US scientists detail the cases of three patients who developed Kaposi's varicelliform eruption (KVE) after hospitalization for an acute flare-up of psoriasis.
"KVE… refers to a disseminated cutaneous infection with herpesvirus type 1 or 2, vaccinia virus, or coxsackievirus A16 in a patient with another underlying dermatosis," explain Beth Santmyire-Rosenberger and co-workers from Washington Hospital Center in Washington, DC.
KVE is most often seen in patients with underlying atopic dermatitis, but rarely occurs in those with psoriasis, the researchers add.
The first patient was a 38-year-old man who was hospitalised with erythrodermic psoriasis and developed septicaemia after 3 days, with blood cultures positive for methicillin-sensitive Staphylococcus aureus. The man's condition worsened, report the authors, and on the 5th day after hospitalisation a punch biopsy was consistent with eczema herpeticum and psoriasis.
Systemic antiviral treatment and topical aluminium subacetate soaks followed by mupirocin ointment were successful in clearing the lesions, the team reports.
The second case report details a 78-year-old woman who was also hospitalised with erythrodermic psoriasis, with plaques of confluent erythema covering approximately 85% of the body surface area. She subsequently developed many painful, punched-out erosions on her upper thighs, lower abdomen, and perineum and herpesvirus culture of these lesions was positive, note Santmyire-Rosenberger and team.
Treatment with oral valacyclovir hydrochloride, oral cephalexin, and topical mupirocin ointment was successful.
In the third instance, a 38-year-old woman was hospitalised following significant worsening of a sinus infection, multiple fever blisters, and a severe flare of her psoriasis. During this time she developed painful pustular lesions, erosions, and ulcerations, which later transformed to sharply demarcated, painful, violaceous plaques that contained multiple punched-out ulcers, some of which were covered with a honey-coloured crust. Again, oral valacyclovir successfully cleared the woman's lesions.
Writing in the Journal of the American Academy of Dermatology, the researchers summarise that KVE may rarely occur in patients with psoriasis. They add that erythroderma and systemic sepsis may possibly increase susceptibility to KVE, as well as therapy with immunosuppressants, systemic steroids and systemic retinoids, which the three reported patients were all initially given combinations of.
The team says: "These patients each had comorbidities that may have increased susceptibility to KVE."
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