Advertisement

American Journal of Clinical Dermatology

, Volume 9, Issue 5, pp 295–305 | Cite as

Mucocutaneous Manifestations of Epstein-Barr Virus Infection

  • Natalia Mendoza
  • Melissa Diamantis
  • Anita Arora
  • Brenda Bartlett
  • Aron Gewirtzman
  • Anne-Marie Tremaine
  • Stephen Tyring
Review Article

Abstract

This review focuses on Epstein-Barr virus (EBV) infection, diagnosis, and current treatment, with emphasis on EBV-associated mucocutaneous manifestations in primary infections, acute EBV-associated syndromes, chronic infections, lymphoproliferative disorders, and lymphomas. In primary infection, EBV infects B cells and can cause mucocutaneous manifestations in infectious mononucleosis or acute EBV-associated syndromes such as Gianotti-Crosti syndrome and hemophagocytic syndrome. EBV then persists in the majority of humans generally without causing disease. In some cases, however, latent EBV infection may result in diseases such as hydroa vacciniforme, hypersensitivity to mosquito bites, and lymphoproliferative disorders such as plasmablas- tic lymphoma, oral hairy leukoplakia, and post-transplant lymphoproliferative disorders, particularly in immunocompromised patients. Latent EBV infection has also been implicated in a variety of malignant conditions such as Burkitt lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma, and Kikuchi histocytic necrotizing lymphadenitis. Since the immune system is critical in preventing the progression of EBV disease, the immunologic status of the patient plays a crucial role in the subsequent development of pathologies.

Keywords

Hodgkin Lymphoma Nasopharyngeal Carcinoma Burkitt Lymphoma Infectious Mononucleosis Plasmablastic Lymphoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

References

  1. 1.
    Brown RS, Campbell C, Lishman SC, et al. Plasmablastic lymphoma: a new subcategory of human immunodeficiency virus-related non-Hodgkin’s lymphoma. Clin Oncol (R Coll Radiol) 1998; 10 (5): 327–9CrossRefGoogle Scholar
  2. 2.
    Puchhammer-Stockl E, Gorzer I. Cytomegalovirus and Epstein-Barr virus sub-types: the search for clinical significance. J Clin Virol 2006; 36 (4): 239–48PubMedCrossRefGoogle Scholar
  3. 3.
    Klein E, Kis LL, Klein G. Epstein-Barr virus infection in humans: from harmless to life endangering virus-lymphocyte interactions. Oncogene 2007; 26 (9): 1297–305PubMedCrossRefGoogle Scholar
  4. 4.
    Klein G. Epstein-Barr virus strategy in normal and neoplastic B cells. Cell 1994; 77 (6): 791–3PubMedCrossRefGoogle Scholar
  5. 5.
    Epstein MA, Achong BG, Barr YM. Virus particles in cultured lymphoblasts from Burkitt’s lymphoma. Lancet 1964; 15: 702–3CrossRefGoogle Scholar
  6. 6.
    Henle G, Henle W, Diehl V. Relation of Burkitt’s tumor-associated herpes-type virus to infectious mononucleosis. Proc Natl Acad Sci USA 1968; 59 (1): 94–101PubMedCrossRefGoogle Scholar
  7. 7.
    Williams H, Crawford DH. Epstein-Barr virus: the impact of scientific advances on clinical practice. Blood 2006; 107 (3): 862–9PubMedCrossRefGoogle Scholar
  8. 8.
    National Center for Infectious Diseases. Epstein-Barr virus and infectious mononucleosis [online]. Available from URL: http://www.cdc.gov/ncidod/diseases/ebv.htm [Accessed 2008 Jun 4]
  9. 9.
    Bennett NJ, Domachowske J, Winnie GB, et al. Mononucleosis and Epstein-Barr virus infection, last updated 2007 Jul 9 [online]. Available from URL: http://www.emedicine.com/ped/topic705.htm [Accessed 2008 Jun 4]
  10. 10.
    Henle W, Henle GE, Horwitz CA. Epstein-Barr virus specific diagnostic tests in infectious mononucleosis. Human Pathol 1974; 5 (5): 551–65CrossRefGoogle Scholar
  11. 11.
    Lanier A, Bender T, Talbot M, et al. Nasopharyngeal carcinoma in Alaskan Eskimos Indians, and Aleuts: a review of cases and study of Epstein-Barr virus, HLA, and environmental risk factors. Cancer 1980; 46 (9): 2100–6PubMedCrossRefGoogle Scholar
  12. 12.
    Ebell MH. Epstein-Barr virus infectious mononucleosis. Am Fam Physician 2004; 70 (7): 1279–87PubMedGoogle Scholar
  13. 13.
    Iwatsuki K, Xu Z, Ohtsuka M, et al. Cutaneous lymphoproliferative disorders associated with Epstein-Barr virus infection: a clinical overview. J Dermatol Sci 2000; 22 (3): 181–95PubMedCrossRefGoogle Scholar
  14. 14.
    Cheng C C, Chang LY, Shao PL,et al. Clinical manifestations and quantitative analysis of virus load in Taiwanese children with Epstein-Barr virus-associated infectious mononucleosis. J Microbiol Immunol Infect 2007; 40 (3): 216–21PubMedGoogle Scholar
  15. 15.
    Rickinson AB, Moss DJ. Human cytotoxic T lymphocyte responses to Epstein-Barr virus infection. Ann Rev Immunol 1997; 15: 405–31CrossRefGoogle Scholar
  16. 16.
    Cohen JI. Epstein-Barr virus infection. N Engl J Med 2000; 343 (7): 481–92PubMedCrossRefGoogle Scholar
  17. 17.
    Amon W, Farrell PJ. Reactivation of Epstein-Barr virus from latency. Rev Med Virol 2005; 15 (3): 149–56PubMedCrossRefGoogle Scholar
  18. 18.
    Babcock GJ, Decker LL, Volk M, et al. EBV persistence in memory B cells in vivo. Immunity 1998; 9 (3): 395–404PubMedCrossRefGoogle Scholar
  19. 19.
    Brooks LA, Lear AL, Young LS, et al. Transcripts from the Epstein-Barr virus BamHI A fragment are detectable in all three forms of virus latency. J Virol 1993; 67 (6): 3182–90PubMedGoogle Scholar
  20. 20.
    Iwatsuki K, Satoh M, Yamamoto T, et al. Pathogenic link between hydroa vacciniforme and Epstein-Barr virus-associated hematologic disorders. Arch Dermatol 2006; 142 (5): 587–95PubMedCrossRefGoogle Scholar
  21. 21.
    Iwatsuki K, Ohtsuka M, Harada H, et al. Clinicopathologic manifestations of Epstein-Barr virus associated cutaneous lymphoproliferative disorders. Arch Dermatol 1997; 133 (9): 1081–6PubMedCrossRefGoogle Scholar
  22. 22.
    Iwatsuki K, Yamamoto T, Tsuji K, et al. A spectrum of clinical manifestations caused by host immune responses against Epstein-Barr virus infections. Acta Med Okayama 2004; 58 (4): 169–80PubMedGoogle Scholar
  23. 23.
    Gershburg E, Pagano JS. Epstein-Barr virus infections: prospects for treatment. J Antimicrob Chemother 2005; 56 (2): 277–81PubMedCrossRefGoogle Scholar
  24. 24.
    Peter J, Ray CG. Infectious mononucleosis. Pediatr Rev 1998; 19 (8): 276–9PubMedCrossRefGoogle Scholar
  25. 25.
    Yoda K, Sata T, Kurata T, et al. Oropharyngotonsillitis associated with nonprimary Epstein-Barr virus infection. Arch Otolaryngol Head Neck Surg 2000; 126 (2): 185–93PubMedGoogle Scholar
  26. 26.
    McCarthy JT, Hoagland RJ. Cutaneous manifestations of infectious mononucleosis. JAMA 1964; 187: 153–4PubMedCrossRefGoogle Scholar
  27. 27.
    Rea TD, Russo JE, Katon W, et al. Prospective study of the natural history of infectious mononucleosis caused by Epstein-Barr virus. J Am Board Fam Pract 2001; 14 (4): 234–42PubMedGoogle Scholar
  28. 28.
    Walling DM, Hudnall SD, Yen-Moore A. Epstein-Barr virus. In: Tyring SK, editor. Mucocutaneous manifestations of viral diseases. New York: Marcel Dekker, 2002: 145–71Google Scholar
  29. 29.
    Barnes CJ, Alio AB, Cunningham BB, et al. Epstein-Barr virus-associated genital ulcers: an under-recognized disorder. Pediatr Dermatol 2007; 24 (2): 130–4PubMedCrossRefGoogle Scholar
  30. 30.
    Sisson BA, Glick L. Genital ulceration as a presenting manifestation of infectious mononucleosis. J Pediatr Adolesc Gynecol 1998; 11 (4): 185–7PubMedCrossRefGoogle Scholar
  31. 31.
    Halvorsen JA, Brevig T, Aas T, et al. Genital ulcers as initial manifestation of Epstein-Barr virus infection: two new cases and a review of the literature. Acta Derm Venereol 2006; 86 (5): 439–42PubMedCrossRefGoogle Scholar
  32. 32.
    Caputo R, Gelmetti C, Ermacora E, et al. Gianotti-Crosti syndrome: a retrospective analysis of 308 cases. J Am Acad Dermatol 1992; 26 (2 Pt 1): 207–10PubMedCrossRefGoogle Scholar
  33. 33.
    Brandt O, Abeck D, Gianotti R, et al. Gianotti-Crosti syndrome. J Am Acad Dermatol 2006; 54 (1): 136–45PubMedCrossRefGoogle Scholar
  34. 34.
    Yen A, Fearneyhough P, Raimer SS, et al. EBV-associated Kikuchi’s histiocytic necrotizing lymphadenitis with cutaneous manifestations. J Am Acad Dermatol 1997; 36 (2 Pt 2): 342–6PubMedCrossRefGoogle Scholar
  35. 35.
    Seno A, Torigoe R, Shimoe K, et al. Kikuchi’s disease (histiocytic necrotizing lymphadenitis) with cutaneous involvement. J Am Acad Dermatol 1994; 30 (3): 504–6PubMedCrossRefGoogle Scholar
  36. 36.
    Iwatsuki K, Xu Z, Takata M, et al. The association of latent Epstein-Barr virus infection with hydroa vacciniforme. Br J Dermatol 1999; 140 (4): 715–21PubMedCrossRefGoogle Scholar
  37. 37.
    Gupta G, Man I, Kemmett D. Hydroa vacciniforme: a clinical and follow-up study of 17 cases. J Am Acad Dermatol 2000; 42 (2 Pt 1): 208–13PubMedCrossRefGoogle Scholar
  38. 38.
    Asada H. Hypersensitivity to mosquito bites: a unique pathogenic mechanism linking Epstein-Barr virus infection, allergy and oncogenesis. J Dermatol Sci 2007; 45 (3): 153–60PubMedCrossRefGoogle Scholar
  39. 39.
    Asada H, Miyagawa S, Sumikawa Y, et al. CD4+ T-lymphocyte-induced Epstein-Barr virus reactivation in a patient with severe hypersensitivity to mosquito bites and Epstein-Barr virus-infected NK cell lymphocytosis. Arch Dermatol 2003; 139 (12): 1601–7PubMedCrossRefGoogle Scholar
  40. 40.
    Greenspan JS, Greenspan D, Lennette ET, et al. Replication of Epstein-Barr virus within the epithelial cells of oral ‘hairy’ leukoplakia, an AIDS-associated lesion. N Engl J Med 1985; 313 (25): 1564–71PubMedCrossRefGoogle Scholar
  41. 41.
    Slots J, Saygun I, Sabeti M, et al. Epstein-Barr virus in oral diseases. J Periodontal Res 2006; 41 (4): 235–44PubMedCrossRefGoogle Scholar
  42. 42.
    Ranganathan K, Reddy BV, Kumarasamy N, et al. Oral lesions and conditions associated with human immunodeficiency virus infection in 300 South Indian patients. Oral Dis 2000; 6 (3): 152–7PubMedCrossRefGoogle Scholar
  43. 43.
    Kamiru HN, Naidoo S. Oral HIV lesions and oral health behaviour of HIV-positive patients attending the Queen Elizabeth II Hospital, Maseru, Lesotho. SADJ 2002; 57 (11): 479–82PubMedGoogle Scholar
  44. 44.
    Reznik DA. Oral manifestations of HIV disease. Top HIV Med 2005; 13 (5): 143–8PubMedGoogle Scholar
  45. 45.
    Itin PH. Oral hairy leukoplakia: 10 years on. Dermatology 1993; 187 (3): 159–63PubMedCrossRefGoogle Scholar
  46. 46.
    Ficarra G, Gaglioti D, Di Pietro M, et al. Oral hairy leukoplakia: clinical aspects, histologic morphology and differential diagnosis. Head Neck 1991; 13 (6): 514–21PubMedCrossRefGoogle Scholar
  47. 47.
    Migliorati CA, Jones AC, Baughman PA. Use of exfoliative cytology in the diagnosis of oral hairy leukoplakia. Oral Surg Oral Med Oral Pathol 1993; 76 (6): 704–10PubMedCrossRefGoogle Scholar
  48. 48.
    Carbone A, Gaidano G, Gloghini A, et al. AIDS-related plasmablastic lymphomas of the oral cavity and jaws: a diagnostic dilemma. Ann Otol Rhinol Laryngol 1999; 108 (1): 95–9PubMedGoogle Scholar
  49. 49.
    Flaitz CM, Nichols CM, Walling DM, et al. Plasmablastic lymphoma: an HIV-associated entity with primary oral manifestations. Oral Oncol 2002; 38 (1): 96–102PubMedCrossRefGoogle Scholar
  50. 50.
    Tan HH, Goh CL. Viral infections affecting the skin in organ transplant recipients: epidemiology and current management strategies. Am J Clin Dermatol 2006; 7 (1): 13–29PubMedCrossRefGoogle Scholar
  51. 51.
    Dunphy CH, Gardner LJ, Grosso LE, et al. Flow cytometric immunophenotyping in posttransplant lymphoproliferative disorders. Am J Clin Pathol 2002; 117 (1): 24–8PubMedCrossRefGoogle Scholar
  52. 52.
    Euvrard S, Noble CP, Kanitakis J, et al. Brief report: successive occurrence of T-cell and B-cell lymphomas after renal transplantation in a patient with multiple cutaneous squamous-cell carcinomas. N Engl J Med 1992; 327 (27): 1924–6PubMedCrossRefGoogle Scholar
  53. 53.
    Salama S. Primary ‘cutaneous’ T-cell anaplastic large cell lymphoma, CD30+, neutrophil-rich variant with subcutaneous panniculitic lesions, in a post-renal transplant patient: report of unusual case and literature review. Am J Dermatopathol 2005; 27 (3): 217–23PubMedCrossRefGoogle Scholar
  54. 54.
    Pascual J, Torrelo A, Teruel JL, et al. Cutaneous T cell lymphomas after renal transplantation. Transplantation 1992; 53 (5): 1143–5PubMedCrossRefGoogle Scholar
  55. 55.
    Tomson CR, Graham S, Hutchinson RM, et al. Sezary cell lymphoma following cyclosporin immunosuppression for renal transplantation. Nephrol Dial Transplant 1991; 6 (11):896–8PubMedCrossRefGoogle Scholar
  56. 56.
    Takahashi S, Watanabe D, Miura K, et al. Epstein-Barr virus-associated post-transplant lymphoproliferative disorder presenting with skin involvement after CD34-selected autologous peripheral blood stem cell transplantation. Eur J Dermatol 2007; 17 (3): 242–4PubMedGoogle Scholar
  57. 57.
    Pettey AA, Walsh JS. Cutaneous involvement with Burkitt-like lymphoma. Am J Dermatopathol 2007; 29 (2): 184–6PubMedCrossRefGoogle Scholar
  58. 58.
    de-Thé G, Geser A, Day NE, et al. Epidemiological evidence for causal relationship between Epstein-Barr virus and Burkitt’s lymphoma from Ugandan prospective study. Nature 1978; 274 (5673): 756–61CrossRefGoogle Scholar
  59. 59.
    Jacobson MA, Hutcheson AC, Hurray DH, et al. Cutaneous involvement by Burkitt lymphoma. J Am Acad Dermatol 2006; 54 (6): 1111–3PubMedCrossRefGoogle Scholar
  60. 60.
    Rickinson A. Epstein-Barr virus. Virus Res 2002; 82 (1-2): 109–13PubMedCrossRefGoogle Scholar
  61. 61.
    Bachmeyer C, Bazarbachi A, Rio B, et al. Specific cutaneous involvement indicating relapse of Burkitt’s lymphoma [letter]. Am J Hematol 1997; 54 (2): 176PubMedCrossRefGoogle Scholar
  62. 62.
    Weiss LM, Movahed LA, Warnke RA, et al. Detection of Epstein-Barr viral genomes in Reed-Sternberg cells of Hodgkin’s disease. New Engl J Med 1989; 320 (8): 502–6PubMedCrossRefGoogle Scholar
  63. 63.
    Landgren O, Caporaso NE. New aspects in descriptive, etiologic, and molecular epidemiology of Hodgkin’s lymphoma. Hematol Oncol Clin North Am 2007; 21 (5): 825–40PubMedCrossRefGoogle Scholar
  64. 64.
    Herbst H, Stein H, Niedobitek G. Epstein-Barr virus and CD30+ malignant lymphomas. Crit Rev Oncog 1993; 4 (2): 191–239PubMedGoogle Scholar
  65. 65.
    Glaser SL, Lin RJ, Stewart SL, et al. Epstein-Barr virus-associated Hodgkin’s disease: epidemiologic characteristics in international data. Int J Cancer 1997; 70 (4): 375–82PubMedCrossRefGoogle Scholar
  66. 66.
    Mueller N, Evans A, Harris NL, et al. Hodgkin’s disease and Epstein-Barr virus: altered antibody pattern before diagnosis. New Engl J Med 1989; 320 (11): 689–95PubMedCrossRefGoogle Scholar
  67. 67.
    Sioutos N, Kerl H, Murphy SB, et al. Primary cutaneous Hodgkin’s disease: unique clinical, morphologic, and immunophenotypic findings. Am J Dermatopathol 1994; 16 (1): 2–8PubMedCrossRefGoogle Scholar
  68. 68.
    Vasef MA, Kamel OW, Chen YY, et al. Detection of Epstein-Barr virus in multiple sites involved by Hodgkin’s disease. Am J Pathol 1995; 147 (5): 1408–15PubMedGoogle Scholar
  69. 69.
    Zeng Y, Zhang LG, Li HY, et al. Serological mass survey for early detection of nasopharyngeal carcinoma in Wuzhou City, China. Int J Cancer 1982; 29 (2): 139–41PubMedCrossRefGoogle Scholar
  70. 70.
    Pathmanathan R, Prasad U, Chandrika G, et al. Undifferentiated, nonkeratinizing, and squamous cell carcinoma of the nasopharynx: variants of Epstein-Barr virus-infected neoplasia. Am J Pathol 1995; 146 (6): 1355–67PubMedGoogle Scholar
  71. 71.
    Pathmanathan R, Prasad U, Sadler R, et al. Clonal proliferations of cells infected with Epstein-Barr virus in preinvasive lesions related to nasopharyngeal carcinoma. New Engl J Med 1995; 333 (11): 693–8PubMedCrossRefGoogle Scholar
  72. 72.
    Halprin J, Scott AL, Jacobson L, et al. Enzyme-linked immunosorbent assay of antibodies to Epstein-Barr virus nuclear and early antigens in patients with infectious mononucleosis and nasopharyngeal carcinoma. Ann Intern Med 1986; 104 (3): 331–7PubMedGoogle Scholar
  73. 73.
    Rogers R, Windust A, Gregory J. Evaluation of a novel dry latex preparation for demonstration of infectious mononucleosis heterophile antibody in comparison with three established tests. J Clin Microbiol 1999; 37 (1): 95–8PubMedGoogle Scholar
  74. 74.
    Luderer R, Kok M, Niesters HG, et al. Real-time Epstein-Barr virus PCR for the diagnosis of primary EBV infections and EBV reactivation. Mol Diagn 2005; 9 (4): 195–200PubMedCrossRefGoogle Scholar
  75. 75.
    Pitetti RD, Laus S, Wadowsky RM. Clinical evaluation of a quantitative real time polymerase chain reaction assay for diagnosis of primary Epstein-Barr virus infection in children. Pediatr Infect Dis J 2003; 22 (8): 736–9PubMedCrossRefGoogle Scholar
  76. 76.
    Brengel-Pesce K, Morand P, Schmuck A, et al. Routine use of real-time quantitative PCR for laboratory diagnosis of Epstein-Barr virus infections. J Med Virol 2002; 66 (3): 360–9PubMedCrossRefGoogle Scholar
  77. 77.
    Jackson JM. Emerging infections in dermatology. Semin Cutan Med Surg 2006; 25 (4): 201–6PubMedCrossRefGoogle Scholar
  78. 78.
    Copur MS, Deshpande A, Mleczko K, et al. Full clinical recovery after topical acyclovir treatment of Epstein-Barr virus associated cutaneous B-cell lymphoma in patient with mycosis fungoides. Croat Med J 2005; 46 (3): 458–62PubMedGoogle Scholar
  79. 79.
    Krause I, Wu R, Sherer Y, et al. In vitro antiviral and antibacterial activity of commercial intravenous immunoglobulin preparations: a potential role for adjuvant intravenous immunoglobulin therapy in infectious diseases. Transfus Med 2002; 12 (2): 133–9PubMedCrossRefGoogle Scholar
  80. 80.
    Drago F, Ranieri E, Pastorino A, et al. Epstein-Barr virus-related primary cutaneous amyloidosis: successful treatment with acyclovir and interferon-alpha. Br J Dermatol 1996; 134 (1): 170–4PubMedCrossRefGoogle Scholar
  81. 81.
    Zompi S, Tulliez M, Conti F, et al. Rituximab (anti-CD20 monoclonal antibody) for the treatment of patients with clonal lymphoproliferative disorders after orthotopic liver transplantation: a report of three cases. J Hepatol 2000; 32 (3): 521–7PubMedCrossRefGoogle Scholar
  82. 82.
    Candy B, Hotopf M. Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev 2006; (3): CD004402PubMedGoogle Scholar
  83. 83.
    Tynell E, Aurelius E, Brandell A, et al. Acyclovir and prednisolone treatment of acute infectious mononucleosis: a multicenter, double-blind, placebo-controlled study. J Infect Dis 1996; 174 (2): 324–31PubMedCrossRefGoogle Scholar
  84. 84.
    Tilly JJ, Drolet BA, Esterly NB. Lichenoid eruptions in children. J Am Acad Dermatol 2004; 51 (4): 606–24PubMedCrossRefGoogle Scholar
  85. 85.
    Lenane P, Murphy GM. Sunscreens and the photodermatoses. J Dermatolog Treat 2001; 12 (1): 53–7PubMedCrossRefGoogle Scholar
  86. 86.
    Reunala T, Brummer-Korvenkontio H, Petman L, et al. Effect of ebastine on mosquito bites. Acta Derm Venereol 1997; 77 (4): 315–6PubMedGoogle Scholar
  87. 87.
    Karppinen A, Kautiainen H, Reunala T, et al. Loratadine in the treatment of mosquito-bite-sensitive children. Allergy 2000; 55 (7): 668–71PubMedCrossRefGoogle Scholar
  88. 88.
    Reunala T, Lappalainen P, Brummer-Korvenkontio H, et al. Cutaneous reactivity to mosquito bites: effect of cetirizine and development of anti-mosquito anti-bodies. Clin Exp Allergy 1991; 21 (5): 617–22PubMedCrossRefGoogle Scholar
  89. 89.
    Greenspan D, De Souza YG, Conant MA, et al. Efficacy of desciclovir in the treatment of Epstein-Barr virus infection in oral hairy leukoplakia. J Acquir Immune Defic Syndr 1990; 3 (6): 571–8PubMedGoogle Scholar
  90. 90.
    Triantos D, Porter SR, Scully C, et al. Oral hairy leukoplakia: clinicopathologic features, pathogenesis, diagnosis, and clinical significance. Clin Infect Dis 1997; 25 (6): 1392–6PubMedCrossRefGoogle Scholar
  91. 91.
    Pastore L, De Benedittis M, Petruzzi M, et al. Efficacy of famciclovir in the treatment of oral hairy leukoplakia. Br J Dermatol 2006; 154 (2): 378–9PubMedCrossRefGoogle Scholar
  92. 92.
    Moura MD, Guimaraes TR, Fonseca LM, et al. A random clinical trial study to assess the efficiency of topical applications of podophyllin resin (25%) versus podophyllin resin (25%) together with acyclovir cream (5%) in the treatment of oral hairy leukoplakia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103 (1): 64–71PubMedCrossRefGoogle Scholar
  93. 93.
    Fraga M, Forteza J. Diagnosis of Hodgkin’s disease: an update on histopathological and immunophenotypical features. Histol Histopathol 2007; 22 (8): 923–35PubMedGoogle Scholar
  94. 94.
    Okebe JU, Lasserson TJ, Meremikwu MM, et al. Therapeutic interventions for Burkitt’s lymphoma in children. Cochrane Database Syst Rev 2006; (4): CD005198PubMedGoogle Scholar
  95. 95.
    Moutschen M, Leonard P, Sokal EM, et al. Phase I/II studies to evaluate safety and immunogenicity of a recombinant gp350 Epstein-Barr virus vaccine in healthy adults. Vaccine 2007; 25 (24): 4697–705PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Natalia Mendoza
    • 1
    • 2
  • Melissa Diamantis
    • 3
  • Anita Arora
    • 4
  • Brenda Bartlett
    • 1
  • Aron Gewirtzman
    • 1
  • Anne-Marie Tremaine
    • 1
  • Stephen Tyring
    • 4
  1. 1.Center for Clinical StudiesHoustonUSA
  2. 2.Universidad El BosqueBogotaColombia
  3. 3.University of Texas Health Science CenterHoustonUSA
  4. 4.Department of DermatologyUniversity of Texas Health Science CenterHoustonUSA

Personalised recommendations