Author Affiliations: Department of Dermatology, Division of Dermatopathology, Naval Medical Research Unit 6, Lima, Peru (Dr Tilley); Departments of Dermatopathology (Dr Satter) and Dermatology (Dr Kakimoto) and Division of Infectious Diseases (Dr Lederman), Naval Medical Center, San Diego, California.
A 60-year-old man with refractory, low grade B-cell lymphoma and persistent neutropenia presented with multiple nontender 2- to 4-mm dome-shaped papules and pustules on his chin, ankles, and hands. Some papules were verrucous, and others, umbilicated (Figure 1). Six weeks previously, he had a herpes zoster outbreak on his left flank, which despite treatment, eventuated in disseminated skin lesions and central nervous system involvement. Lesions resolved under treatment with intravenous acyclovir, but new lesions appeared after tapering doses of the antiviral agent.
Tilley DH, Satter EK, Kakimoto CV, Lederman ER. Disseminated Verrucous Varicella Zoster With Exclusive Follicular Involvement. Arch Dermatol. 2012;148(3):405–407. doi:10.1001/archdermatol.2011.2801