VIRAL SKIN DISEASES

Dr. Adel Al-najar Presented By :

ASEEL ALBURIHI
The viruses of dermatological interest are:

1. Varicella-zoster virus
2. Herpes virus hominins
3. Human papilloma virus
4. Pox virus
1. Chicken pox

■ It is caused by varicella-zoster virus .

■ It affects children (2-10 years) but may oc-
cur also in adults.
■ It is transmitted by droplet infection.
■ Its incubation period is 10 - 24 days.
Clinical picture

■ It is preceded by little or no prodrome.

■ There may be fever or malaise.
■ These symptoms precede the exan-
themaby 24-48 hours.
Skin lesions

■ Begin abruptly with the appearance of erythe-

matous macules and papules.
■ They progresses rapidly to vesicles which sur-
rounded by an erythematous halo.
■ The contents of the vesicles become cloudyand
purulent.
■ A crust is formed in 2-4 days which separates in
few days leaving shallow
■ Lesions in all stages of development may be-
seen within one area (D.D form small pox).
■ Lesions heal within 10-14 days without scar-
ring.
■ The lesions are distributed over the trunk, scalp,
face, distal extremities.
Treatment

■ Drying antipruritic lotion as calamine lotion.

■ Antihistamines for pruritus.
■ Acyclovir orally for severe cases.
■ Antibiotics for secondary bacterial infection.
2. Herpes Zoster

■ It is caused by varicella-zoster virus.

■ Following chicken pox, the virus lies dor-
mant residing in dorsal root and/or cranial nerve
ganglia.
■ Herpes zoster is an activation of latent infec-
tion.
Clinical picture

l.Pain
■ Usually severe.
■ Occurs in area supplied by the affected root.
■ Usually precede, accompany, or follow the
skin lesions.
2- Skin eruption
■ Erythematous macules and plaques are seen first.
■ Grouped vesicles appear within 24 hours.
■ The vesicles become purulent.
■ The contents dry up after 1 -2 weeks forming
crust.
■ It heals usually with scar formation.
■ May be localized in cervical, trigeminal,
facial...etc.
■ A characteristic feature of the disease is that it is
strictly unilateral.
■ It does not cross the middle line.
Common sites of shingles

Front Back
Clinical types

1. Ordinary vesicular type.

2. Abortive type (only some redness).
3. Bullous type.
4. Hemorrhagic type.
5. Gangrenous type.
6. Disseminated type in immunosup-
pressed patients.
Predisposing factors

1. Old age
2. Trauma.
3. Stress
4. Sunburn
5. Fever
6. Immunosuppression.
Complications of herpes zoster:

1. Postherpetic neuralgia.
■ Persistence of pain after disap-
pearance of skin lesions.
■ It occurs more in older persons.
2. Ramsy-Hunt syndrome:
■ Herpes zoster of geniculate ganglion.
■ It affects VII th nerve which innervate
deep facial tissues.

Clinical picture
■ Paresis/paralysis of affected muscle of fa-
cial expression.
■ Jaw pain.
■ Vesicles on uvula, palate and auricle.
3. Eye complications:
Uveitis.
Keratitis
Ocular muscle palsies.
4. Haemorrhagic, bullous and gan-
grenous lesions.
N.B.
Bilateral HZ occurs in:
■ Trauma to spinal cord.
■ Tabes dorsalis.
■ Cold abscess.
■ Nerve crossing the middle
line.
 Diagnosis of HZ:

■ Cytological smear of vesicle: large multin-

ucleate giant cells and ballooning degener-
ation.
■ Skin biopsy: ballooning degeneration.
Treatment of HZ

■ Acyclovir 800 mg/5 times/daily for 7 days.

■ Analgesics:
Treatment of postherpetic neuralgia:
■ Topical capsicin.
■ Amitriptyline 75 mg/day.
■ Carbamazepine 800 mg/day.
■ Gabapentin 100 mg to 400 mg /day.
3. Herpes simplex

The causative agent of herpes simplex:

■ Herpes-virus hominis type 1 which
causes facial (non genital) herpes sim-
plex.
■ Herpes-virus hominis type II which
causes genital herpes simplex.
Clinical picture:

■ Two types of infections are present:

1. Primary infection.
2. Recurrent infection.
1. Primary infection:

■ Usually occurs in children (1-5 years).

■ Incubation period: 3-5 days.
Clinical presentations:

1. Primary gingivostomatitis
■ Painful vesicles on the lips and mucous membranes.
■ Gums are swollen and red.
■ Fever, malaise and regional lymphadenopathy.
■ Fever subsides after 3-5 days and recovery in2
weeks.
 2. Herpetic keratoconjunctivitis ■ Se-
vere purulent conjunctivitis.
■ Superficial corneal ulceration.
3. Herpetic whitlow
■ A painful vesicles or pustule on a
finger.
■ Due to direct inoculation of the
virus.
4. Eczema herpeticum:
■ Generalized herpetic skin infection in a
child with atopic dermatitis.
5. Disseminated infection: - In immuno¬
compromised patients.
6. Herpes genitalis:
■ Usually caused by type 2 virus.
■ In males, it causes penile ulcerations.
■ In females, it causes vulvovaginitis in the
form of ulcerations of vulva, vagina and
cervix.
2.Recurrent infection Precipitating fac-
tors
1. Fever.
2. Upper respiratory tract infection.
3. Menstruation.
4. Sunlight.
5. Trauma.
6. Psychological disturbance.
Clinical picture:

Site:
■ Type 1 : face especially around the
mouth.
■ Type 2: genital area.
1. Herpes labialis.
■ Lips, nose, other parts of the face.
■ Acute eruption of grouped vesicles on ery-
thematous base.
■ Burning sensation.
■ May be bilateral and symmetrical.
■ After few days, vesicles rupture and crust
occur.
■ The lesions heal without scar.
■ The condition is recurrent.
2. Herpetic keratoconjunctivitis.
3. Herpes genitalis
■ A sexually transmitted disease.
■ Recurrent irregular, superficial grouped ulcersand
or intact vesicles.
■ In males on the glans or penile shaft.
■ In females on labia or cervix.
■ Lymph node may enlarge and tender.
 Differences between primary and recurrent HS.

Recurrent infection Primary infection

-The vesicles are small. - -The vesicles are larger. -

The vesicles are close Widespread.
grouping
-Less severe eruption. -No -More severe eruption. -
constitutional There are constitutional
manifestations. manifestations.
 Differences between H.Z and H.S.
Point H. zoster H. simplex
Recurrence Not recurrent Recurrent
Symptoms Neuralgic pain No pain but mild
burning
Distribution -Along sensory Around orifices
nerve. - bilateral or
Unilateral. - unilateral
Neurotropic
Enlarged Not enlarged
Regional lymph
nodes
Complications of H simplex:

■ Secondary bacterial infection.

■ Systemic involvement.
■ Herpes encephalitis.
■ Eczema herpeticum.
Treatment

a. Local treatment:
1. Drying antiseptic lotion for vesicular stage
e.g aluminum acetate 5%.
2. Topical acyclovir ointment 5 times per day.
■ For mild recurrent H. simplex.
■ Apply early as possible.
 b. Systemic treatment
■ Oral acyclovir: 200 mg 5 times per day for
5 days.
■ Antibiotics for secondary infection.
4. Warts

■ Warts are common benign epidermal

proliferations caused by human papil-
loma virus (HPV).
Types of warts:

a. Non venereal:
1. Common warts.
2. Filiform warts
3. Digitiform warts.
4. Flat (plane) warts.
5. Plantar warts.
b. Venereal warts:
1. Condyloma accuminata.
Clinical picture of non venereal warts:

1. Common warts:
■ Circumscribed solid papule.
■ With rough surface.
■ Skin colored or darker.
■ Size few mm to 1 cm or more
■ Located on the hands and fingers, any-
where.
■ Koebner’s phenomenon is present.
2. Filiformis
■ Selender, soft, thin, finger like prjections.
■ Located on the face and neck.
■ May be solitary or branched.
3. Digitiformis
■ Solid, firm papules having finger-like pro-
jections on its base.
■ Located on the face and scalp.
4. Flat (plane) warts
■ Flat, slightly raised on the face, neck, hands
■
Smooth and multiple.
5. Plantar warts:
■ Located on planter surface of the feet
especially on pressure areas.
■ Pressure makes the warts grow into the
dermis.
■ Well-defined rounded lesion .
■ The skin surface have rough surface.
■ Paring of the surface reveals small
bleeding points.
■ Multiple individual warts make a mosaic
plaque.
b. Clinical picture of condyloma accuminata:

■ Moist, soft, pink with foul smelling tumors

like growth.
■ The wart divides at its free margin into lobules
giving it a cauliflower appearance.
■ With pendunculated and lobulated masses.
■ Located on genitalia and the perineal and pe-
rianal regions.
Point C.accuminata C. lata
Cause Human papilloma virus T. pallidum

Shape Cauliflower, Flat topped, sessile

pedunculatd smooth
Surface Rough Smooth
Base Not indurated Indurated
Color Bright ed Greyish white
Odour Foetid No specific
Lymph nodes No Generalized LNs
Serology Negative Positive for syphilis
N.B.
Koebner’s phenomenon:
■ Appearance of new lesions at the site of
trauma,occur in:
1. Verruca vulgaris and plana.
2. Psoriasis.
3. Lichen planus.
4. Vitilligo.
Treatment:

I. Common warts, plane, filiform, digitiform:

■ Electrocautery.
■ Cryotherapy (frequent application).
■ Chemical cautery: trichloroacetic acid 20-
30%.
■ Keratolytic as salicylic acid or lactic acid.
■ Topical tretinoin: for plane warts.
2.Condyloma accuminata:

1. Podophyllin 25% in tincture benzoic.

2. Podophyllotoxin 0.5%:
1,2 are contraindicated in pregnancy.
3. Cryosurgery.
3.Planter warts:
■ Salicylic acid 100% incorporated in
adhesive plaster for several days then
curettage .
5. Molluscum contagiosum

■ It is an infectious skin disease caused byDNA

virus, pox virus.
■ It affects children and adults.
Mode of transmission:
■ Direct contact.
■ Sexual transmission.
■ Indirect transmission by towels.
■ Incubation period: 2-6 weeks.
■ Clinical picture:
1. Located on face, genitalia, anywhere.
2. Lesions are papules which are:
■ small
■ multiple - pearly white - doom shaped
■ central umblication
■ firm containing cheesy white material.
■ Treatment

1. Curettage + cauterization of base by

silver nitrate.
2. Cryotherapy.
3. Electro-dissection.
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