acyclovir and Folliculitis

Topics: Acyclovir; Antibodies, Viral; Antigens, Viral; Biopsy; DNA, Viral; Folliculitis; Hair Follicle; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunohistochemistry; Male; Meningitis, Viral; Young Adult

Eczema herpeticum is a dermatological emergency causing a mortality of up to 10% if untreated. It frequently presents in a localised form and rarely disseminates via haematogenous spread with pulmonary, hepatic, ocular and neurological manifestations. Although it commonly appears on a background of atopic dermatitis, many other dermatological conditions have been described preceding this disease. Eczema herpeticum can be easily mistaken for folliculitis and is often treated accordingly with antibacterial drugs; therefore patients will often deteriorate before a diagnosis of eczema herpeticum has been considered.

Topics: Acyclovir; Adult; Antiviral Agents; Dermatitis, Atopic; Diagnosis, Differential; Encephalitis, Viral; Folliculitis; Humans; Kaposi Varicelliform Eruption; Male

Varicella zoster virus (VZV) is an uncommon cause of folliculitis. We present a case of a 29-year-old woman who presented with an atypical follicularly-based eruption localized to her inner thigh with an associated pain in her lower back and inner thigh prior to the papular eruption. She was successfully treated with valacyclovir 1,000 mg three times daily with no complications.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Biopsy; Female; Folliculitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Skin; Thigh; Valacyclovir; Valine

We present an unreported coexistence: eczema herpeticum (EH) with histopathological findings of herpetic folliculitis (HF) after allogeneic bone marrow transplantation (BMT). A patient with atopic dermatitis (AD) underwent allogeneic BMT for idiopathic acquired aplastic anemia. She had been receiving cyclosporine (150 mg/12 h) and acyclovir (400 mg/12 h) for 6 months. A facial rash was observed, composed of monotonous erythematous, umbilicated papulo-vesicles and papulo-crusts <4 mm in size. The histopathological study showed herpetic cytopathic changes within the epidermis that extended into the hair follicle epithelium. Interestingly, microscopic HF has not previously been associated with post-transplant patients or EH. However, it is reasonable to hypothesize that the coexistence of these herpes simplex virus-related events may be underreported in the literature. Although further studies are necessary, we suggest that the prophylactic antiviral dose after BMT be enhanced in patients with underlying dermatologic diseases, especially in those with AD.

Topics: Acyclovir; Adult; Anemia, Aplastic; Antiviral Agents; Bone Marrow Transplantation; Cyclosporine; Dermatitis, Atopic; Female; Folliculitis; Herpes Simplex; Herpesvirus 1, Human; Humans; Kaposi Varicelliform Eruption; Risk Factors

Topics: Acyclovir; Aged; Antiviral Agents; Edema; Erythema; Exanthema; Face; Female; Folliculitis; Herpesviridae Infections; Humans; Treatment Outcome

Topics: Acyclovir; Adult; Antibodies, Monoclonal; Antiviral Agents; Crohn Disease; Diagnostic Errors; Female; Folliculitis; Herpes Simplex; Humans; Immunocompromised Host; Immunologic Factors; Infliximab; Perineum; Simplexvirus; Tumor Necrosis Factor-alpha; Valacyclovir; Valine; Virus Activation

A 33-year-old woman presented with a 5-year history of a relapsing erythematous, indurated plaque on the left cheek. Herpes simplex virus (HSV) immunostain revealed the presence of HSV in the follicular and perifollicular keratinocytes. After oral treatment with valaciclovir for a period of 3 months the lesion disappeared without leaving a scar. At the last check-up, no recurrence had occurred. Herpes folliculitis has various clinical presentations. In rare cases it mimics a pseudolymphoma, as was the case for this patient. A viral aetiology, such as HSV or varicella-zoster virus, should be considered in patients with folliculitis, especially when the condition does not respond to antibacterial and antifungal therapy.

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Facial Dermatoses; Female; Folliculitis; Herpes Simplex; Humans; Simplexvirus; Valacyclovir; Valine

Post herpes zoster (HZ) reactions have been associated with panoply of neoplastic, inflammatory, and fibro-inflammatory cutaneous disorders. Varicella zoster virus (VZV) DNA has not been identified in most of these reports. After an episode of HZ, a healthy, active 90-year-old female developed ulcerative nodules in the affected trigeminal V1 dermatome and the contra-lateral trigeminal region over a 1-year period. Excision and/or biopsy of all these lesions showed similar pathologic changes that consisted of herpetic folliculitis, adjacent dense mixed nodular lymphocytic infiltrates with germinal centers (cutaneous lymphoid hyperplasia (CLH)), and in the deeper excision specimens, an obliterative vasculitis of a vessel with smooth muscle in its wall. Immunophenotype analysis revealed a mixed, predominate T- and B-cell population without loss of pan-T cell antigens or aberrant expression by B cells of T-cell antigens. Polymerase chain reaction for herpetic DNA was positive for VZV DNA. Lymphocyte gene rearrangement analysis revealed 2 distinct, anatomically and chronologically, monoclonal B-cell populations and a monoclonal T-cell population in one nodule. Treatment with valacyclovir has lead to almost complete resolution of her cutaneous nodules after 6 months of therapy. In this case, it can be surmised that persistence of VZV infection and lack of effective cell-mediated immunity lead to development of both immunopathology (vasculitis) and excessive lymphoid cell proliferation (CLH).

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Arteritis; Clone Cells; DNA, Viral; Female; Folliculitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunophenotyping; Polymerase Chain Reaction; Pseudolymphoma; Valacyclovir; Valine

A 60-year-old male athlete developed a folliculitis in the beard region after several competitions. After identification of herpes simplex antigen within the lesions, systemic therapy with acyclovir led to rapid improvement. In folliculitis resistant to antibiotic and anti-inflammatory therapy, viral and mycotic infections as well as eosinophilic folliculitis should be considered as differential diagnostic possibilities.

Topics: Acyclovir; Antiviral Agents; Conjunctivitis, Bacterial; Dermatitis, Perioral; Diagnosis, Differential; Disease Progression; Facial Dermatoses; Folliculitis; Herpes Simplex; Humans; Male; Middle Aged

Fulminant herpetic sycosis is a rare but well-known manifestation of herpes simplex virus (HSV) infection occurring in the context of viral recurrence in immunodepressed patients. We present here the case of a 32-year-old male patient, without notable medical history, who developed papulovesicular lesions of the beard accompanied by fever, painful cervical lymphadenopathy and odynophagia, with a clinical evolution that was initially unfavourable under antibiotic treatment. The diagnosis of herpetic sycosis was established by means of direct immunofluorescence and culture which confirmed positivity for HSV-1 and serologies compatible with a primary viral infection. No sign for a latent immune deficit was found at the time of investigations. The clinical evolution was rapidly favourable with administration of intravenous aciclovir for 1 week. To our knowledge, herpetic sycosis as a presentation of primary viral infection has not been reported previously. The possibility of a herpetic sycosis of the beard must be considered in the case of non-response to antibiotic or antifungal treatment.

Topics: Acyclovir; Adult; Antiviral Agents; Facial Dermatoses; Folliculitis; Herpes Simplex; Humans; Male

Viral folliculitis is a rare disease usually caused by herpes simplex, herpes zoster and molluscum contagiosum in immune-compromised patients. An otherwise healthy 30 year old patient without history of herpes simplex contracted a folliculitis in the beard region after a flu-like illness. He had no oral or labial lesions but instead showed a crusty erythematous folliculitis confined to the beard region with small grouped vesicles on the neck and reactive cervical lymph nodes. Bacterial and mycological analysis from swabs were negative. The culture was positive for herpes simplex virus and the immune fluorescence showed HSV type 1. Systemic therapy with valaciclovir 2x 500 mg/d and lotio alba locally led to rapid improvement. When confronted with folliculitis, non-bacterial causes such as viral (herpes simplex, herpes zoster, molluscum contagiosum), mycological (pityrosporon, candida), demodex and eosinophilic follicultitis should be taken under consideration.

Topics: Acyclovir; Adult; Antiviral Agents; Facial Dermatoses; Fluorescent Antibody Technique; Folliculitis; Herpes Simplex; Humans; Male; Prodrugs; Skin; Valacyclovir; Valine

Topics: Acne Vulgaris; Acyclovir; Administration, Oral; Antiviral Agents; Diagnosis, Differential; Facial Dermatoses; Female; Folliculitis; Herpes Simplex; Humans; Middle Aged; Valacyclovir; Valine