Recurrent scarring papulovesicular lesions on sun-exposed skin in a 22-year-old man

Key teaching points
- Typical HV is a self-limited EBV-associated disorder of children and adolescents characterized by recurrent outbreaks of scarring papulovesicular lesions. The criterion standard diagnostic test is biopsy of an active lesion showing reticular degeneration and demonstrating EBV RNA (EBER positivity) in lymphocytes.
- Avoiding sun exposure by using photoprotection can reduce outbreaks.
- Patients typically have high levels of circulating EBV DNA, which is best detected from whole blood rather than from serum or plasma.
- In patients with persistent skin disease activity, following EBV DNA levels in the blood can help assess for the development of aggressive systemic disease.
- Severe HV disease associated with chronic active EBV may progress to lymphoproliferative disorders or lymphoma with increased mortality.