Viral Skin Diseases Flashcards
Herpes Simplex Virus: HSV-1 vs. HSV-2
HSV-1 primarily infects the orofacial, HSV-2 primarily the genital
**Both can cause to either location
Infection of HSV
- via direct contact
- virus transmitted up peripheral sensory nerve to ganglia where resides in latent stage
- recurrent infection with reactivation of the virus when travels back to skin/mucous membrane
- frequency of reactivation/recurrent infection varies greatly
S/sx of HSV
- when initially infected, most have no findings/sx
- first clinical lesion is usually a recurrence
More severe s/sx of HSV
1% or less with more severe first clinical presentation, frequently with systemic signs and symptoms (for ex. gingivostomatitis, fever, lymphadenopathy, malaise)
Infectious nature of HSV
All persons infected with HSV1 and HSV2 are potentially infectious even if they have no clinical signs/sxs (asymptomatic shedding)
What is Tzanck smear?
- scraping the base of a freshly ruptured vesicle and staining the slides with Giemsa or Wright stain
- examine for the multinucleated giant cells
Dx of HSV
- Viral cx takes several days
- DFA test and PCR are the preferred method for diagnosis
HSV lesion presentation
- grouped vesicles on erythematous base
- prodrome of tingling itching burning up to 24 hrs prior
- vesicles break and form crusts or grouped erosions with scalloped border (genital)
Tx of HSV
- depends on frequency of recurrences, severity of, etc
- intermittent and suppressive therapy with acyclovir, famciclovir, valacyclovir, topical acyclovir and penciclovir
- chronic suppressive therapy reduced asx shedding by almost 95%
Common triggers of HSV
- UV exposure**
- surgical
- laser
- dental procedures
- stress
- other viral infections
Define herpes gladiatorum
- herpes transmitted between athletes involved in contact sports, wrestling.
- across the thorax, ears, face, arms, and hands
Define herpetic whitlow
- herpetic infection of finger/periungually
- can simulate a felon
What is disseminated HSV?
widespread with immunosuppression
Explain Herpes Zoster reactivation
- After primary infection or vaccination, VZV latent in sensory dorsal root ganglion
- Becomes reactivated, traveling down sensory nerve to skin, leading to the cutaneous eruption in the distribution of the affected sensory nerve(s)
MCC of Herpes Zoster
- Immunosuppression and increased age MCC**
- Induced by trauma, stress, fever, radiation therapy, or immunosuppression
Pain with Herpes Zoster
- pain often precedes: superficial itching, tingling, or burning to severe, deep, boring, or lancinating pain
- tenderness and hyperesthesia of the skin
Clinical presentation of Herpes Zoster
- Grouping of vesicles/pustules on erythematous base - nearly always unilateral limited to the area of skin innervated by one, two or more sensory ganglion
- Thoracic (>50%), trigeminal (10 to 20%), lumbosacral, and cervical (10 to 20%)
Trigeminal N and Herpes Zoster
Trigeminal nerve, particularly the 1st (ophthalmic) division- vesicles on the tip or side of the nose (Hutchinson’s sign), eye is more likely to be affected
Define Ramsay Hunt Syndrome
Facial palsy with involvement of the ear and/or oropharynx with or without tinnitus, vertigo, and deafness d/t Herpes Zoster
Visceral involvement with Herpes Zoster
Dissemination with immunosuppressed with necrosis of skin and scarring - can have visceral involvement.
What is MC complication of Herpes Zoster?
Post herpetic neuralgia-pain persists for months or years, especially in the elderly
Herpes Zoster vaccine
- Prevention with vaccine (Zostavax) rec 60 yrs or >.
- Reduce the risk herpes zoster by 51% and the risk of postherpetic neuralgia by 67%
What causes warts?
HPV (Human Papillomavirus) infection- >100 types
Define verruca vulgaris
discrete, round skin colored, papillomatous papules
Define verruca plana
minimally pigmented flat topped papules
-light brown-ish discoloration
Define verruca plantaris
- bottom of the foot
- multiple black dots on surface are thrombosed capillaries
Which HPV strains are known to cause cancer?
HPV 16, 18, 42-45 associated with cervical carcinoma, SCC to genitalia, vagina, rectal mucosa and nasopharyngeal carcinomas
HPV vaccine
HPV vaccine, Gardisil/Cervarix for girls 11-26 yo and boys from age 9
Tx of warts
refer to Letassy’s lecture
Etiology of molluscum contagiosum
- D/t Poxvirus - up to 4 types
- Sharply circumscribed, superficial, pearly, dome-shaped papillae: often umbilicated Contagious
- Teens and adults to genital area is considered an STD
Tx of molluscum contagiosum
- Spontaneous resolution 6mo-2yr
- Tx with blistering agent cantharidin, LN2, curette, topical retinoids
- *Encourages eczema flares surrounding
List the disorders associated with HIV/AIDS
- Kaposi sarcoma
- Oral hairy leukoplakia
- Eosinophilic folliculitis
- Seborrheic dermatitis
Kaposi sarcoma etiology
- *Most frequent AIDS-associated tumor in homosexual patients
- Classic KS is a Caucasian in 60s with a Mediterranean or Jewish background
- More rapid course and multifocal dissemination in HIV
Kaposi Sarcoma appearance
- Erythematous to violacious (violet in color) macules progressing to plaques/nodules
- Predilection to hard palate, face and trunk
Dx of Kaposi Sarcoma
biopsy
Oral hairy leukoplakia etiology
- Manifestation of EBV mainly in HIV but also other immunosuppressed
- > 1/3 AIDS patients
- Usually asx
Oral hairy leukoplakia appearance
- Poorly demarcated gray to white corrugated plaques usu on lateral tongue
- Not removed by scraping with tongue blade
Is oral hairy leukoplakia suggestive of malignancy?
**Not a premalignant condition but can indicate poorer HIV prognosis
Etiology of Eosinophilic Folliculitis
- Chronic pruritic dermatosis in HIV or transplant pt
- Th count <200
Appearance of Eosinophilic Folliculitis
- *Very pruritic** small pink to red, edematous, folliculocentric papules
- Pustular lesions uncommon
- Above nipple line of chest, back, neck and arms
Dx/Tx of eosinophilic folliculitis
- Bx for dx
- Tx topical steroids + antihistamines; oral prednisone; Itraconazole 200 mg BID; phototherapy; oral antivirals
Seborrheic Dermatitis etiology
- One of the most common skin manifestations in HIV (83%)***
- Can occur at any stage.
- Frequently occurs early in infection
- More extensive presentation which may include forehead and malar areas, chest, back, axillae, and groin
- Refractory to treatment
