Eruptive Hypomelanosis in a Young Child as a "Paraviral Exanthem".

We recently reported a wave of nine children with a novel paraviral exanthem, which we have termed eruptive hypomelanosis. We subsequently witnessed a second wave of children with this exanthem and present a patient here to alert clinicians.

Eruptive hypomelanosis: a novel exanthem associated with viral symptoms in children.

IMPORTANCE: Recognition of different clinical presentations of viral and virally triggered ("paraviral") exanthems is necessary for patients to be appropriately diagnosed and counseled. OBSERVATIONS: Nine children presented with eruptions of hypopigmented macules following coryzal symptoms. Other diagnostic considerations, such as pityriasis alba, pityriasis versicolor, and progressive macular hypomelanosis, were excluded. This novel clinical presentation, eruptive hypomelanosis, may represent a paraviral exanthem with a prodromal coryzal phase, sudden eruption of fairly monomorphic lesions, and predictable time course with spontaneous resolution. CONCLUSIONS AND RELEVANCE: Eruptive hypomelanosis is a novel viral exanthem. Further investigation is needed to elucidate the etiology of this condition and its relationship to other exanthemas and eruptions such as pityriasis rosea.

Intrauterine herpes simplex virus infection presenting with hypopigmented lesions.

Genital herpes simplex virus (HSV) is a sexually transmitted infection that can be transmitted from mother to child in utero, perinatally, or postnatally. Cutaneous infection with HSV commonly presents as vesicles affecting the skin, eyes, or mouth. In our case, we report a well child with cutaneous hypopigmented patches at birth that preceded typical blistering.

Purpuric macules with vesiculobullous lesions: a novel manifestation of Chikungunya.

BACKGROUND: Chikungunya (CHIK) is an emerging viral disease with a myriad of cutaneous manifestations. AIMS: The aim of our study was to document the morphology and evolution of skin lesions in cases presenting with fever, purpuric macules and vesiculobullous lesions, to confirm its causative relationship with CHIK, and to investigate further in order to delineate possible mechanisms of bulla formation in these cases. MATERIALS AND METHODS: A prospective, descriptive hospital-based study was carried out at a tertiary health care centre in Kerala. A total of 10 patients were enrolled in the study and investigated. RESULTS: All cases had morbilliform eruption prior to onset of purpuric macules. Eight cases developed vesiculobullous lesions that arose either de novo or over a part or whole of the purpuric macules. Skin lesions resolved within an average of 7.6 days leaving post-inflammatory hypopigmentation. IgM CHIK enzyme-linked immunosorbent assay (ELISA) was positive in all 10 patients. Tzanck smear from the bullae showed lymphocytes in most cases along with acantholytic cells, necrotic keratinocytes or occasional neutrophils. Skin biopsy showed intraepidermal or subepidermal bullae. Immunohistochemistry revealed predominantly CD8 positive T lymphocytes in the infiltrate. The prognosis was good with supportive management alone. DISCUSSION: The clinical features in our cases are comparable to the 3 previous reports of vesiculobullous lesions in CHIK affected infants. Based on the current evidence, we hypothesize that at least 2 mechanisms are at play for these skin lesions; CHIK virus induced keratinocyte necrosis followed by a cytotoxic immune response, and possible modulation of rash by drugs. CONCLUSION: With severe epidemics of CHIK spreading from Asia and Africa to the Western hemisphere, we must consider bullous CHIK as a differential diagnosis in cases with fever and purpuric and vesiculobullous lesions.

Scarring alopecia and sclerodermatous changes of the scalp in a patient with hepatitis C infection.

Hepatitis C virus (HCV) is a common cause of chronic hepatitis and is frequently associated with extrahepatic disease. Recently, cutaneous disorders have been a presenting manifestation of HCV infection. Porphyria cutanea tarda (PCT) is one of the cutaneous diseases associated with hepatitis C. PCT manifests in an acute form with tense bullae and erosions and in a chronic form with milia, scarring, and sclerodermatous changes. HCV has also been implicated as a cause of vasculitis through immune complex deposition. We report a patient in whom HCV was associated with sclerodermoid PCT and a medium vessel vasculitis. This case underscores the importance of HCV and its potential cutaneous manifestations, as well as the importance of recognizing cutaneous manifestations of internal disease that may be the first clue to diagnosis of HCV.