Viral Exanthems and Viral Skin Infections

Question 1

What is the hallmark of HSV blisters and how do they differ from molluscum?

Answer 1

Herpes = blisters on an erythema base.
Umbilical crust only happens later.
Molluscum = Always have the umbilical crust even early on.

Question 2

What is similar about molluscum and eczema?

Answer 2

They are both likely to happen on a person with an atopic problem. There is already a combination of a very thin skin and an overly sensitive immune system. This makes people more prone these reactions and irritations.

Question 3

Treatment of HSV infection

Answer 3

• Acyclovir, famciclovir, valacyclovir
• used for primary and recurrent
• Suppressive therapy: frequent recurrence; decrease asymptomatic dissemination; decrease transmission

Question 4

What is characteristic about shingles?

Answer 4

It distributes in a dermatome
- thoracic dermatome
- can jump from one dermatome to the next
NB: if someone has bell’s palsy, look into the ear as well

Question 5

What is characteristic about ophthalmic zoster?

Answer 5

Very painful and can infect the eye.

Question 6

List the general characteristics of common warts

Answer 6

hyperkeratotic, mosaic, punctate micro hemorrhages, papillomatosis

Question 7

List types of warts covered:

Answer 7

Common, genital, flat/plane, digitate, plantar, genital, anal

Question 8

What is a common viral cause of warts?

Answer 8

HPV virus --> different subtypes cause the different warts
3&10 --> plantar
1 --> palmoplantar
6&8 --> genital
16&18 --> vulva etc cervical cancer

Question 9

What is seborrheic keratosis

Answer 9

common benign skin lesions
mistaken for warts
not viral
benign growth patter

Question 10

Characteristics of Plantar Warts and how they differ from corns

Answer 10

they can have a callus or corn appearance
normal surface skin lines are interrupted
treat when painful
viral cause –> HPV 3 and 10
punctate micro hemorrhages
shave –> tips of blood vessels
Corn would have a smooth hard base when shaved

Question 11

Characteristics of digitate warts?

Answer 11

digitate warts –> look like digits
occur on thin skin like on eyelids etc.
plane or flat warts –> on face or forehead –> flat ontop

Question 12

Differential diagnosis of warts?

Answer 12

Pearly penile papules –> angiofibroma, common variant on the penile head
seborrheic keratosis
Sexual abuse –> children with anal warts (or autoinoculated)

Question 13

Where do warts (HPV) like to grow

Answer 13

Genital, urethra, anal, –> moist areas

Question 14

Epidemiology of HPV

Answer 14

By age 50, about 80% have acquired genital HPV
by 25, the number ranges from 26-46%
If infection happens less that 30yo, it is likely transient
At greater than 30 –> persistent –> cervical cancer risk

Question 15

What are the guidelines for gardasil?

Answer 15

Targets HPV 6, 11, 16, 18
people between the ages of 9 and 26yo
3 injections over 6months
both males and females

Question 16

What is molluscum contagiosum?

Answer 16

multiple, dome shapes, pink papules, umilicated, caseous plug

• caused by mulloscum contagiosum virus
• can become inflamed and look like herpes simplex infection
• can be obscurred by hair
• can appear in an atopic dermatitis patient
• if seen in child, think sexual abuse

Question 17

What is erythema infectiosum?

Answer 17

slapped cheek appearance and net like pattern over the body
Caused by parvo B19
Happens most likely in children from ages 5-14yo epidemic
Blood group P antigen bone marrow cells
Assoc with polyarthropathy syndrome
Women –> itching, arthralgias and arthritis
Mimics RA in acute state
Lasts weeks to months

Question 18

What is the etiology of Hand, foot and mouth?

Answer 18

Coxsackie A16 virus, enterovirus 71

• fever cough lesions on hands, feet and buttocks
• dorsum of hand, sides of fingers, palmar surfaces
• starts as 2-10 erythematous macules which develop a gray elliptical vesicle
• also has oral lesions –> painful ulcers on a red base