Epstein-Barr virus involvement in the pathogenesis of hydroa vacciniforme: an assessment of seven adult patients with long-term follow-up.
BACKGROUND
Hydroa vacciniforme (HV) is a chronic papulovesicular photodermatosis of childhood, with some cases persisting through adulthood. In children, the Epstein-Barr virus (EBV) has been detected in typical HV and in HV evolving into natural killer/T-cell lymphoma. No exploration of EBV infection has been performed in adult patients with HV with long-term follow-up.


OBJECTIVE
To assess EBV infection systematically in blood and in experimentally photoinduced lesions in adult patients with HV.


METHODS
Repeated tests for EBV DNA blood load using real-time polymerase chain reaction (PCR) and serological EBV tests were performed in seven adult patients with long-term follow-up. Skin samples from phototest-induced lesions and surrounding normal skin were studied using PCR, in situ hybridization and electron microscopy. ZEBRA protein was detected using immunostaining. Thirty-five patients with other photosensitive disorders were included as controls.


RESULTS
The EBV DNA blood load was strongly positive in the seven patients with HV and negative in 34 of 35 of the patients with other photosensitive disorders (P < 0.001). The levels were higher in photosensitive patients with HV than in patients with HV in clinical remission. Ultrastructurally, viral particles were detected in lymphocytes and also in keratinocytes in three experimentally phototest-induced lesions; they were not found in the surrounding normal skin. ZEBRA protein was also detected in phototest-induced lesions, but not in the surrounding normal skin.


CONCLUSIONS
EBV is involved in HV pathogenesis and persists in adult patients with HV. A positive EBV DNA load, specific to HV in the spectrum of photosensitive disorders, might be a useful biomarker in HV.
Verneuil
L
L
Department of Dermatology, CHU Caen, Avenue Georges Clemenceau, Caen F-14033, France. verneuil-l@chu-caen.fr
Gouarin
S
S
Comoz
F
F
Agbalika
F
F
Creveuil
C
C
Varna
M
M
Vabret
A
A
Janin
A
A
Leroy
D
D
D000293:Adolescent; D000328:Adult; D015415:Biomarkers; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D006837:Hydroa Vacciniforme / Q000473:pathology / Q000821:virology*; D008297:Male; D012720:Severity of Illness Index; D055815:Young Adult
D015415:Biomarkers