Author: Dr Brian Oh, Resident Medical Officer, Flinders Medical Centre, Australia (2026)
Edited by the DermNet content department.
A 19-year-old male with known Darier disease presented to the emergency department with a two-day history of fevers, lethargy, vomiting, and diarrhoea. In the month leading up to presentation, he noticed increased weeping and crusting on his face, neck, and chest.
The lesions can be described as monomorphic, grouped vesicles and pustules, which appear to be coalescing in areas. The more recent and intact lesions on the chest and neck show central umbilication. Older regions demonstrate erosions and crusting.
This is Kaposi varicelliform eruption. It is a disseminated cutaneous skin infection most commonly caused by herpes simplex virus type 1. It most commonly complicates atopic eczema but it can also occur in Darier disease and pemphigus.
Prompt treatment with antiviral therapy is required. Oral aciclovir 400-800 mg, five times daily, for 10-14 days or until lesions heal, is recommended. However, in this case, where the patient is unwell or too sick to take tablets, intravenous aciclovir was administered.
Systemic antibiotics should also be prescribed as prophylaxis against any superimposed secondary bacterial infection, particularly Staphylococcus aureus.
