Exclusive Involvement of Folliculosebaceous Units by Herpes

Abstract

The histopathological changes of herpes simplex, herpes zoster, and varicella are considered to be indistinguishable from one another. Evaluation of the clinical setting, with adjunctive studies if necessary, generally clarifies the specific diagnosis. Vesicular lesions in all three conditions can involve epidermal and adnexal epithelium with characteristic cytopathic features. We describe three patients with non-vesicular eruptions on the head and neck whose biopsies revealed exclusive folliculosebaceous involvement by herpes. All three patients developed typical herpes zoster within days of the biopsy. There is compelling scientific evidence in the literature indicating that, in herpes zoster, the virus is transported from dorsal root or trigeminal ganglia via myelinated nerves to the skin. These terminate at the isthmus of hair follicles and primary infection of follicular and sebaceous epithelium occurs. Spread of infection to the epidermis follows. In contrast, data pertaining to recurrent herpes simplex indicates that axonal transport of the virus from sensory ganglia to the skin is directed primarily to the epidermis, via terminal non-myelinated nerve twigs. The clinical evolution of our three cases and scientific data in the literature indicate that exclusive folliculosebaceous involvement by herpes, in the setting of a non-vesicular eruption, represents early herpes zoster.

Wolf Isotopic Response Manifesting as Postherpetic Granuloma Annulare: A Case Series

“…Interestingly, prominent involvement of folliculosebaceous units, sometimes exclusively, and/or perineural involvement of the infiltrate, are typically reported to represent early herpes zoster. 20 In herpes zoster, it is postulated that the virus is transported from dorsal root ganglia to skin via myelinated axons, with nerve endings at the hair follicle isthmus leading to folliculosebaceous and subsequently, to epidermal spread of the virus. 20 Herpes viral antigens have also been reported to occupy dermal histiocytes.…”

“…20 In herpes zoster, it is postulated that the virus is transported from dorsal root ganglia to skin via myelinated axons, with nerve endings at the hair follicle isthmus leading to folliculosebaceous and subsequently, to epidermal spread of the virus. 20 Herpes viral antigens have also been reported to occupy dermal histiocytes. 20 This suggests a possible link between herpes viral infection and the development of postherpetic granuloma annulare, particularly given the histologic finding of a perineurovascular and/or perifollicular lymphohistiocytic infiltrate with multinucleated giant cells in our cases.…”

“…20 Herpes viral antigens have also been reported to occupy dermal histiocytes. 20 This suggests a possible link between herpes viral infection and the development of postherpetic granuloma annulare, particularly given the histologic finding of a perineurovascular and/or perifollicular lymphohistiocytic infiltrate with multinucleated giant cells in our cases.…”

Haarausfall nach Varicella-Zoster-Virusinfektion

“…Ferner lässt sich eine aktive VZV-Replikation und Infektion auch in infundibulären Keratinozyten der Haartalgdrüsenstrukturen beobachten. Dies kann eine VZV-Follikulitis zur Folge haben, die sich in Form einer lokalisierten, auf ein Dermatom begrenzten oder vesikulopustulären Follikulitis äußert [5][6][7][8][9][10][11][12] [13]. Die AA ist eine der häufigsten durch Th1-Lymphozyten vermittelten, nicht vernarbenden kutanen Autoimmunerkrankungen [14,15].…”

Foliculitis necrotizante herpética

“…Estudios complementarios con RPC permiten establecer o confirmar la presencia del ADN viral en muestras incluidas en parafina, siendo este examen más sensible que el cultivo viral 13 . El virus más frecuentemente aislado en estos pacientes según publicaciones recientes es el VVZ, aunque existe evidencia contradictoria en la literatura 2,14 . El uso de antivirales en el episodio agudo está descrito en algunos casos 12,15 , sin embargo, no se dispone de evidencia suficiente para evaluar su efectividad.…”