Inflammatory Blistering Diseases

Question 1

Herpes Simplex

Answer 1

Group of vesicles on a red base which rapidly become purulent and crusted
HSV 1: Primary infection usually occurs in childhood with lesions on the lips or face
HSV 2: STD of adults involving the genital area, primary infection extensive, painful vesiculations and necrosis
Seropositivity rate general popluation Type 1 ~ 85%
Recurrence: Greater Type 2
Treatment Options: Anti-viral (Zovirax) and contagion prevention
Special Cases: Immunosuppressed, Eczema herpeticum

Question 2

Herpes Simplex 1

Answer 2

Transmitted during childhood via nonsexual contact
90% of recurrrent HSV 1 infections cause the orofacial lesions called herpes labialis
Treatment with oral acyclovir
Recurrent treatment with acyclovir, famciclovir and valacyclovir

Question 3

Herpes Simplex 2

Answer 3

Recurrent, lifelong disease with no cure
Viral culture is preferred for diagnosis
First episode infections are more extensive
Treatment for initial, episodic and suppression
RX: Acyclovir, Famciclovir and Valcyclovir

Question 4

Varicella

Answer 4

Herpes varicella – zoster virus
Incubation: average 14 days
Prodrome: fever, chills, malaise, 2-3 days before onset of rash
Hallmark of clinical exam – “dew drop on a rose petal”

Primary infection with varicella zoster virus with generalized eruption of successive crops of 2-3 mm size vesicles, more prominent on the trunk
Lesions rapidly become pustules and crust
Spread is by respiratory droplets

2-3 week incubation period
2-3 day prodrome with fever, chills headache, malaise, dry cough
Major complications: encephalitis, pneumonia, hepatitis, Reye’s syndrome

Immunization:
Children who have never had chickenpox
should receive 2 doses:
1st dose at 12-15 months
2nd dose at 4-6 years
People over 13 years of age who have never had
chickenpox should receive 2 doses at least
28 days apart

Question 5

Herpes Zoster (Shingles)

Answer 5

Recurrence of varicella
Following nerve root – single dermatome
Prodrome: pain along nerve root up to 5 days prior to rash
Cross dermatomal spread – up to 30 vesicles with diagnosis of dissemination
Dissemination: Rule out immunosuppression (cancer, HIV, connective tissue disease)
Treatment options: Acyclovir, Prednisone,
IV Acyclovir

Vesicular eruption in a dermatomal distribution caused by recrudescence of the latent varicella-zoster virus
“Chickenpox the second time around.”
Prodrome or radicular pain.
Incidence, severity and persistence of pain increase with age.

Immunization:
Zostavax-live, attenuated vaccine for
prevention of herpes zoster in patients
aged 50 and over
Treat within 48 H to decrease Postherpetic Neuralgia