Drug eruption secondary to aciclovir with recall phenomenon in a dermatome previously affected by herpes zoster

Abstract

Classically, recall dermatitis refers to chemotherapy-induced reactivation of skin damage caused by radiotherapy months, or even years, earlier. The concept of recall dermatitis has now been extended to include radiation recall dermatitis induced by other drugs, ultraviolet radiation, extravasation of drugs, and allergic contact dermatitis. We now describe recall dermatitis along the residual cutaneous lesions of a previous thoracic herpes zoster in a patient who developed a drug eruption after oral administration of aciclovir. The most striking feature consisted of confluent linear erythema along the dermatomes previously involved by the herpes zoster episode. Histopathologic study demonstrated small foci of spongiosis, vacuolar changes involving the basal layer of the epidermis and single necrotic keratinocytes scattered within the epidermis. The papillary dermis appeared oedematous and with dilated blood capillaries surrounded by a sparse inflammatory infiltrate composed mainly of lymphocytes. Serial sections failed to demonstrate cytologic changes of herpes varicella zoster infection. We interpreted this case as an example of recall dermatitis because the widespread cutaneous eruption secondary to aciclovir was more intense in skin previously compromised by herpes varicella zoster infection. To the best of our knowledge, recall dermatitis has not been described before at the site of previous involvement by herpes zoster.

The immunocompromised district in dermatology: A unifying pathogenic view of the regional immune dysregulation

“…10 Exactly the same occurs with acquired ICD, in which the supervening opportunistic skin disorder can selectively involve and keep confined to the injured cutaneous area, thus remaining isolated and representing a typical instance of ICD, or can be only superimposed on the injured site, with similar (though less severe) lesions present on the rest of the body. [53][54][55] The latter event can be well considered a Köbner phenomenon, because it is a mere repetition (and concentration) of a basically preexisting skin disease on an injured cutaneous site (a herpes zoster [HZ]-affected dermatome in the examples reported earlier). 53,54 Immunocompromised district in immunocompromised patient An ICD has its raison d'être in immunocompetent individuals; however, the possibility also exists that an ICD takes place in patients with a preexisting systemic immune deficiency.…”

“…[53][54][55] The latter event can be well considered a Köbner phenomenon, because it is a mere repetition (and concentration) of a basically preexisting skin disease on an injured cutaneous site (a herpes zoster [HZ]-affected dermatome in the examples reported earlier). 53,54 Immunocompromised district in immunocompromised patient An ICD has its raison d'être in immunocompetent individuals; however, the possibility also exists that an ICD takes place in patients with a preexisting systemic immune deficiency. We found five examples in the literature and another one occurred to some of us concerning this unusual but speculatively important condition.…”

Symmetrical Drug-Related Intertriginous and Flexural Exanthema Caused by Valacyclovir

“…Our case met all of these criteria, and the typical distribution of the eruptions was reproducibly confirmed by an oral provocation test. Although 7 cases of drug-related eruption from systemic acyclovir or valacyclovir have been described to date, SDRIFE due to acyclovir and/or valacyclovir has not been reported [6,7,8,9,10,11,12]. …”

Beyond Zoster: Sensory and Immune Changes in Zoster-affected Dermatomes: A Review*

“…3). In fact, zoster-affected dermatomes become privileged sites for a subsequent development of heterogeneous disorders, featuring the well-deflned "Wolf post-herpetic isotopic response" (PHIR) (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). This term describes the occurrence of a new disorder at the site of a previous and already healed herpetic infection, in most cases herpes zoster, with an extremely variable latency (days, weeks, months (18), years, decades (11)), no age or gender predilection, and unknown prevalence rate.…”

“…Another demonstrative case of PHIR is that ofthe development of cutaneous melanoma métastases along 3 dermatomes that had been affected by a herpes zoster infection 10 years previously and had been photodocumented by the patient (17). Table I summarizes the 176 PHIRs we have collected (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Although strikingly heterogeneous in nature, most of these cases have a possible common denominator, i.e.…”