II.

會痛

• Herpes zoster

• Cellulitis

• Furunculosis

• Folliculitis

• Paederus dermatitis
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 II.1 HERPES ZOSTER (SHINGLES)
A painful affliction of cutaneous nerves with the varicella
varicella--
zoster virus (VZV)
(VZV)..
It represents a reactivation of a dormant chickenpox virus
(VZV) belonging to the herpesvirus family
family..
• Preceding pain
• Grouped vesicles on an erythematous base
• Unilateral
• Dermatomal distribution of a cutaneous cranial or
peripheral nerve
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 II.2 CELLULITIS AND ERYSIPELAS
An acute infection of the dermis and subcutaneous tissues by
group A Streptococcus or Staphylococcus aureus, and
occasionally other organisms, which may cause a profound
systemic disturbance.
disturbance.
(Erysipelas is a form of more superficial cellulitis mainly caused
by group A Streptococcus.)
• Redness, swelling, local heat, pain or tenderness
• Regional lymphadenopathy with tenderness
• Systemic symptoms such as fever, chills, and malaise
accompanied or sometimes may antedate
• Lower extremities 5
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 II.3 FURUNCULOSIS (FURUNCLE/BOIL)

An acute deep folliculitis and perifolliculitis due to infection

by Staphylococcus aureus.
• Painful
• Red folliculocentric nodules
• Rupture with pus discharge and often a core of necrotic
material

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 II.4 SUPERFICIAL FOLLICULITIS
(BOCKHART IMPETIGO)

An acute painful, pustular eruption of hair follicles caused

by Staphylococcus aureus.
• Painful yellow pustules
• Surrounded by erythema
• Central hair in the pustule
• Scalp, axillae, limbs or buttocks

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 II.5 PAEDERUS DERMATITIS

An irritant contact dermatitis resulting from the

contact of body fluid of Paederus
Paederus..
· Itchy or hot sensation
· Erythematous, band or linear plaques
· Vesiculation,
Vesiculation, pustulation and crust formation
· Exposed areas: face or four limbs

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 III.起水皰
III.起水皰
• Herpes simplex
• Herpes zoster
• Bullous pemphigoid [Autoimmune clinic]
• Pemphigus vulgaris [Autoimmune clinic]
• Varicella
• Miliaria
• Acute eczema (see I.1)
• Erythema multiforme
• Stevens
Stevens--Johnson syndrome
• Fixed drug eruption
• Pompholyx (see I.1) 14
 III. 1 HERPES SIMPLEX

An acute self
self--limiting affliction of the skin and mucous
membranes, caused by herpes simplex virus.
virus. After primary
inoculation, recurrences are common.
common.
• Premonitory symptoms of itch or tingling
• Grouped vesicles
• Surrounding erythema
• Progression to crusting
• Lasts 5-14 days
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III.2 HERPES ZOSTER (SHINGLES)
(SEE II.1)

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III.3 BULLOUS PEMPHIGOID
[AUTOIMMUNE CLINIC]

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III.4 PEMPHIGUS VULGARIS
[AUTOIMMUNE CLINIC]

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 III.5. VARICELLA (CHICKEN POX)
A primary infection caused by varicella-
varicella-zoster virus (VZV)
characterized by successive crops of pruritic vesicles.
· Disseminated eruptions of various evolution stages:
papules, vesicles, pustules, crusted vesicles
· Characteristic “dew drop on a rose petal” vesicles
· Itchy
· Children

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 III--6 MILIARIA
III
• Most common in baby and children
• Prolonged exposure to high temperature and humidity
• Sweat duct obstruction
• Obstruction at different level gives different clinical
presentations.
• Miliaria crystallina
crystallina:: obstruction within stratum corneum
corneum,,
clear vesicles, non-
non-pruritic.
• Miliaria rubra
rubra:: obstruction within epidermis, pruritic, vesicles
on erythematous base.
• Miliaria profunda
profunda:: obstruction at D-
D-E junction, white
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papules or pustules.
pustules.
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III.7 ACUTE ECZEMA (SEE I.1)

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 III.8 ERYTHEMA MULTIFORME

A distinctive clinical and histological pattern affecting the skin

and, sometimes, mucous membranes (mostly oral cavity).
• Hands, feet, elbows, knees, and face
• Symmetrical ‘ target
target’
’ papules or plaques with or without
central blisters
• Recurrences
• Mucous membrane ulceration with systemic toxicity
(Stevens--Johnson syndrome).
(Stevens syndrome). 27
 III.8 ERYTHEMA MULTIFORME

• Etiology: mostly infections

• Herpes simplex virus
• Mycoplasma pneumoniae
• Drugs: rare
• EM minor vs
vs.. EM major
• EM major vs
vs.. Stevens
Stevens--Johnson syndrome
• Toxic epidermal necrolysis (TEN)
• TEN vs
vs.. Staphylococcal scalded skin syndrome
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TARGET SIGN

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MUCOSA ULCERATION

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 SJS-TEN SSSS

History Drug intake; perhaps previous Drug intake not typical; first
episodes with similar symptoms appearance
Age preference Over 20 years Under 5 years

Family History Negative Cases of impetigo in the

neighborhood
Eruptions Generalized without preference Typical distribution :
pattern in sequence begins on the face, neck, axillae and
groin and spread
Nikolsky’s sign Positive on the involved skin Positive also on the clinically
uninvolved skin
Mucous Severely involved Not involved
membranes

Mortality High Very low

Histologic distinguishing Epidermal necrosis Acantholysis, fissure development

features Beginning in basal cell layer under the stratum granulosum

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Cytological criteria Necrotic epidermal cells, Normal-appearing, acantholytic
neutrophils and debris cells
STAPHYLOCOCCAL SCALDED SKIN SYNDROME (SSSS)

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 III.9 STEVENS-
STEVENS-JOHNSON SYNDROME
• A rare life-
life-threatening reaction mainly induced by medication
• Severe Cutaneous Adverse Reactions to drugs (SCAR)
• Confluent purpuric and erythematous macules (atypical flat target lesion)
evolving to flaccid blisters and epidermal detachment
• Mucous membrane involvement (nearly always on at least two sites)
sites)
• A dozen “high-
“high-risk” drugs account for one half of cases
• Antibacterial sulfonamides,
sulfonamides, aromatic anticonvulsants (carbamazepine),
lamotrigine, oxicam nonsteroidal anti-
anti-inflammatory drugs
drugs,, and
nevirapine
• Most inducing medications revealed the first continuous exposure between
4 and 28 days before reaction onset 33
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 III.10 FIXED DRUG ERUPTION
• Itchy or tender
• Erythema, followed by dusky red or violaceous
discoloration or blister formation
• Oval shaped
• Commonly on lip or genitalia
• Recurred on the same sites, but also new location, after
drug intake (30 minutes to 8-
8-16 hours)
• Drug allergy to NSAIDs, barbiturates
barbiturates,, sulfonamides,
tetracyclines,, etc.
tetracyclines
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