7/28/2019 Topic 10. Skin Diseases Caused by Varicella Zoster Virus

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Efi. Gelerstein 2011

Topic 10. Skin diseases caused by varicella zoster virus

Cause

Spread by respiratory route; its incubation period is ~ 14 days. Second infection or reactivationPresentation and course

Sensory ganglions are affected dermatomes, nerve segments Unilateral spread of painful vesicles on red base Papules + Slight malaise papules turn rapidly into clear

vesicles w/ pustular content lesions crust and then clear,

sometimes leaving white depressed scars

Prodromal stage, provoking agents Special localizations:

1. nerves V/1comeal ulcers2. V/2,3aptha, deafness3. N. facialis paresis = Ramsay-Hunt syndrome.

Lesions appear in crops, are often itchy, and are most profuse on the trunk and least profuse on theperiphery of the limbs (centripetal

Varicella can be fatal in those who are immunologically compromisedComplications

Pneumonitis, with pulmonary opacities on X-ray. Secondary infection of skin lesions. Scarring.Differential diagnosis

Smallpox, mainly centrifugal anyway, has beenuniversally eradicated, and the diagnosis of chickenpox

is seldom in doubt.

Treatment

Acyclovir, famciclovirand valaciclovirshould be reservedfor severe attacks and for immunocompromised patients (prophylactic acyclovir)

A live attenuated vaccine is now available

7/28/2019 Topic 10. Skin Diseases Caused by Varicella Zoster Virus

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Efi. Gelerstein 2011

Herpes zoster (Shingles)

Reactivation for no obvious reason of virus that has remaineddormant in a sensory root ganglion since an earlier episode of

chickenpox (varicella).

Incidence of shingles is highest in:1. Old age2. Hodgkins disease3. AIDS4. Leukaemia (weak defense)

Presentation and course

Attacks usually start with a burning pain followed by erythemaand grouped, sometimes blood-filled, vesicles scattered over a

dermatome.

The clear vesicles quickly become purulent, and over the space of afew days burst and crust. Scabs usually separate in 23 weeks,sometimes leaving depressed depigmented scars.

Zoster is characteristically unilateral. It may affect more than oneadjacent dermatome.

Complications

Secondary bacterial infection is common. Motor nerve involvement (uncommon) paralysis of ocular muscles, facial muscles, diaphragm and

the bladder.

Ophthalmic division of the trigeminal nerve corneal ulcers and scarring. Persistent neuralgic pain, after the acute episode is over, is most common in the elderly. Other complications:

1. Zoster hemorrhagicus2. Zoster gangrenous3. Zoster ophtalmicus4. Zoster generalisatus5. Zoster post-herpetic neuralgia

Therapy:

Antiviral (acyclovir, valacyclovir, famcyclovir) Vitamin B NSAID Glucocorticoids