Herpes Simplex Virus-Associated Dermatitis with Either High or Normal IgE Responded Well to Antiviral Therapy: A Study of 787 Quick-Tzanck-Test-Positive Patients
Hsiao, Lily
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Objective: Early diagnosis of the herpes simplex virus (HSV)-associated dermatitis by Quick Tzanck test and its response to antiviral agents. Serum IgE and HSV IgG antibody levels were evaluated to study the relationship between HSV-associated dermatitis and atopic dermatitis.
Design: Quick Tzanck test was used to diagnose 787 patients cytologically who presented as vesiculopapular plaque, erythema multiforme, folliculitis, and prurigo. Results and Conclusions: There were 787 HSV-associated dermatitis patients diagnosed by Quick Tzanck test, of whom 578 (73%) were also HSV IgG-positive. Patients with normal and high IgE responded well to antiviral agents in addition to previous treatment for dermatitis, which suggests that HSV-associated dermatitis may include atopic dermatitis. Moreover, that the QTT diagnosed more than HSV-seropositive patients shows the possibility and importance of a systemic search for HSV-associated lesions in seropositive patients. Early diagnosis and treatment can shorten the clinical course and help attenuate the infection. |
Family Transmission of Herpes Simplex Virus-Associated Dermatitis in Neonates and Children: Cytologic and Serologic Study of Thirty Families
Hsiao, Lily
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Objective: The number of people seropositive for herpes simplex virus (HSV) by the fourth decade of life is estimated at up to 90%. Early diagnosis of the transplacental transmission from a seropositive mother to her newborn will bring about an early antiviral therapy.
Design: Quick Tzanck test was used to diagnose HSV infections in thirty families. HSV antibody and serum IgE levels including possibly related familial members were also evaluated to confirm the origin of the HSV-associated dermatitis. Results and conclusions: Infection originated in mothers (21 families), fathers and other family members (6 families), and siblings (3 families). Dense inflammatory infiltration, compared with the paucity of HSV-infected cells often observed cytologically, may cause an easy misdiagnosis of HSV infection and become indistinguishable from atopic dermatitis. Moreover, the early diagnosis and treatment of HSV-associated dermatitis is warranted because the retrograde transport to the central nervous system is always possible. |
Considerable Remission after Continuous Oral Antiviral Therapy in Darier's Disease: Two SistersHsiao, Lily*
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Background: Darier’s disease is an autosomal dominant transmitted disease with variable penetrance. In addition to bacterial and fungal infection, Darier’s disease may be accompanied by recurrent localized or widespread herpes simplex virus (HSV) infection. However, early recognition may be hindered by its complex clinical picture. A delayed diagnosis may result in visceral dissemination and death. A readily available, quick, noninvasive, bedside cytologic diagnostic technique is required for early diagnosis.
Methods: A one-step, two-minute cytologic microscopic quick Tzanck test was used to find and follow the degree of the HSV infection in 2 sisters with Darier’s disease. Because it is quick and noninvasive, a bedside follow-up to determine the necessity of continuing antiviral therapy is possible. Results: The cytopathic changes including balloon cells, giant cells, and inclusion bodies revealed a severe and persistent HSV infection in erosive plaques and keratotic papules. Continuous therapy with oral acyclovir (400 mg bid) was prescribed after a routine 5-day course of acyclovir or valacyclovir. Obvious mitigation of itching and pain occurred 3 months after this therapy. Normal skin appeared, and gradual but satisfactory clinical and cytologic improvement occurred. The antiviral therapy continued for more than 4 years without adverse effects. Conclusions: The quick Tzanck test was helpful for detecting virus-infected cells and monitoring the treatment of Darier’s disease complicated by HSV infection. Although the quick Tzanck test cannot diagnose type-1 or -2 HSV antigens as specifically as can an immunohistochemical Tzanck test, it is a handy screening tool. Continuous oral antiviral therapy proved safe and effective. |
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