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Diagnosis of Herpes Simplex

Mary Ellen Brademas, MD
JAMA. 1984;252(8):1010. doi:10.1001/jama.1984.03350080016010.
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To the Editor.—  In their article comparing the effectiveness of Tzanck smears with viral isolation in the diagnosis of cutaneous infection by herpes simplex, Solomon et al1 found that the Tzanck smear was positive in only 53.1% of examinations, whereas cultures were positive in 78.1%. Tzanck smears were performed as follows: "The lesion base was then scraped vigorously with the edge of a scalpel blade."According to A. Bernard Ackerman, MD, however, if only the base of a lesion is scraped, Tzanck preparations will be negative in some cases of indubitable infection by herpes simplex (oral communication, February 1984). The reason is that herpes infections are intraepidermal. When the vesicles become tense, they rupture, and what was at first an intraepidermal vesicle becomes subepidermal. When such a subepidermal vesicle is scraped, the smear may show only inflammatory cells.In short, to demonstrate multinucleated epithelial giant cells that are characteristic


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