Deep Herpes.

Area of Science:

• Dermatology
• Virology
• Pathology

Background:

• Herpes viruses typically infect epithelial cells, causing vesicular lesions.
• Ocular stromal infections by herpes viruses are known, but cutaneous stromal herpes is undocumented.
• Deep herpes infections may evade typical clinical and microscopic detection.

Purpose of the Study:

• To identify and characterize cutaneous stromal herpes infections.
• To raise awareness of this deep herpes manifestation in clinical practice.

Main Methods:

• Retrospective search for skin biopsies with suspected herpes stromal disease.
• Analysis of clinical, histopathological (H&E, IHC), and molecular (PCR) data.
• Identification of herpes simplex virus 1/2 and varicella-zoster virus in stromal tissues.

Main Results:

• 12 specimens from 10 patients with cutaneous stromal herpes (HSV-1/2 or VZV) were identified.
• Common sites included the buttocks/perianal region; ulceration was frequent.
• Most cases (80%) occurred in immunosuppressed individuals and often mimicked pyoderma gangrenosum.

Conclusions:

• This is the first report of herpes viruses infecting deep dermal stromal cells (cutaneous stromal herpes).
• Awareness is crucial for diagnosing atypical lesions, especially in immunocompromised patients.
• Accurate diagnosis is essential for appropriate therapeutic intervention.