Herpes simplex: autoinoculation versus dissemination

Autoinoculation and dissemination (or Kaposi's varicelliform eruption (KVE) or eczema herpeticum) of herpetic lesions are two forms of viral spread, and it is essential to differentiate the two. Autoinoculation means true infection with retrograde transport of the virus to the dorsal root ganglia of the relevant dermatome that allows the virus to remain there in a latent state for a lifetime, with periodic reactivation. Autoinoculation is, in a manner of speaking, a kind of self-infection with a virus that exists in the host. In contrast, KVE involves a spread of the lesions to the skin areas affected by another skin disease, but there is no true inoculation, i.e. the nerve endings and ganglion are not affected, and so reactivation and recurrences of these lesions will not usually occur. Four cases of autoinoculation and two of KVE illustrate the differences between these two forms of viral spread.