Herpetic Dermatitis: Correlation of Clinical Impression, Histopathologic Findings and PCR
Christopher L Kinonen, Briana C Gleason, Antoinette B Thomas, Karen L Kaul, Geoffrey Turner, Thomas A Victor, Thomas L Cibull. Evanston Hospital - NorthShore University HealthSystem, Evanston, IL; Diagnostic Pathology Medical Group, Sacramento, CA
Background: Herpetic dermatitis (HD) due to herpes simplex virus (HSV) and varicella zoster virus (VZV) can present with similar clinical and histologic features, although treatment for these two entities differ. Confounding matters, viral cytopathic changes are not always observed in biopsy specimens. Therefore, PCR can play an integral role in the definitive diagnosis of HD, and in the distinction of VZV from HSV-1/2. We correlated clinical impression, histologic findings and PCR results. We also describe cases of HD without viral change (“herpes incognito”) that histologically demonstrate the pattern of a dermal hypersensitivity reaction (DHR).
Design: 40 patients with skin biopsies from NorthShore University HealthSystem (2004-2011) had PCR performed to detect HSV-1/2 or VZV. Patient demographics, clinical impression and histologic characteristics were reviewed and correlated with PCR findings.
Results: Patient demographics and results are illustrated in tables 1 and 2. Sites include head & neck, face, chest, abdomen, back, extremities, penis, and perineum.
|Total Number of Patients||Mean Age||Female||Male|
|40||53 (range 10-90)||22 (55%)||18 (45%)|
|Clinical Impression||Histologic Viral Changes||PCR Positive||HSV-1||HSV-2||VZV||HSV&VZV|
|Herpetic dermatitis (28)||Present (21/28)||21/21||8||2||11||0|
|Other (12)||Present (12/12)||12/12||7||1||2||2|