Herpesvirus infection of seborrheic keratoses

We present three examples of patients with seborrheic keratoses complicated by necrotizing herpesvirus infection, Two patients had localized cutaneous herpetic infections, and the third patient had a generalized cutaneous her pesvirus infection. Two of the lesions were: thought to be squamous cell ca rcinoma. The third was clinically identified as inflamed seborrheic keratos is. Herpesvirus infection was not clinically suspected in two of the patien ts. The histologic changes were similar in all cases, Epidermal proliferati on was accompanied by hyperkeratosis and pseudo horn cyst formation. Extens ive keratinocyte necrosis was present along with balloon degeneration of ke ratinocytes, herpetic viral inclusions, and multinucleated giant cells, Vir al lesions of molluscum contagiosum and human papillomavirus have been obse rved in benign skin proliferations. Nevertheless, we were unable to find de scriptions of herpesvirus involvement in seborrheic keratosis in a Medline search. Necrotic seborrheic keratoses should be carefully examined for the possibility of herpesvirus infection, a condition that may be improved by p rompt medical intervention as demonstrated in one of nul cases.