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Papuloerythroderma of Ofuji (PEO) is a rare erythroderma with "deckchair" sign, and there is no specific treatment yet. Here, we present two cases of PEO, which are responsive to wet-wrap therapy (WWT) combined with Compound Glycyrrhizin and oral antihistamines.Case one, a 72-year-old Chinese male who had generalized pruritic rashes for 1 month. He had cerebrovascular stenosis for 4 years.Dermatological examination showed a wide range of erythema, covering more than 80% of the body surface, which was characterized by the solid and flat-topped papules except for the skin folds, presented as the "deck-chair" sign (Figure 1A), combined with palmoplantar keratoderma (Figure 1D). Laboratory tests showed leucocytosis (15.34 Â 10 9 /L), eosinophilia (18.3%; 2.8 Â 10 9 /L), and IgE (466.6 IU/ml). The complete screening for internal malignancy was unrevealing. Skin biopsy showed epidermal hypertrophy, and infiltration of perivascular inflammatory cells in the superficial dermis, consisting of lymphocytes, histiocytes, and eosinophils (Figure 1F,G).Case two, an 85-year-old Chinese male who had generalized pruritic rashes on the trunk after a liver cancer operation 2 years ago, and the lesions spread to the whole body for 3 months. He had hypertension and hyperlipemia for 20 years. The clinical manifestation (Figure 1H) was similar to case one. Laboratory tests showed eosinophilia (11.5%, 0.76 Â 10 9 /L), IgE (763.0 IU/ml), and ANA (1:80). The patient was followed up for more than 2 years without recurrence. They all denied medical history of skin diseases and lymphadenopathy.Treatment protocol: patients were treated with WWT (2 h, BID) for 1 week (Figure 1J). From day 8, the patients used topical halometasone (BID) without WWT. Compound Glycyrrhizin (40 ml, ivgtt, QD) F I G U R E 1 Skin lesions of the trunk (A) and the palm (D) before the treatment of case one, showed a wide range of erythema with the "deckchair" sign and palmoplantar keratoderma. Skin lesions of case one at 3 days after the treatment (B) and 21 days after the treatment (C). Dermoscopic examination of papules of case one showed multiple red dots, surrounded by whitish halos (E). Histopathology of skin lesions of case one: epidermal hyperplasia; some inflammatory cells, including lymphocytes, histiocytes, and eosinophils were present in the dermis, with prominent perivascular infiltration (HE staining, F: 100Â; G: 400Â). Clinical manifestations of case two before the treatment (H) and 7 days after the treatment (I). Case one with WWT (J). WWT used 0.05% Halometasone cream (Ao Neng ® . Batch No. 1601508). Patients applied Halometasone cream (Daily dose: 30 g) on the lesions first, and then used Vaseline jelly (Daily dose: 100 g). After that, a set of the cotton longsleeved sweatshirts and pants, were soaked in warm water, squeezed dry, and worn by the patients. This set of damp clothing was overlaid with a second, dry set of cotton clothing, lasting for 2 h, and adjusted the course of treatment was according to the condition. WWT, Wet-wrap therapy.

Background: Bickerstaff brainstem encephalitis (BBE) is a rare demyelinating disease of the central nervous system (CNS) that is caused by a direct viral infection or secondary autoimmune responses. BBE secondary to Herpes zoster has rarely been reported. Case Presentation: A 68-year-old man developed a painful vesicular rash and drooping eyelid on the left side of his face for 20 days. Physical examination revealed left-sided blepharoptosis and crusted erythema on the left front side of his face, left upper eyelid, and left nasal tip. Neurological examination showed impaired sensation over the left side of his face and cheek. His left pupil was dilated (4mm compared to 2mm on the right side), and the Pupillary light reflection (PLR) was absent, with an ocular movement disorder (limited adduction) and diplopia. Brain imaging did not reveal abnormalities. Cerebrospinal fluid (CSF) examination showed leukocytosis and increased protein levels. He was treated with intravenous acyclovir for 7 days, but developed disturbance of consciousness and right limb weakness. Neurological examination revealed right lower limb hypoesthesia. The Heel-Knee-Shin test was positive on the left side, and Babinski's sign was present on the right side. He was diagnosed with Bickerstaff brainstem encephalitis caused by herpes zoster. After 2 days of intravenous acyclovir combined with intravenous immune globulin (IVIG), the patient developed acute kidney injury (AKI). Then, his treatment was changed to systemic steroids. At the 3-month follow-up, his pupils were bilaterally equal and reactive to light, and there was a significant improvement in ocular motility and ptosis. At the 6-month follow-up, his diplopia had completely resolved. Conclusion: BBE associated with herpes zoster is very rare and can be overlooked. Dermatologists should be aware of the expanding spectrum of neurological complications caused by varicella zoster virus (VZV) infections to aid early diagnosis and treatment.