Peculiar papular skin lesions occurring in hepatitis B carriers

Various cutaneous signs and syndromes have been associated with hepatitis B virus infection. This is a report of the clinical, pathologic, immunofluorescence, and immunoperoxidase studies of peculiar papular lesions that have been observed to occur during the chronic phase of hepatitis B virus infection. A total of thirteen patients positive for hepatitis B surface antigen (HBsAg) were studied. Twelve had asymptomatic, recurrent, erythematous papular lesions localized on the back, chest, and proximal areas of the upper extremities that lasted 6 to 7 days. The histopathology of these skin lesions showed a superficial and deep perivascular dermal mononuclear cell infiltrate. Immunoperoxidase studies for HBsAg and direct immunofluorescence for IgG, IgM, IgA, and C3 showed negative results. An abnormal host response to viral antigens other than HBsAg is suggested as a possible mechanism responsible for appearance of these skin lesions.