Viral infections of the skin

By

Hamza Abdel-Raouf

Professor of Dermatology,

Minia University, Minia - Egypt

Viral Skin infections

1- Herpes Simplex virus

2- Varicella Zoster virus

3- Warts

4- Molluscum Contagiosum

Common Criteria of Herpetic infections

1- clinical recovery

2- no viral eradication

3- dormant

4- reactivation

5- 2ry attack

Herpes Simplex

Aetiology

Type 1 (HSV-1): non genital infections

Type- 2 (HSV-2): genital infections

Incubation peroid

2 - 5 days

Mode of infection

1- droplet infection

2- direct contact

Primary attack of Herpes Simplex

1- no previous infection

2- no neutralizing antibodies

3- usually subclinical

4- constitutional symptoms

Lesions of primary attack of Herpes Simplex

1- vesicles and bullae on an erythematous edematous base affecting certain sites

2- no tendency to grouping

3- enlarged and tender L.N.

Clinical types

1- Gingivo-stomatitis

2- Kerato-conjunctivitis

3- Herpes progentalis

4- Anorectal

5- inoculation Herpes (Herpetic

whitlow)

6- Neonatal Herpes

1- acquired during birth

2- maternal herpes

3- 50% mortality

4- C.S. Is indicated

5- ttt by IV acyclovoir

7- Eczema Herpeticum

1- HS in atopic patient

2- generalized lesions regardless their atopic status whether active or not

Fate of the primary infection

1- spontaneous recovery within 7 days

2- latent (dormant) in sensory ganglia

3- re-activation

4- 2ry attack

Triggering factors

1- fever

2- URTI

3- menses

4- exposure to sun

5- emotional stress

6- GIT disturbance

symptoms

1- no constitutional symptoma

2- tingling sensation

Lession of 2ry attack of HS

1- grouped vesicles on erythematous and edematous base

2- no LN enlargement

3- clear, cloudy, crust

4- normal skin on recovery

Clinical types of 2ry attack

1- Herpes Facialis

2- Herpetic kerato-conjunctivitis

3- Herpes gentalis

Herpes Simplex

Diagnosis

1- Clinical picture

2- Tzank Smear

3- Histopatholoy

Treatment of Herpes Simplex

1- topical ttt

2- systemic ttt

Topical treatment of Herpes Simplex

1- Gentian violet 2%

2- Boric acid 2 – 4%

3- topical antibiotic

4- topical Acyclovir

Systemic treatment of Herpes Simplex

1- Antibiotics

2- Acyclovir 400 mg/ 4 hours for 7 days

Thank You

Varicella Zoster

Common Criteria of Herpetic infections

1- clinical recovery

2- no viral eradication

3- dormant

4- reactivation

5- 2ry attack

Varicella (chickenpox)

Aetiology

It is a primary infection with Varicella Zoster virus

Incubation peroid

2 - 3 weeks

Mode of infection

1- droplet infection

2- direct contact

Symptoms

1- mild fever

2- malaise

3- Anorexia

4- itching

Site

1- trunk

2- mucous membrane

Lesions of Varicella

1- sudden appearance

2- in crops

3- pleomorphic

Fate of the primary infection

1- spontaneous recovery within 7-10 days

2- crusts fall leaving normal skin.

3- scarring only with 2ry bacterial infction

4- latent (dormant) in sensory ganglia

Chickenpox and pregnancy

- Infection with VZV during pregnancy

-- congenital anomalies

-- fetal chickenpox

Varicella

Diagnosis

1- Clinical picture

2- Tzank Smear

3- Histopatholoy

Treatment of Varicella

1- topical ttt

2- systemic ttt

Topical treatment of Herpes Simplex

1- soothing and drying agent (calamine)

2- topical antibiotic

Systemic treatment of Varicella

1- Antibiotics

2- antihistaminic agent for itching

3- Acyclovir 800 mg/ 4 hours for 7 days

Herpes Zoster

Reactivation of latent VZV in the dorsal root or cranial nerve ganglion cells

Triggering factors

1- radiation therapy

2- neoplasm

3- immunosuppressive drugs

Symptoms

Pain

Site

1- unilateral

2- dermatomal

Lesions of H. Z

1- grouped vesicles on an erythematous edematous base

2- along the distribution of sensory nerve

3- tender L N

Herpes Zoster Ophthalmicus

Lesions on the tip of nose are associated with involvement of nasociliary branch of the ophthalmic division of trigeminal nerve with the occurrence of Kerato-conjunctivitis

Ramzy Hunt Syndrome

Lesions on the ear pinna are associated with affection of the geniculate ganglia (VII nerve) leading to

- 1- ear pain

- 2- loss of taste ant 2/3 of tongue

- 3- facial palsy

Disseminated H Z

- IMMUNOCOMPROMIZED

- HODGKIN’S LYMPHOMA

Fate of H Z

1- spontaneous recovery within 7-15 days

2- crusts fall leaving normal skin.

3- scarring may occur with or without 2ry bacterial infection

4- post-herpetic neuralgia

Herpes Zoster

Diagnosis

1- Clinical picture

2- Tzank Smear

3- Histopatholoy

Treatment of H Z

1- topical ttt

2- systemic ttt

Topical treatment of Herpes Simplex

1- soothing and drying agent (calamine)

2- topical antibiotic

Systemic treatment of Varicella

1- Analgesics

2- Antibiotics

3- Acyclovir 800 mg/ 4 hours for 7-10 days

Warts (Verrucae)

- Common benign tumor

- Caused by Human Papilloma Virus (HPV)

MODE OF TRANSMISSION

DIRECT CONTACT

AUTO-INOCULATION

Common Warts (Verruca Vulgaris)

- Asymptomatic

-- Hands and sites of trauma

-- hyperkeratotic papules, rough papillary surface, dry, skin coloured or darker, usually multiple.

Plane Warts (Verruca Plana)

- Common in children

- face and back of hands

-- flat-topped papules, dry, skin coloured or darker, in tens or hundreds.

Filiform Warts (Verruca Filiformis)

- Asymptomatic

- neck and eyelids

- long slender growths

Plantar and Palmar Warts (Verruca plataris and palmaris)

- Painful and tender (pressure on nerve)

- palms and soles

- exophytic or usually endophytic, single or multiple.

Genital Warts (Condyloma Acuminata)

- Usually STDs

- Genital area peri-anal, and pubic area

-- pedunculated, soft, friable lobulated mass (cauliflower), bright red and bleeds easily on touch.

Verruca Vulgaris

Treatment of Warts

- Electrocautery

- Cryotherapy

- Laser therapy

Topical Treatment of Warts

- Topical Retinoic acid derivatives

- Topical Salicylic acid (3 – 6%)

-- Topical saliclic and lactic acid

- Topical TCA

- Podophyllin 15%

- Imiquimod cream stimulates local IFN production

Molluscum Contagiosum

Molluscum Contagiosum

Aetiology

Pox virus

Mode of infection

1- direct contact

2- indirect contact (toilet seats)

3 STDs

Clinical picture of Molluscum Contagiosum

- common in children

- face, neck, trunk

- usually multiple

- pearly white smooth, round and slightly umbilicated papules. On squeezing a white cheesy material can be expressed.

Molluscum Contagiosum

Treatment of Molluscum

- Simple mechanical expression

- Electrocautery

- Cryotherapy

- Laser therapy

- Chemical cautery: conc phenol

Thank you