Case Number 4: A patient with various clinical manifestations at the same time. (Keratosis pilaris concurrent with HSV reactivation)
This 6-year-old girl presented with many itchy papules on her abdomen and four extremities for a week. She had been treated with TCS as atopic dermatitis for 3 years before she visited our clinic 9 months ago.
Case4-1 Many red pin-sized papules, punched-out erosions, and keratosis pilaris on her trunk.
Case4-2 Many red pin-sized papules, punched-out erosions, and keratosis pilaris on her lower extremities.
Case4-3. A vesicle (circle) together with crusted vesiculopapules and erosions with clinical features of multiple HSV recurrence over her left wrist.
Case4-4 QTT proved that there were also HSV-infected cells (circle) taken from the keratosis pilaris over her abdomen. Magnification: 400´.
Case4-5 Five days later, there were no more papules on her abdomen.
Case 4-6 Five days later, there were also no papules over her lower extremities.
Case4-7. Five days later, the vesicle and crusted vesiculopapules disappeared. There was only an erosion and crusts over her left wrist.
The four cases above showed that HSV infection, especially in patients with herpes simplex virus immunoglobulin G
( HSIgG ) , may be concealed in eczema, vesiculopapular plaque, keratosis pilaris, erythema multiforme, or prurigo. The number of people seropositive for herpes simplex virus (HSV) by the fourth decade of life is estimated at up to 90%.
( HSIgG ) , may be concealed in eczema, vesiculopapular plaque, keratosis pilaris, erythema multiforme, or prurigo. The number of people seropositive for herpes simplex virus (HSV) by the fourth decade of life is estimated at up to 90%.
Case Number 5: Early diagnosis of the transplacental transmission from a seropositive mother to her newborn will bring about an early antiviral therapy.
A two months -old newborn visited due to many pin-sized vesiculopapules appearing on her mandible and neck 3 days ago. The vesicopapules desquamated gradually. Perioral erythema accompanying by scales was also noted. The eruption appeared at first over her face 3 weeks after her birth. She was treated with topical corticosteroids, yet the eruptions recurred and extended from her face to neck. Her mother had past history of aphtha.
Case5-1 Perioral erythema accompanying by scales.
Case5-2. 2-month old baby with vesiculopapules over her neck and desqumated papules over her mandible.
Case5-3 Balloon degeneration in the spinous layer (circle), and degenerated nerves (arrow) were observed by a QTT from the vesiculopapules. Magnification: 100x.
Case5-4 Nine days later, there were only a few vesiculopapules on his anterior chest.After 2 courses of
antiviral agents, there was no recurrence of skin eruption for 2 months.
We have treated and followed thousands of patients with HSV-AD before we present to you. However, the value of the QTT and the necessity of the antiviral agent need follow, confirmation and discussion by concerned doctors and patients. We sincerely looking forward to hearing from you.
For detail of the QTT and cases need differential diagnosis from contact dermatitis, hand eczema, drug eruption and insect bites please consult: Hsiao L, Chien HP. The 2-minute Quick Tzanck Test to Diagnose Herpes Simplex Viral Infection. Taipei, Taiwan, Ho-Chi Publications, 2011. [In Chinese and English.]
For detail of the QTT and cases need differential diagnosis from contact dermatitis, hand eczema, drug eruption and insect bites please consult: Hsiao L, Chien HP. The 2-minute Quick Tzanck Test to Diagnose Herpes Simplex Viral Infection. Taipei, Taiwan, Ho-Chi Publications, 2011. [In Chinese and English.]