Introduction of a quick cytologic diagnostic tool for patients suffering from Atopic Dermatitis Please search: http://limitlessly.weebly.com/ The purpose of this website is to show the cytologic evidences, clinical courses of the HSV-AD patients treated in our clinic and to expect broaden of QTT. HOME Evidence-Based specific therapy of Atopic Dermatitis If the Quick Tzanck test (QTT) for herpes simplex virus (HSV) is positive, the itchy, miserable atopic dermatitis responds dramatically to antiviral agents.
This book introduces a diagnostic cytological technique named the Quick Tzanck Test (QTT). This book includes 27 HSV-infected patients from newborn to old age with various clinical presentations in different regions
of the skin. This book together with the content of this website proposes the usage of QTT to detect the underlying HSV infection in atopic dermatitis. It is non-invasive, simple and quick, and takes only 2 minutes. All the Dr. has to do are 1)
Remove the specimen including the epidermal sheet and vesicular content with a fine pincer.
2)
Drop enough of the modified Giemsa stain solution to cover the sample.
3)
Cover the sample with a cover glass and observe 2 minutes later.
The modified Giemsa stain solution in the bottle was made by
mixing Giemsa solution with isopropanol and propylene glycol in a ratio of 2:1:1. 1. Evidences from QTT demonstrating the immune response to HSV
infection a. Typical recurrent HSV
It is so typical clinically, nobody needs cytologic evidence for HSV infection.
The cytologic evidence revealed by QTT: besides balloon degeneration of the epidermis (circle), many degenerated dermal nerves (arrow) were observed.
Under 400X magnification, HSV-infected cells (circle) are surrounded by inflammatory infiltration.
b. atypical recurrent HSV
A nine years old girl presented with an eczematous change of redness, swelling of mouth with scaly desquamation. QTT was performed from the small vesicles (circle).
Some HSV-infected cell groups (arrows) are surrounded by severe inflammatory infiltration.
8 days after treatment with antiviral agents, anti-allergic agent and low-potency corticosteroid, she was completely recovered.
These 2 cases evidenced that positive findings from patients with multiple vesiculopapules reveal severe balloon degeneration of the epidermis and Schwann cells around the dermal nerves. The consequence of balloon degeneration is change of the HSV-infected cells into balloon cells, balloon cell nests, and giant cells. Scanty inflammatory infiltration indicates active viral proliferation. On the other hand, the stronger the degree of the cell mediated immunity in immunocompotent individuals, the greater the likelihood that HSV-infected cells will be overwhelmed by the dense inflammatory infiltration and hinder the proper diagnosis as in the 2nd case. Without QTT she may have been diagnosed clinically and pathologically as having contact dermatitis. In order to estimate how many patients suffering from HSV-associated dermatitis (HSV-AD) may have been treated as atopic dermatitis, contact dermatitis, drug eruption, or chronic urticarial, the serum IgE and HSV-IgG level of 787 QTT-positive patients were studied. They are all immunocompetent individuals who visited our skin clinic in year 2011.
There were 787 HSV-AD patients diagnosed by Quick Tzanck test, of whom 578 (73%) were also HSV IgG-positive. Patients with normal and high IgE responded well to antiviral agents in addition to previous treatment for dermatitis, which suggests that HSV-AD may include atopic dermatitis. In other words, most of the patients diagnosed as atopic dermatitis only If the QTT is positive, the itchy, disability may
respond to antiviral agents.
For detail of the QTT and cases need differential diagnosis from contact dermatitis, hand eczema, drug eruption and insect bites please consult: Hsiao L, Chien HP. The 2-minute Quick Tzanck Test to Diagnose Herpes Simplex Viral Infection.Taipei, Taiwan, HoChi Publications, 2011. [In Chinese and English.]