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VIRAL INFECTIONS OF THE SKIN

Ma. Assumpta Cecilia Realubit-Serrano, MD, DPDS


Macule
Congenital white macule of nevus depigmentosus on
thigh
Papules
n the trun! of a patient with lichen nitidus
Plaques
"ith silver# scale in severe psoriasis
Nodules
$odules on the forehead of a woman with l#mphoma
Vesicles and bullae
%n a child with severe chic!enpo&
Pustules
%n a patient with inflammator# acne
Poiilode!"a
%n a patient with m#cosis fungoides ' a form of s!in
cancer
#lac esc$a!
%n a patient with invasive Rhi(opus infection
APPROACH TO THE %ERMATOLO&' PRO#LEM PATIENT
%s the diagnosis correct)
%s the histor# correct)
Prescription or over-the-counter drugs, or herbal therapies)
*Drug eruptions+
Re-evaluate ph#sical findings
Review the biops# slide #ourself
Repeat laborator# tests, biopsies, or consider new tests
Consider sending tests or biopsies to a different laborator#
or dermatopathologist
Did the patient actuall# receive the prescribed therap#)
%s the patient compliant with the therap#)
%s the dose ade,uate, or is absorption suboptimal)
%s there a drug interaction that interferes with efficac#)
%s the patient re-infected) *Scabies, S-D, etc+
Do other close contacts have the same problem) *%nfectious
agents+
%s contact with antigen continuing) *Contact dermatitis+
%s the patient irritated b# or allergic to the prescribed
therap#) *Contact dermatitis+
Reinvestigate travel, previous doctor visits and other
therapies prescribed b# others
Repeat ,uestioning about other organ s#stem s#mptoms
*Review of s#stems+
btain records from previous treating doctors to loo! for
hidden information
Relati(e Si)e and S$ape o* Vi!uses In*ectin+ Hu"ans
DNA viruses RNA viruses
Po&virus *biggest+ Param#&ovirus *biggest+
.erpesvirus rthom#&ovirus
Adenovirus Rhabdovirus
Papovavirus Reovirus
Parvovirus *smallest+ /nterovirus *smallest+
Papillo"a(i!us Li*e C,cle
Des,uamation of virus-invaded dead cells
*s,uamous+
0-gene e&pression1 virion assembl#
2egetative viral D$A amplification 3444
genomes5cell
/pisomal viral D$A *nucleus+ 634 copies5cell
%nfection of basal cells following minor abrasion
/&tensive and chronic verrucosis of the sole
causing pain when wal!ing. .P2-7a was isolated
from the lesions of this otherwise immunocompetent
and health# patient
Ve!!ucae planae or flat warts. -he warts are
s!in colored to pin!, smooth surfaced, falt papules
*.P2-34 was detected+
Cond,lo"ata acu"inata o! +enital -a!ts. -he
warts are located on the prepuce and penis shaft
8iant cond#lmata acuminta *9usch!e-
0owenstein tumor+ Cauliflower-li!e deepl#
infiltrating giant cond#lomata acuminate
0owenstein tumor+ in an older woman
#asic Pat$o+enesis o* Hu"an He!pes(i!us In*ectios
Primar# mucocutanoeus infection
%nfection of the ganglia
/stablishment of latenc#
Recurrent infection
Reactivations
THE EI&HT H/MAN HERPESVIR/SES0 THEIR
CLASSIFICATION AN% %IFFERENTIAL %/A&NOSES
Human
herpesvirus
Classification Differential Diagnosis
..erpes simple&
virus *.S2-3+
*..2-3+
.erpes simple&
virus *.S2-:+
*..2-7+
Alpha
herpesvirinae
rolabial herpes;
herpangina, aphthous
stomatitis, Stevens-<ohnson
s#ndrome, phar#ngitis *e.g.
due to /92+, oral
candidiasis, mucositis
secondar# to chemotherap#
8enital trauma chancre
*primar# s#philis+, aphthae,
chancroid, granuloma
inguinale
2aricella (oster
virus *2:2+
*..2-=+
Alpha
herpesvirinae
2aricella1 vesicular viral
e&anthema */C.,
Co&sac!ie+, P0/2A,
ric!ettsial po&, .S2, insect
bites, drug eruption, scabies,
contact dermatitis, smallpo&
.erpes (oster1 (osteriform
.S2, locali(ed contact
dermatitis,
ph#tophotodermatitis,
bullous impetigo
/pstein-9arr virus
*..2->+
8amma
herpesvirinae
8roup-A streptococcal
infection, acute viral
hepatitis, anti-convulsant
h#persensitivit# s#ndromes,
to&oplasmosis, l#mphoma,
and primar# CM2, ..2-?,
.%2 infection
C#tomegalovirus
*..2-@+
9eta
herpesvirinae
/92-induced infectious
mononucleosis,
to&oplasmosis, viral
hepatitis, l#mphoma
.uman
herpesvirus ?
*..2-?+
8amma
herpesvirinae
2iral e&anthems *measles,
enterovirus infections,
adenovirus, /pstein-9arr
virus, rubella, parvovirus+,
scarlet fever, Roc!#
Mountain spotted fever,
Aawasa!i disease
.uman
herpesvirus B
*..2-B+
8amma
herpesvirinae
Similar to ..2-?
.uman
herpesvirus C
*..2-C+
8amma
herpesvirinae
Acroangiodermatitis
*pseudo-AS+, bacillar#
angiomatosis, ecch#mosis,
hemangioma, angiosarcoma,
p#ogenic granuloma,
psuedol#mphoma5l#mphoma
ANTIVIRAL THERAP' FOR HERPES SIMPLE1 VIR/S AN%
VARICELLA 2OSTER VIR/S
D%S/AS/ C$-/D- Drug and dosage
Herpes simplex infections
rolabial herpes *recurrence+
8enital herpes *first episode+
8enital herpes *recurrence+
Chronic suppression
$eonatal
%mmunocompromised
Ac#clovir-resistant .S2 in
immunocompromised patients
Penciclovir1 3E cream applied ,7
hours & > da#s
2alac#clovir 7 g P bid & 3 da#
Ac#clovir1 744 mg P @&5d & 34
da#s or >44 mg P tid & 34 da#s
Famciclovir1 7@4 mg P tid & 34
da#s
2alac#clovir1 3 g P bid & 34
da#s
Ac#clovir 1 744mg P @&5d & @
da#s or >44 mg P tid & @ da#s
Famciclovir1 37@ mg P bid & @
da#s
2alac#clovir1 @44 mg P bid & =-
@ da#s
Ac#clovir1 >44 mg P bid
Famciclovir1 7@4 mg P bid
2alac#clovir1 @44 mg P ,d for
634 outbrea!5#r or3 g P ,d for
34 or more outbrea!s5#r
Ac#clovir1 34 mg5!g %2 ,C hours
& 34-73 da#s
Ac#clovir1 >44 mg P @&5d&B-3>
da#s or @ mg5!g %2 ,C hours & B-
3> da#s
Famciclovir1 @44 mg P bid
Foscamet1 >4 mg5!g %2 ,C-37
hours & 7-= wee!s *or until all
lesions are healed+
Cidofovir1 3E cream ,d & 7-=
wee!s
Varicella zoster virus infections
2aricella
:oster
Ac#clovir1 74 mg5!g *C44 mg
ma&+ P ,id & @ da#s
Ac#clovir1 C44 mg P @&5d & B-
34 da#s
Famciclovir1 @44 mg P tid & B
da#s
Adult immunocompromised
Pediatric immunocompromised
Ac#clovir1 34 mg5!g *@44 mg5m
7
+
%2 ,C hours & B-34 da#s
Ac#clovir1 34 mg5!g *@44 mg5m
7
+
%2 ,C hours & B-34 da#s
%$-RDGC-%$
"hat are viruses)
o %nfectious agent
o Hobligate intracellular parasiteI
o Composition
PA-.8/$/S%S
3. Direct %noculations
7. S#stemic infection
=. 0ocal Spread
M/C.A$%SM F PA-.08J
3. Blister K necrosis
/&1 .erpes and Po&
7. Growth K proliferation
/&1 Papova and Molluscum
=. xanthem ! blood vessel r&n
x" R$A viruses
"hat are the viruses that cause s!in diseases)
D$A viruses K specific s!in lesions
R$A viruses K non-specific s!in lesions
RNA VIR/SES
3. M#&ovirus K Measles, Mumps
7. Rhabdovirus K 2esicular stomatitis
=. -ogavirus K Rubella
>. Picornavirus
- Co&sac!ie A and 9 K .FMD, .erpangitis,
/&anthem
- /chovirus K /&anthem
#easles
HRubeolaI
Caused b# a Param#&ovirus
Gniversal, highl# contagious, acute
Childhood
Florid, generali(ed maculopapular rash
Preceded b# high fever, cough, cor#(a,
conLunctivitis M Aopli!Ns spots
Ru$ella
H8erman measlesI
Caused b# a -ogavirus
Children5#oung adults
Pin!-red macules and papules spreads
centrifugall#, lasts for 7-= da#s followed b#
des,uamation
Mild prodrome, l#mphadenopath#
Hand%&oot%#outh Disease
Caused b# Co&sac!ie A3? or /nterovirus B3
Characteristic vesicular lesion in mouth *hard palate,
tongue, and buccal mucosa+ and e&tremities
*handsOpalms, dorsumOpalms5soles+
%NA VIR/SES
3. Po& virus K 2ariola, 2accinia, Molluscum
contagiosum, Mil!erNs $odules, Paravaccinia,
/cth#ma contagiosum
7. .erpes virus K .erpes simple&, /92, CM2,
2aricella5.erpes (oster
=. Papova virus K "arts *2erruca vulgaris, 2erruca
plana, 2erruca plantaris, Cond#loma acuminate,
9owenoid papulosis, 9usch!e-0owenstein tumor,
/pithelioma cuniculatum+
Po& 2irus
#olluscum Contagiosum
Common, benign
8enerall# affects children
Person to person spread5fomites
/tio1 Molluscum contagiosum virus
o A po&virus
o MC2 % and MC2 %% strains
Resolve spontaneousl# K ?-P mos or t&1
e&traction
#il'er(s Nodules
9enign viral disease
-ransmitted to cattle handlers
/tio1 paravaccinia po&virus *pseudocowpo&
in infected cows+
Self-limited
-&1 s#mptomatic
.erpes 2irus
Herpes )implex
S#non#ms K Hcold soresI
- Hfever blistersI
- Hherpes labialisI
/tiolog#
.erpes virus hominis
o -#pe 3 and -#pe 7
o Composed of1
- D$A genome
- protein coat
- lipid envelope
Herpes *oster
S#non#ms1
o HshinglesI
o H(osterI
A locali(ed disease limited to dermatome levels
/lderl# people
Result of reactivation of latent endogenous
infection
Pathogenesis
o 2:2 from s!in *healed 2aricella+
sensor# ganglion *harmless, silent+
reactivation s!in
o +rimar, Viremia1 virus respirator#
tract blood R/S
o )econdar, Viremia1 R/S blood
*fever+ s!in *vesicles+
-reatment1
o S#mptomatic and supportive
o Antivirals
o %nterferon
Papovavirus
-arts
S#non#ms
o Hcommon wartI
o Hflat wartI
o Hplantar wartI
o Hgenital wartsI
-reatment1
o Reassurance *spontaneous resolution+
o Ph#sical and Chemical Destruction
o Resistant wart treatment
3EN%3