematic because EPF may share the clinical appearance and histological findings with other diseases. Moreover, EPF has several clinical subtypes, including the classical type, infantile type and immunosuppression‐associated type. Because the therapies of EPF are relatively specific as compared to eczematous disorders, accurate diagnosis is essential for the management of EPF. Clinical differential diagnoses include tinea, acne, rosacea, eczematous dermatitis, granuloma faciale, autoimmune annular erythema, infestations and pustular dermatosis. Histologically, cutaneous diseases with eosinophilic infiltrates can be differentially diagnosed. Follicular mucinosis, mycosis fungoides and other cutaneous T‐cell lymphomas are the most important differential diagnoses both clinically and histopathologically. It should be kept in mind particularly that the initial lesions of cutaneous T‐cell lymphoma resemble EPF.     

生殖器疱疹HSV定量PCR检测及分析

目的:检测生殖器疱疹(GH)皮损的HSV含量并分析其与复发的关系。方法:用定量PCR技术检测96例临床诊断为GH的患者皮损标本中的HSV量。结果:HSV的阳性率为87.5％,男女性病例之间(2.7×109拷贝对2.1×108拷贝)、初发病例与复发病例之间(4.5×109拷贝对2.3×108拷贝),检出拷贝量的差别没有显著性意义(P>0.05),GH病人发作间歇期长短与检出的HSV拷贝量呈负相关(r=-0.728,P<0.01),病人病期、发疹天数、皮损数目与HSV拷贝量无明显相关关系(P值均大于0.05)。结论:通过定量PCR检测GH病人皮损中的HSV含量,可帮助判断预后并指导治疗。     

Relationship between prior knowledge about herpes zoster and the period from onset of the eruption to consultation in patients with herpes zoster

Herpes zoster (HZ) is a common internal infection caused by latent varicella zoster virus. Emergence of antiviral chemotherapy has changed the treatment of HZ dramatically, but the effects of such therapy are documented only in patients who started treatment within 72 h of HZ onset of the eruption. There have been few studies addressing the question of factors that determine early attendance of patients at a clinic. We questioned 256 patients with acute HZ about: (i) date from onset of the eruption to first clinic visit; and (ii) their prior knowledge of HZ. We found a tendency that patients who already knew about HZ had consulted dermatology clinics earlier (P < 0.05). People most commonly obtained information about the disease from friends and family members who had previously had HZ, but not from the Internet or other mass media. Our results indicate that patient education is important for early attendance at dermatology clinics, which in turn, should result in the improved outcome of antiviral chemotherapy and prevention of postherpetic neuralgia.     

生殖器疱疹患者尿道和宫颈HSV感染的研究

目的：了解生殖器疱疹（GH）患者伴发宫颈和男性尿道单纯疱疹病毒（HSV）感染情况，进一步探讨HSV和非淋菌性尿道炎／官颈炎（NGU）的关系。方法：用HSV聚合酶链反应（PCR）方法检测了56例GH患者的宫颈和男性尿道拭子标本。结果：56例患者中HSV PCR检测阳性共5例，阳性率为8．93％（5／56）。20例女性生殖器疱疹患者宫颈HSV PCR检测阳性率为25．0％（5／20）；36例男性GH患者尿道HSV PCR检测结果均为阴性。结论：生殖器疱疹患者伴发女性宫颈HSV感染更为常见，而伴发男性尿道HSV感染相对少见。HSV感染可能是非淋菌性尿道炎／宫颈炎的一个致病因子，在女性宫颈炎的发病中可能更有意义。     

Cutaneous larva migrans with folliculitis: a new clinical presentation of this infestation

Two patients (a 35-year-old woman and a 33-year-old man, just returned from trips to Jamaica and Barbados, respectively) presented with cutaneous larva migrans with folliculitis, a rare and atypical clinical presentation of this infestation. Histopathological examination revealed a follicular and perifollicular infiltrate prevalently consisting of lymphocytes and neutrophils, with numerous eosinophils. Both patients were successfully treated with oral albendazole.     

Extramammary Paget's disease with superimposed herpes simplex virus infection: immunohistochemical comparison with cases of the two respective diseases

We describe an extremely rare case of genital Paget's disease with superimposed herpes simplex virus (HSV) infection. We also describe immunohistochemical comparison of this lesion with 19 cases of genital Paget's disease and 12 cases of skin lesions caused by HSV or varicella-zoster virus. The Paget cells expressed simple epithelial keratins (CK7 and CK19) and carcinoembryonic antigen (CEA), but did not express stratified epithelial keratins (CK1, CK2e, CK10, CK5/8, CK14). Conversely, the virus-infected keratinocytes were positive for stratified epithelial keratins but negative for simple epithelial keratins and CEA. In the present case, simple epithelial keratins, stratified epithelial keratins, CEA and HSV were heterogeneously expressed in the ballooning and multinucleated giant cells. These results suggest that these cells were derived from keratinocytes and Paget cells and that the production of many multinucleated giant cells resulted from the virus-mediated cell fusion between Paget cells and neighbouring keratinocytes.