A report describes a case of a 19-year-old male who presented with extensive facial skin lesions and fever for 3 days. He reported a 3 years history of moderate and severe acne, treated with topical 0.025% tretinoin cream and fusidic acid cream and also with oral minocycline. Treatment resulted in the subsiding of facial follicular papules and acne-like lesions; however, it left atrophic scars on the lesion area. 

He then visited an individual cosmetic clinic to improve the atrophic scars, where he received skin microneedling plus platelet-rich plasma therapy before this onset. The following day after receiving therapy, he experienced burning and tingling over his face and also developed eruptions, but he could not contact his doctor. In the next 24 hours, he experienced a rapid expansion of his facial lesions with fever and approached another team of experts. They confirmed the history of herpes simplex. 

Physical examination revealed diffuse papulovesicle and pustules with erosion, exudation, and little scabs on the face, distributed along the treatment site. Laboratory findings displayed the absolute values of white blood cells, neutrophils and erythrocyte sedimentation rate (ESR) within the normal range, except for the increase in the lymphocytes. The polymerase-chain-reaction (PCR) assay from the specimen of the blister fluid from the lesion showed a positive reaction for herpes simplex virus type 1 (HSV-1) and the positive findings of HSV-1 IgM and IgG antibody in peripheral blood. 

All the aforementioned findings pointed to a diagnosis of eczema herpeticum. Subsequently, the patient received the treatment of valaciclovir (1 g, twice a day for 7 days) and showed regression of skin lesions in telemedicine follow-up. His 3 months follow-up showed no evidence of recurrence.

Source: Wu R, Leng M, Sa Q, et al. Eczema herpeticum following skin microneedling plus platelet-rich plasma therapy in a patient with atrophic acne scars. Clin Cosmet Investig Dermatol. 2022;15:653-5.