By: Inne Arline Diana, dr, SpKK

Dermato-Venereology Department Faculty of Medicine

Padjadjaran University Bandung
 VIRAL DISEASES
• Common  children

• Mild

• Complete remission

• Often  silent infection

• Sometimes severe 
unussual susceptable patient
• Mortality rate 
 VIRAL DISEASES
OF THE ORAL CAVITY
1. Herpes simplex infections
2. Varicella
3. Herpes zoster
4. Herpangina
5. Hand, foot and mouth disease
6. Verruca
7. Molluscum contagiosum
8. Infectious mononucleosis
9. Oral hairy leukoplakia
10. Human immunodeficiency virus
 HERPES SIMPLEX
= Fever blister - cold sore, herpes febrilis,
herpes labialis, herpes genitalis

DEFINITION :
Acute viral infection caused by human
herpes virus type 1 & 2  group of vesicle
on the skin or mucocutaneous  primary or
reccurent
 ETIOLOGY
• Human herpesvirus type 1 or 2
• Type 1 (labialis) : Predilection  above waist
 mucocutaneous, especially lips
• Type 2 (genitalis) : Predilection  below waist
especially genital area
HERPES SIMPLEX LABIALIS
CLINICAL
MANIFESTATION
1. Primary infection
2. Latent infection
3. Recurrent infection
 PRIMARY INFECTION
Primary contact
5 - 8 days

Primary infection
Fever
Lymph node reg > 24 hours
Leucocytosis
Malaise
Anorexia " PRIMARY INOCULATION COMPLEX"
* Painful on the nerve
* Adenopathy regioner
1-3 Weeks * Group of vesicle on erythematous
& oedematous skin, contains
serous fluid  seropurulent
Latent phase Crusted / ulceration
 Acute herpetic gingivostomatitis:
oral pain, excess salivation, fever, and malaise

 erythema, edema, and hemorrhage

interdental papillae  other oral mucosa &
lips  diffuse painful stomatitis
 Assosiated skin lesion: occasionally a
few vesicles around mouth
 Gingivitis : occasional
 Moderate – severe
 14-21 days
 LATENT INFECTION

- Clinical symptoms (-)

- Viral  inactive  afferent nerves  the dorsal

of ganglia
 RECURRENT INFECTION

- Location : on the primary infection

- Trigger : physical trauma, local trauma,
fever, infection, sunburn,
sexual intercourse, menstruation
- Clinical manifestation :
• Mild
• Lesion : few
• Duration : shorter
• Healing in 7 days
Clinical manifestations:
• Indistinct macule on vermilion of the lip 
painful papulovesicle
• grouped papulovesicles on erythematous
base  erode to large erosion/ulcer &
covered with crust
• Heal 7-10 days without scarring
Herpetic gingivostomatitis
 LABORATORIUM

Tzanck smears :
multinucleated giant cell (+)
 TREATMENT
 Aims :
- Course of the diseases : shorter
- Time of remission : longer
- Prevention of complication

1. Topical antiviral
2. Systemic antiviral :
 acyclovir 200 mg  5x / day  7 - 10 days
3. Symptomatic therapy
 PROGNOSIS
Early treatment  better prognosis
 VARICELLA - ZOSTER VIRUS
Etiology : - VARICELLA
- HERPES ZOSTER
Varicella-zoster virus
Inhalation
R.E.S.

VIREMIA
" SILENT INFECTION" MANIFEST. VARICELLA
Immunity (+) Immunity (+)

LATENCY VIRUS
SENSORY GANGLIA
SKIN / MUCOUS
MEMBRANES

Low Low

H.ZOSTER
 VARICELLA ( CHICKEN POX )

Definition :
- Primary acute infection of varisella–
zoster virus
- Skin and mucous membranes
- Systemic symptoms (+)
-Skin lesions : polymorph
-Distribution : especially on the trunk

Etiology : Varicella – zoster virus

(Herpes virus group)
• Transmission : airborned droplets
• Commonly occur in children

• Predilection : especially on the trunk,

spreading to the face, oral mucous,
scalp, proximal extremities
(centrifugal)
CLINICAL SYMPTOMS :
- INCUBATION PERIOD 10 - 20 DAYS } R.E.S

VIREMIA I

- PRODROME } headache R.E.S.

(24 HRS) fever, malaise
VIREMIA II
- ERYTHEAMATOUS MACULES +/-
Few hours
PAPULES

- VESICLE " TEAR DROPS " + umbilicated with surrounding

erythematous hallo
5 - 20 days (+ 7 days)
CRUST
- ITCHY SENSATION
- SECONDARY INF. LYMPH NODE REGIONER
>>
 Clinical symptoms:
a few vesicopustules (scattered, few lessions),
along with the characteristic skin eruption of
chicken pox

 Predilection on the oral mucosa,

particularly in the soft palate, uvula or anterior
tonsillar pillar tissues
• Therapy : - Topical : powder, lotion, cream (skin)
- Systemic : analgetic, antipruritic,
antibiotic (if needed),
antiviral

• Complication : - Bronchopneumonia
- Secondary infections

• Prognosis : good  intact vesicle  scar (-)

 HERPES ZOSTER (SHINGLES)

Definition :
• Acute varicella-zoster viral infection
with neurocutaneous manifestation

• Reactivation viral after primary infection of

varicella

• Most commonly involves the skin but can also

affect the mucous membranes
•Transmission : Aerogen
• Incidence : Adult >>
• Predilection :
- Unilateral  especially Dermatomal C2 - L2.
nd rd
- The 2 & 3 divisions ( maxillary &

mandibulary) of the trigeminal nerve

may be involved
CLINICAL SYMPTOMS
- INCUBATION PERIOD 7 - 12 DAYS

-PRODROME 1 - 2 DAYS painful, myalgia, itchy & burning sens.

-ERYTHEMATOUS MACULE ( group & segmental papules, vesicle

 sensory nerves )
4 - 5 DAYS
CRUST

2 – 3 WEEKS
HEAL

- EACH GROUP OF LESION  DIFFERENT IN AGE

- RESOLUSION HYPERPIGMENTASION / SCAR

 Clinical symptoms
 Grouped, painful vesicles unilaterally on
the palate, gingivae and tongue

 Distribution of the lesion:

regional, unilateral and dermatomal
 Oral location : unilateral
 Gingivitis : occasional
 Assosciated skin lesions:

occasional facial involvement

 Severe pain
 14-18 days
 Multinucleated Giant cell (+)
• Supporting examinations : Lab. Tzanck Smears
Therapy :
- Topical : powder, cream
- Systemic :
- Neuroanalgetic
- Antipruritic
- Antibiotic (if needed)
- Antiviral : Acyclovir 5x400mg /day  5-7 days
• Complication : - Post herpetik neuralgia
(age > 40 year old)
 HERPANGINA
 Most painful condition of the oral cavity

 Etiology: Coxsackieviruses A1-A10

 Predilection: the soft palate, uvula &

oropharyngeal mucosa

 Children & young adults >>

 Clinical symptoms
 fever  papulovesicular grouped eruption,
yellowish white slightly raised 2 mm vesicles,
surrounded by intense areola

 headache, fever, malaise, oral & abdominal

pain, sore throat, dysphagia, anorexia

 Recovery in 1 week
 DD/ - aphthosis
- primary herpes gingivostomatitis

 Th/ symptomatic
 Oral lesion: soft palate, uvula, tonsilar
 Gingivitis (-)
 Associated skin lesion (-)
 Moderate
 5-7 days
 Multinucleated Giant cell (-)
 HAND, FOOT and MOUTH
DISEASE

 Etiology: Coxsackie virus infection

 Occur in chilhood
 Predilection: the soft palate &
oropharynx, hand and feet
 Clinical symptoms:
papulovesicles & discrete lesions
surrounded by a perilesional erythematous
halo (scattered with relatively few lesions)
 Oral location : scattered, with relatively
few lesion
 Gingivitis (-)
 Assosiated skin lesion : hands and feet
 Mild
 5-7 days
 Multinucleated Giant cell (-)
 Th/ symptomatic
 VERRUCA
 Etiology : human papillomavirus
 Predilection : lips or oral mucosa
 Young children with periungual warts
who suck their fingers >>
 Transmission: autoinokulasi
 Clinical symptoms:
white, warty growths, macerated appearance

 Treatment:
- observation for spontaneous regression
- excision
- cryotherapy
- electrodesiccation
- topical podophyllin
MOLLUSCUM CONTAGIOSUM
Definition :
- Viral infection on the skin
- Clinical manifestation :
papules with umbilicated  contain
molluscum bodies
• Etiology : DNA virus  pox virus

• Transmission
- Auto inoculation
- Direct contact
- Often in children  Atopic dermatitis
- Adult  STI
Predilection

- Children : face, conjunctiva, lips,

mouth, arms & stomach

- Adult : genital area  pubic,

perianal
 CLINICAL MANIFESTATION

- Incubation period : 1 - several weeks

- Lesion : single / multiple, small papules

spherical, dome shaped
umbilicated,  1 - 5 mm

- Early lesion : hard, solid, pink

 soft, white  sometimes with suppuration
 SUPPORTING EXAMINATION

• Histopatology
• Intracytoplasmic inclusion bodies
= Molluscum bodies
= Henderson paterson bodies
TREATMENT

1. Curretage
2. Electrocautery
3. Surgery
 INFECTIOUS MONONUCLEOSIS
 Etiology: Epstein Barr virus

 Clinical symptoms:
- oral involvement >>
- exudative pharyngitis, tonsilitis or both
- small petechiae & papulovesicles of the
palate

 Systemic symptoms: headache, malaise, fever.

Cervical adenopathy  generalized adenopathy
 ORAL HAIRY LEUKOPLAKIA

 Unique lesion accompanying severe

immunodeficiency
 Etiology : Epstein Barr virus
Clinical symptoms :
- White thickening of the lateral
margins of the tongue
- hairy surface

Usually asymptomatic  mild local

discomfort
 HUMAN IMMUNODEFICIENCY
VIRUS

 Severe immunosuppression
 Extensive & atypical mucocutaneous
manifestations
Oral lesion include:
- neoplasma (Kaposi’s sarcoma, SCC)
- infections (candidiasis, verruca,
extensive herpes simplex, oral hairy
leukoplakia, histoplasmosis and
tuberculosis)
- intractable recurrent aphthous
stomatitis