Viral infections

Viruses of dermatologic interest Nucleic acidVirus groupVirus disease DNA HerpesHerpes simplex Chicken pox Herpes zoster PapillomaWarts PoxMolluscum contagiosum RNARetrovirusesAIDS Majdy Naim Viral infections 2

Viral infections Majdy Naim Viral infections 3 Herpes simplex Herpes zoster Warts Molluscum contagiosum AIDS

Herpes simplex A very common acute/ self-limiting vesicular eruption due to infection with Herpesvirus hominis Majdy Naim Viral infections 4

Types of Herpes simplex Majdy Naim Viral infections 5 Type 1: Facial and oral infection Type 2: Genital infection

Pathogenesis of Herpes simplex Majdy Naim Viral infections 6 The virus penetrates the epidermis especially through traumatized skin or mucous membrane epithelium and replicates within the epithelial cells. This produces the primary infection, witch is clinically inapparent in 99% of cases. After the primary infection, the latent non-replicating virus resides within the dorsal root ganglion Descending through the peripheral nerve to the skin at time of reactivation can occure ( recurrence )

Clinical varieties Majdy Naim Viral infections 7 Herpes labialis Herpes genitalis Herpetic gingivostomatitis Eczema herpeticum Disseminated herpes simplex

Herpes labialis Majdy Naim Viral infections 8

Herpes genitalis Majdy Naim Viral infections 9

Herpetic gingivostomatitis Majdy Naim Viral infections 10

Predisposing factors of Herpes simplex Majdy Naim Viral infections 11 Fever Trauma Sun light Menstruation Psychic stress Immunodeficiency

Treatment Majdy Naim Viral infections 12 Prevention Topical antiviral therapy Systemic antiviral therapy in severe cases

Varicella (Chickenpox) Majdy Naim Viral infections 13 Acute highly infectious disease Usually mild but can be very serious in adults and immunocompromised patient Caused by varicella-zoster virus More common in late winter and early spring Confers solid immunity Incubation period is days

Clinical picture of chicken pox Majdy Naim Viral infections 14 Skin rash, which appears in crops, is characterized by rapid change from macules to papules to vesicles, and to pustules over a period of 1-4 days The vesicles are superficial, surrounded by erythematous area, itchy and rupture easily

Varicella (Chickenpox) Majdy Naim Viral infections 15

Complications Majdy Naim Viral infections 16 Pneumonia Secondary bacterial infection of skin lesions Haemorrhagic or lethal chickenpox in the immunocompromised patient Scarring/ keratitis Reye syndome: fetal encephalopathy in association with varicella Neonatal varicella Congenital varicella syndrome

Treatment Majdy Naim Viral infections 17 In mild attacks, calamine lotion topically and antihistamines is all that is required. In severe attacks and for immunocompromised patients; Aciclovir, famciclovir and valaciclovir A live attenuated vaccine is now available (Varivax)

Herpes zoster Majdy Naim Viral infections 18

Herpes zoster Majdy Naim Viral infections 19 Caused by the varicella-zosters virus. An attack is a result of the reactivation, of virus that has remained in a sensory root ganglion since an earlier episode of chickenpox.

Herpes zoster ( predisposing causes) Majdy Naim Viral infections 20 Old age Drugs ( e.g. Immunosupressive agents) Trauma Diseases of spine Malignant diseases

Herpes zoster Majdy Naim Viral infections 21 Attacks usually start with a burning pain, soonfollowed by erythema and grouped, sometimes bloodfilled, vesicles scattered over a dermatome Characteristically unilateral. It may affect more than one adjacent dermatome. The thoracic segments and the ophthalmic division of the trigeminal nerve are involved disproportionately often.

Complications Majdy Naim Viral infections 22 Secondary bacterial infection is common. Scar formation Motor nerve involvement is uncommon Zoster of the ophthalmic division of the trigeminal nerve can lead to corneal ulcers and scarring. Persistent neuralgic pain, after the acute episode is over, is most common in the elderly.(post herpetic neuralgia )

Treatment Majdy Naim Viral infections 23 Systemic treatment should start within the first 5 days of an attack. Famciclovir and valaciclovir are as effective as aciclovir. Treatment should be supportive with rest, analgesics and bland applications such as calamine. Secondary bacterial infection should be treated appropriately.

Treatment of post herpetic neuralgia Majdy Naim Viral infections 24 A trial of systemic carbamazepine, gabapentin or amitriptyline, or 4 weeks of topical capsaicin cream for established post-herpetic neuralgia.

Viral warts Majdy Naim Viral infections 25 Most people will have a wart at some time in their lives. Their prevalence is highest in childhood and they affect an estimated 4–5% of schoolchildren in the UK. Caused by the human papilloma virus (HPV).

Majdy Naim Viral infections 26 HPV-1, 2 and 4, for example, are found in common warts, whereas HPV-3 is found in plane warts, and HPV-6, 11, 16 and 18 are most common in genital warts

Common warts Majdy Naim Viral infections 27

Plantar warts Majdy Naim Viral infections 28

Plantar warts Majdy Naim Viral infections 29

Plantar warts Majdy Naim Viral infections 30 The presence of bleeding capillary loops allows plantar warts to be distinguished from corns

Course Majdy Naim Viral infections 31 Warts resolve spontaneously in the healthy as the immune response overcomes the infection. This happens within 6 months in some 30% of patients and within 2 years in 65%.

Plane warts Majdy Naim Viral infections 32 These smooth flat-topped papules are most common on the face the hands. Usually skin-coloured or light brown

Anogenital warts (condyloma acuminata) Majdy Naim Viral infections 33 Papillomatous cauliflower-like lesions, with a moistmacerated vascular surface, can appear anywhere inthis area. They may form huge lesions causing discomfort and irritation. The vaginal and anorectal mucosae may be affected. Anogenital warts in children raises the spectre of sexual abuse, but is usually caused by autoinoculation from common warts elsewhere.

Condyloma acuminata Majdy Naim Viral infections 34

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Treatment Majdy Naim Viral infections 36 Many warts give no trouble, need no treatment and will go away by themselves. Keratolytic agents Cryotherapy Electrodessication Laser Topical 5-flourouracil Podophylline Imiquimode (Aldara)

Cryotherapy Majdy Naim Viral infections 37

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Molluscum contagiosum Majdy Naim Viral infections 39 Waxy pearly white to skin color hemispherical papules with smooth center and umblication, a white cheesy material can be expressed

Molluscum contagiosum Majdy Naim Viral infections 40 A common, contagious viral infection Molluscum contagiosum virus (MCV) Incubation period is 2-6 weeks More common in young children and sexually active adults Extensive lesions can occur in immunocompromised patients. In children mainly the trunk. In adults on the lower abdominal wall, inner thighs, pubic area.

Majdy Naim Viral infections 41 Molluscum contagiosum

Therapy Majdy Naim Viral infections 42 Curettage Cryotherapy Electrodessication laser Aldara cream 5%.

ORF (Ecthyma contagiosum) Majdy Naim Viral infections 43 Caused by infection with the orf virus (Parapoxvirus) The incubation period is 5–6 days The condition clears up spontaneously in about a month The condition clears up spontaneously in about a month.

Therapy Majdy Naim Viral infections 44 Self limiting disease Local antiseptics Topical and systemic antibiotics by secondary infection Curettage, Electrodessication, Cryotherapy

Acquired immunodeficiency syndrome AIDS Majdy Naim Viral infections 45 can be acquired from contaminated body fluids, particularly semen and blood. In the UK and the USA, most cases have been in homosexual or bisexual men In parts of Africa the disease is most often spread heterosexually.

Majdy Naim Viral infections 46 Intravenous drug abusers who share contaminated needles and syringes are also at high risk. Up to half of babies born to infected mothers are infected transplacentally, but this reduces to less than 2% with the use of maternal antiretroviral therapy, elective caesarean section and avoidance of breastfeeding.

Skin changes in AIDS Kaposi’s sarcoma Caused by human herpesvirus 8 and is the most common HIV-associated malignancy Majdy Naim Viral infections 47

Majdy Naim Viral infections 48 Seborrhoeic eczema and folliculitis Seen in at least 50% of patients Often starting at an early stage of immunosuppression The underlying cause may be an overgrowth of Pityrosporumyeasts

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Skin infections herpes simplex, herpes zoster molluscum contagiosum oral and cutaneous Candida Tinea scabies staphylococci. Facial and perianal warts are common Majdy Naim Viral infections 50

Hairy leukoplakia Often on the sides of the tongue, may be caused by proliferation of the Epstein– Barr virus. Majdy Naim Viral infections 51

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dry skin is common in AIDS pruritus Psoriasis may start or worsen Diffuse alopecia Drug eruptions are often seen in AIDS patients Majdy Naim Viral infections 53

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