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Immunohistochemistry in the Diagnosis of Cutaneous Viral Infections—Part I. Cutaneous Viral Infections by Herpesviruses and Papillomaviruses

Molina-Ruiz, Ana M. MD*; Santonja, Carlos MD; Rütten, Arno MD; Cerroni, Lorenzo MD§; Kutzner, Heinz MD; Requena, Luis MD*

The American Journal of Dermatopathology: January 2015 - Volume 37 - Issue 1 - p 1–14
doi: 10.1097/DAD.0000000000000203
CME Article

Background: Cutaneous viral infections are of increasing clinical importance, particularly in patients who are immunocompromised.

Objective: The use of immunohistochemistry (IHC) in the diagnosis of cutaneous infections provides a rapid morphological diagnosis and can be applied to confirm the diagnosis of specific viral infections that may be difficult to diagnose with certainty using routine microscopy alone, thus facilitating clinical decisions in patient care.

Methods: Several immunostains for specific viruses that have been useful in dermatopathology are reviewed. Emphasis is placed on new stains and novel uses of existing stains.

Results: This article is an up-to-date overview of the potential uses and limitations of IHC in the histopathologic diagnosis of cutaneous viral infections by herpesviruses and papillomaviruses.

Limitations: Whereas specific monoclonal antibodies effectively distinguish infections by herpes simplex virus-1, herpes simplex virus-2, varicella zoster virus, Epstein–Barr virus, and cytomegalovirus, IHC does not distinguish between the 120 antigenically distinct strains of human papillomavirus.

Conclusions: IHC may assist dermatopathologists to appropriately diagnose viral infections caused by herpesviruses and papillomaviruses.

*Associate Professor of Dermatology and Dermatologist (Dr Molina-Ruiz), Chairman and Professor of Dermatology (Dr Requena), Department of Dermatology;

Pathologist, Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain;

Dermatopathologist, Dermatophatologisches Gemeinschaftslabor, Friedrichshafen, Germany; and

§Director of Dermatopathology and Professor of Dermatology, Department of Dermatology, Medical University of Graz, Austria.

Reprints: Luis Requena, MD, Department of Dermatology, Fundación Jiménez Díaz, Avenida Reyes Católicos 2, Madrid 28040, Spain (e-mail:

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

© 2015 by Lippincott Williams & Wilkins.