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Research Article | Volume 19 Issue 2 (April-June, 2026) | Pages 151 - 154
Cutaneous Clues to Hereditary Hemochromatosis: Refractory Herpes Labialis and Atypical Facial Dermatosis
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 ,
1
College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
2
Department of Dermatology, MetroHealth Medical Center, Cleveland, Ohio, USA
3
Division of Dermatology, Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
Under a Creative Commons license
Open Access
Received
May 18, 2026
Revised
May 30, 2026
Accepted
June 1, 2026
Published
June 12, 2026
Abstract

Hereditary hemochromatosis (HH) is a genetic iron overload disorder classically associated with hepatic, endocrine, cardiac, and rheumatologic complications. Although cutaneous hyperpigmentation is well recognized, other dermatologic manifestations may serve as early clues to systemic disease. We report a 24-year-old female presenting with recurrent herpes labialis refractory to over-the-counter antiviral therapy, constitutional symptoms, and an atypical unilateral facial eruption composed of erythematous papules and pustules coalescing into crusted plaques. Despite the patient’s concern for an underlying immunocompromised state, symptoms were initially attributed to stress. The facial eruption progressed with topical clindamycin use, although resolved following empiric treatment with topical clotrimazole. The coexistence of recurrent herpes simplex virus (HSV) outbreaks and a facial eruption concerning for a fungal process prompted laboratory evaluation, which revealed elevated serum iron and transferrin saturation. Genetic testing subsequently confirmed H63D homozygous hereditary hemochromatosis. Following the discontinuation of oral contraceptive pills, restoration of physiologic menstrual blood loss, and initiation of therapeutic phlebotomy, iron indices normalized. The patient experienced marked symptomatic improvement, substantial reduction in herpes simplex virus recurrence, and complete resolution of the facial eruption. This case highlights the potential role of dermatologic findings as early indicators of systemic iron dysregulation and underscores the importance of maintaining a broad differential diagnosis in patients with persistent or atypical cutaneous presentations.

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