HSV-encoded proteins and HSV DNA can be identified within lesional skin of EM, and virally encoded antigens have been detected on keratinocytes.HSV-1 may also infect and reactivate in the cornea.As individual lesions evolve, they become hemorrhagic and then develop a more typical “punched-out” appearance ().
Mollaret's (aseptic) meningitis is a related condition caused by recurrent HSV-2 reactivation from the sacral ganglia into the spinal cord and meninges, often without accompanying genital lesions.
Patients with AD may suffer acute superimposed eruptions of umbilicated vesicular or pustular lesions due to superinfection by HSV, coxsackievirus, vaccinia virus, and variola virus.
The phenomenon has been referred to as Kaposi varicelliform eruption because of its resemblance to severe varicella infection.
When the causative agent is HSV, the condition is specifically called ; when it is vaccinia, the term eczema vaccinatum is used.
The risk of eczema vaccinatum is one of the primary reasons that smallpox vaccination is contraindicated in patients with AD.