Viral Skin Diseases Flashcards
(42 cards)
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
