Viral Skin and Soft Tissue Infections

Question 1

Which strain of herpes simplex virus typically causes mouth ulcers and which typically causes genital ulcers?

Answer 1

HSV-1 - mouth ulcers

HSV-2 or -1 cause genital ulcers

Question 2

Describe the presentation of HSV ulcers?

Answer 2

Painful cluster of blisters on the face, pharyngeal or oral mucosa for HSV-1 or on genitalia for HSV-2.
There may be associated with tingling and burning prior to blister development, then blisters crust and heal within 10 days.
It may be induced by UV light or trauma.

Question 3

How is HSV infection treated/

Answer 3

Oral antivirals (Aciclovir, valaciclovir)
Analgesia
Long-term suppressive antivirals if recurrent infection

Question 4

Complications of HSV infection are rare but can include..?

Answer 4

Oesophagitis
Erythema multiforme
Hepatitis
Meningitis
Encephalitis
Treatment failure
Recurrence Bell's palsy
Acute retinal necrosis

Question 5

In which groups of patients is there increased risk of adverse outcome in VSV infection?

Answer 5

Adults
Immunocompromised individuals
Pregnancy

Question 6

What is the management of VSV infection?

Answer 6

Supportive care - antipyrexials, emollients, antihistamines

Oral / Iv antivirals only if individual is at high risk of severe disease

Question 7

What are the potential complications of VSV infection?

Answer 7

Pneumonia
Hepatitis
Secondary bacterial infection
Neurological sequelae
Death

Question 8

Describe the classical presentation of shingles?

Answer 8

Erythematous macular rash in a dermatomal distribution
Severe constant or intermittent burning, stabbing or throbbing pain
Vesicles develop within 1-2 days, last 3-4 days then resolve with pustulation, ulceration and crusting

Question 9

What are the risk factors for the reaction of VSV resulting in shingles?

Answer 9

Age >50 years
HIV
Chronic steroid use
Chemotherapy
Malignancy

Question 10

What is the management of shingles?

Answer 10

Oral antivirals
Oral / IV and topical analgesia
Other supportive care
Ophthalmology referral if there is eye involvement

Question 11

Describe the appearance of viral warts.

Answer 11

Elevated, round, hyperkeratotic papules
Rough greyish / white / light brown surface
Tiny black dots revealed on light paring
Typically found on fingers, hand, periungal areas, elbows, knees, feet
(Often flattened by pressure when on feet)

Question 12

What features of a viral wart should warrant biopsy to look for cancer?

Answer 12

Rapidly progressing / enlarging lesion
Non-healing
Lack of treatment response 
Bleeding 
Crateriform appearance

Question 13

How are viral warts managed?

Answer 13

Watchful waiting (particularly in children who may not tolerant Tx)
Removal with debridement, salicylic acid, cryotherapy, silver nitrate solution