When skin barriers fail: the emergence of Kaposi varicelliform eruption following disulfiram-induced erythroderma

Abstract

A 35-year-old male farmer developed drug-induced erythroderma following disulfiram therapy, leading to generalized skin dryness and scaling. Treated with systemic and topical corticosteroids, he later presented with facial vesiculopustular lesions, which progressed to erosions due to manipulation. A Tzanck smear revealed multinucleated giant cells, confirming herpes simplex virus (HSV) infection and diagnosing Kaposi varicelliform eruption (KVE). He was treated with oral acyclovir (800 mg, five times daily for seven days), showing marked improvement. KVE, commonly caused by HSV-1 or HSV-2, may also result from vaccinia virus or Coxsackievirus A16. It is vital to differentiate KVE from similar conditions like eczema coxsackium and eczema vaccinatum. In this case, erythroderma compromised the skin barrier, while corticosteroid-induced immunosuppression likely facilitated viral spread. KVE can also occur with conditions like HHD, Darier’s disease, burns, and psoriasis. Early diagnosis and antiviral therapy are crucial to prevent complications such as bacterial superinfections or systemic viremia.