acyclovir and Dermatitis--Allergic-Contact

Topics: Acyclovir; Administration, Cutaneous; Adult; Antiviral Agents; Dermatitis, Allergic Contact; Female; Herpes Labialis; Humans; Hypersensitivity, Immediate; Ointments

We present a case of a 10-year-old boy with a longstanding history of seborrheic dermatitis (SD) referred to the Allergy and Immunology Department for recurrent Kaposi varicelliform eruption (KVE) secondary to herpes simplex 1 (HSV-1) infection and possible primary immunodeficiency. The patient was the second child of non-consanguineous parents, with an older, healthy brother. Family history was negative for primary immunodeficiency and skin disorders. The patient's skin problems began in infancy when he was diagnosed and treated by a dermatologist for SD. From preschool age, he was under the care of a pediatric neurologist and a defectologist for a sensory processing disorder. For the last two years, the patient had been receiving chlorpromazine therapy for aggressive behavior. The first episode of KVE was diagnosed at the age of six, following potent topical corticosteroid therapy for SD and sun exposure, another known risk factor for HSV infection. After the third KVE episode, prophylaxis with oral acyclovir was initiated. The skin changes were treated with topical steroids and oral antibiotics during disease flares, with poor clinical response. On presentation, the patient was in good general health, adipose, and of unremarkable somatic status, except for numerous symmetrical yellowish-brown keratotic papules and plaques on the forehead, cheeks, and the lateral side of the neck (Figure 1). The nail plate had multiple red and white longitudinal streaks and V-shaped notches on the distal free end of the nail plate (Figure 2). The allergy tests revealed increased total immunoglobulin E (IgE) and sensitization to ragweed. Immunological workup showed normal immunoglobulins and good specific immunity (good vaccine response and normal humoral response to HSV-1) but a decreased number of T- cells (CD3+ 1020/µL (1320-3300), CD3+CD8+ 281/µL (390-1100) with normal T-cell response after antigen stimulation. The diagnosis of Darier disease (DD) was confirmed based on medical history, clinical findings and histological finding of focal suprabasal acantholysis and dyskeratosis (Figure 3). Low-dose oral retinoid therapy was initiated with modest clinical response after 6 months of therapy. In the light of recent publication (1), we initiated intravenous immunoglobulin (IVIG) substitution (400 mg/kg every month) with excellent clinical response. After 4 months, the patient's skin improved in terms of reduced inflammation, scab healing, and reduced itching. Acyclovir p

Topics: Acyclovir; Adolescent; Adult; Child; Child, Preschool; Darier Disease; Dermatitis, Allergic Contact; Dermatitis, Seborrheic; Herpes Simplex; Humans; Immunoglobulins, Intravenous; Kaposi Varicelliform Eruption; Male; Retinoids; Young Adult

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Antiviral Agents; Cicatrix; Dermatitis, Allergic Contact; Facial Dermatoses; Female; Gels; Herpes Labialis; Humans; Recurrence; Skin Cream

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Dermatitis, Allergic Contact; Diagnosis, Differential; Facial Dermatoses; Glucocorticoids; Herpes Simplex; Herpes Zoster Oticus; Humans; Impetigo; Mouth Mucosa; Prednisone; Tongue

Topics: Acyclovir; Administration, Cutaneous; Adult; Cosmetics; Dermatitis, Allergic Contact; Female; Humans; Pharmaceutical Vehicles; Propylene Glycol; Skin Cream

Despite the widespread use of oral or topical acyclovir, allergic contact dermatitis caused by it has been rarely reported, with fewer than 20 case studies published in the English literature to date.. A diagnosis of allergic contact dermatitis from acyclovir cream was established in a 62-year-old female patient who had been continuously using acyclovir cream for 3 weeks after systemic therapy for herpes zoster with acyclovir, and in a 35-year-old female patient, who had undergone liver transplantation in 2008 and subsequently developed a severe form of herpes zoster treated orally with 4 g/day acyclovir and prolonged topical administration of acyclovir cream. In both cases, patch tests were performed with extended European Baseline Series, with the excipients of acyclovir cream (propylene glycol, sodium lauryl sulfate, cetostearyl alcohol, dimethyl sulfoxide) and commercial cream containing acyclovir 2%. Positive reactions were obtained only with the commercial cream with acyclovir 2%. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Allergic contact dermatitis caused by acyclovir is rarely reported and frequently misdiagnosed, despite the wide use of oral or topical acyclovir. Allergic contact dermatitis due to acyclovir applied topically is a clinical problem with which health care providers should be familiar, and which prompts patch testing in suspected patients. Knowledge and education focused on allergens are important to clinicians in daily practice.

Topics: Acyclovir; Administration, Topical; Adult; Antiviral Agents; Dermatitis, Allergic Contact; Emergency Service, Hospital; Female; Herpesvirus 3, Human; Humans; Liver Transplantation; Middle Aged; Skin Cream

Topics: Acyclovir; Administration, Topical; Allergens; Dermatitis, Allergic Contact; Drug Hypersensitivity; Female; Follow-Up Studies; Herpes Simplex; Humans; Patch Tests; Risk Assessment; Young Adult

A 35-year-old woman with a history of atopic diathesis presented to the emergency department with 2 weeks of widespread facial vesiculopustules and eroded vesicles. HSV-1 was found on viral culture and direct fluorescent antibody testing. She was diagnosed with eczema herpeticum, an uncommon and potentially life-threatening viral infection that arises in areas of pre-existing dermatosis. Antiviral treatment for eczema herpeticum is very effective, and should be instituted without delay to avoid significant morbidity and mortality.

Topics: Acyclovir; Adult; Antiviral Agents; Codeine; Dermatitis, Allergic Contact; Dermatitis, Atopic; Diagnostic Errors; Disease Susceptibility; Facial Dermatoses; Female; Floxacillin; Herpesvirus 1, Human; Humans; Kaposi Varicelliform Eruption; Morphine; Prednisone; Respiratory Hypersensitivity; Staphylococcal Skin Infections; Valacyclovir; Valine

A 29-year-old Turkish woman with allergic contact cheilitis from a lipstick was misdiagnosed as herpes labialis and subsequently worsened with the application of Zovirax cream. Patch tests were positive to Zovirax cream, propylene glycol, the patient's favourite lipstick and propyl gallate. No reaction was seen with Zovirax ophthalmic ointment and Zovirax tablet. The propylene glycol component of the Zovirax cream and the propyl gallate component of the lipstick were regarded as the responsible contact sensitizers. The differential diagnosis was challenging due to concomitant contact sensitization with these agents.

Topics: Acyclovir; Adult; Antiviral Agents; Cheilitis; Cosmetics; Dermatitis, Allergic Contact; Diagnostic Errors; Female; Herpes Labialis; Humans

Parthenium dermatitis is one of the most common causes of airborne contact dermatitis in India. Eczema herpeticum has been reported in association with various eczematous conditions, including Parthenium dermatitis. We report a case of eczema herpeticum in association with Parthenium dermatitis. Because Parthenium dermatitis is a common condition in this region, one should be aware of this complication so that appropriate treatment is not delayed.

Topics: Acyclovir; Agricultural Workers' Diseases; Allergens; Cistaceae; Dermatitis, Allergic Contact; Dermatitis, Occupational; Diagnosis, Differential; Facial Dermatoses; Humans; Kaposi Varicelliform Eruption; Male; Middle Aged; Patch Tests

Allergic contact dermatitis caused by acyclovir is rare. We report the 5th case of systemic acyclovir reaction subsequent to acyclovir contact dermatitis, with investigations made to determine an alternative antiviral treatment. A 23-year-old woman, after dermatitis while using Zovirax cream, went on to develop urticaria after oral acyclovir. Patch tests were performed with the components of Zovirax cream (acyclovir, propylene glycol and sodium lauryl sulfate) and with other antiviral drugs. Patch tests were positive to Zovirax cream, acyclovir, valacyclovir and propylene glycol. Patch and prick tests with famciclovir were negative, but its oral administration caused an itchy erythematous dermatitis on the trunk and extremities. Our patient developed a systemic acyclovir reaction subsequent to acyclovir allergic contact dermatitis, with cross-reactions to valacyclovir and famciclovir. Their common chemical structure is the 2-aminopurine nucleus. It is probably this part of the molecule that provokes both contact allergy and systemic reactions. The only antiviral drugs not having this core are foscarnet and cidofovir, and these could therefore be alternatives.

Topics: Acyclovir; Administration, Cutaneous; Administration, Oral; Adult; Antiviral Agents; Dermatitis, Allergic Contact; Diagnosis, Differential; Facial Dermatoses; Female; Herpes Simplex; Humans; Lip Diseases; Patch Tests

Topics: Acyclovir; Adult; Antiviral Agents; Dermatitis, Allergic Contact; Female; Herpes Labialis; Humans

Topics: Acyclovir; Adult; Antiviral Agents; Dermatitis, Allergic Contact; Drug Eruptions; Female; Herpes Genitalis; Humans; Patch Tests; Skin; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Dermatitis, Allergic Contact; Drug Hypersensitivity; Famciclovir; Female; Herpes Labialis; Humans; Keratitis, Herpetic

We report 4 patients with acute contact dermatitis of the lips following application of Zovirax cream. Patch tests with pure acyclovir, and combinations of the ingredients of the cream base, with and without acyclovir, provided no evidence of sensitization to any constituents of the cream.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Cheilitis; Dermatitis, Allergic Contact; Female; Humans; Male; Patch Tests

Topics: Acyclovir; Administration, Cutaneous; Dermatitis, Allergic Contact; Herpes Zoster; Humans; Male; Middle Aged; Pharmaceutic Aids; Propylene Glycol; Propylene Glycols

Topics: Acyclovir; Administration, Cutaneous; Cellulose; Cryoprotective Agents; Dermatitis, Allergic Contact; Drug Eruptions; Estradiol; Female; Humans; Middle Aged; Propylene Glycol; Propylene Glycols