Kaposi Sarcoma

Kaposi Sarcoma may manifest as either eczema herpeticum or as eczema vaccinatum. The former is caused by herpes simplex hominis virus (HSV-1) in primary infection and the latter by vaccinia virus. Both are complication of atopic dermatitis.

Eczema herpeticurn is a serious, sometime fatal complication of atopic eczema manifested by sudden widespread papulo-vesicular eruption often umbilicated, chiefly on the areas usually affected in atopic dermatitis with associated fever and lymphadenopathy. It can occur even in patients whose atopic dermatitis is quiescent.

Eczema vaccinatum occurs usually in a child who has recently been inadvertently vaccinated against small pox with live vaccinia virus or has come into contact with an individual with an active vaccinia lesion. Profuse clusters of umbilicated vaccinal vesicles and pustules arise on the affected skin.

Kaposi's Idiopathic Haemorrhagic Sarcoma

It is rare condition. Seen on the hands and feet of adults as reddish-brown nodules, it may result in infiltrated plaques associated with telangiectasia, soft tumors and purpuric, cystic and bullous lesions. It may involute into atrophic, pigmented scars. The lesions are painful and itchy. Metastases occur everywhere. The histology is characteristic. The treatment is unsatisfactory. Radio-therapy and excision are useful in small localized areas. Where there is extensive involvement, chemotherapy with nitrogen mustard and vinblastine can be used.

Clinical picture and symptoms of Kaposi Sarcoma usually consists of:

1. Pre-existing eczema.

2. A constitutional upset in the form of fever and malaise.

3. A sudden onset of rapidly developing vesiculo-pustules on the face, neck and extremities, less so, on the trunk. Sometimes, the lesions may be umbilicated, or impetiginized.

4. The regional, cervical and axillary lymph glands are enlarged.

Cytological examination of the smears demonstrates intranuclear inclusion bodies in herpes and intracytoplasmic in vaccinia and also typical ballooning degeneration with multinucleate giant cells in herpes simplex. Relatively milder constitutional symptoms and adenopathy and associated oral lesions will suggest herpes infection.

Treatment of Kaposi Sarcoma

Treatment consists in isolation from susceptible subjects, managing the preexisting eczema and secondary infection. Broad-spectrum antibiotics may give good results. Hyperimmune vaccinal gammaglobulin should be given in eczema vaccinatum. It may be a useful standby in eczema herpeticum. Acyclovir is worth using in cases with fresh lesions.