One hundred twenty recurrences of herpes simplex virus in an immunocompetent patient

A 60-year-old woman presented to our clinic with a complaint of a dermatitis that had recurred 2 or 3 times a month for the past 5 years. No trigger episode or obvious pattern of recurrence was noted. She reported some itching or burning as a prodromal symptom. Recurrence has been at multiple sites, in a dermatome pattern, including areas around the arm, face, back, abdomen, knees, and ears. Each occurrence is at a different anatomic site (and she only has lesions at this 1 site during each occurrence. For example, after formation and resolution at 1 site (ie, the right medial forearm) the patient will then have a later recurrence at another site (ie, the upper left part of the back). The patient has no complaints of fevers, chills, or adenopathy. Medical history includes type 2 diabetes and hypertension. Results of a basic laboratory screening at the time were all within normal limits. No other contributory history was noted. On examination, the medial arm just proximal to the elbow had clusters of vesicles (Figure). Viral culture performed on the lesion confirmed our suspicion of the presence of herpes simplex virus (HSV). The patient was started on valacyclovir and asked to return if no improvement was noted. To date the patient has not returned to the clinic.