Viral Skin Infections Clinical Cases PDF

Viral skin Infections Clinical cases Verruca vulgaris (Ordinary/Common warts) Asymptomatic grayish papules which are few mm in diameters With verrucous (irregular) rough surface. Plane warts Usually affect children. They appear as multiple skin-colored small papules. With flat s...

Viral skin Infections Clinical cases Verruca vulgaris (Ordinary/Common warts) Asymptomatic grayish papules which are few mm in diameters With verrucous (irregular) rough surface. Plane warts Usually affect children. They appear as multiple skin-colored small papules. With flat smooth surface. Affect mostly the face or extensor surface of hands. Plane warts Plantar warts They affect the soles or inbetween the toes, usually against bony prominence. Pain is variable Differential Diagnosis: Callus which is hyperkeratotic area present in weight bearing area. Callus is crossed by skin creases. Genital warts Pedunculated grayish cauliflower mass called condyloma accuminata or in the form of grayish small papules. They present on the vulva, vagina and cervix in female and glans and penile shaft in men. Sexual partner of genital warts patients should be examined and follow up of two years is required. Differential Diagnosis: Condyloma lata of syphilis Genital warts Complications Condyloma accuminata can affect the cervix where it may be too huge and obliterate normal delivery necessitating cesarean section. Cervical intraepithelial neoplasm (CIN) may develop which is a premalignant condition. Treatment of warts Warts may resolve spontaneously without trace! Chemical cautery: - Salicylic acid 40 % in plantar warts. - Salicylic acid +lactic acid in flexible collodion (ratio1:1:4). - Trichloroacetic acid (TCA) 70-90% (safe in pregnancy). Treatment of warts (cont.) Electric cautery. Cryotherapy with liquid nitrogen (-196°C) Laser Topical keratolytics e.g. retinoic acid preparation in plane warts. Genital warts are treated by 25% Podophyllin in tincture benzoin (contraindicated in pregnancy). Herpes simplex infection Clinical picture: Primary attack: It usually occurs in children. In a great majority, lesions are subclinical but when clinical attacks occur, vesicles are painful, often accompanied with fever, malaise and local lymphadenopathy. They do not show a tendency to grouping as in recurrent herpes simplex. Type I Herpes simplex: They commonly affect sites e.g.: Herpetic gingivostomatitis. Herpetic keratoconjunctivitis. Herpetic whitlow (fingers affection as in dentists). Primary herpes simplex Recurrent Herpes simplex Predisposing factors: ▪ Fever. ▪ Gastrointestinal tract disturbance. ▪ Psychological disturbance. ▪ Flu and upper respiratory tract infection. ▪ Exposure to sun. ▪ Mechanical trauma. ▪ Menstruation. Recurrent Herpes simplex Clinical picture It presents by a group of vesicular eruption on an erythematous base usually around the mouth. Burning sensation may precede or accompany the eruption. Finally, lesions become crusted in few days. Healing occurs in 5-7 days with normal skin. Differential Diagnosis: ▪ Impetigo. ▪ Herpes zoster. Recurrent Herpes simplex Recurrent Herpes simplex Recurrent Herpes simplex Treatment Topical: - Antiseptics e.g. Gentian violet 2 %, potassium permanganate 1/8000. - Antiviral e.g. acyclovir cream (5 times/day for 7 days). Systemic: - Antiviral drugs as Acyclovir 200mg 5 times/day for 7-10 days. - Other antivirals: Famcyclovir, Valacyclovir. Varicella (chicken pox) The patient is infectious 4 days before the eruption until lesions are crusted. Prodromal stage of approximately 1-2 days shows fever, malaise, headache. The eruption is itchy shows macules, papules, vesicles, pustules and crusts. The eruption is polymorphic and centripetal é mucous membrane affection (eye, mouth, gingival).  Healing occurs within 10 days without sequelae Sometimes leaves post-inflammatory pigmentation and scarring especially in adults. Differential Diagnosis: Papular urticaria. Scabies. chicken pox chicken pox Treatment Prophylactic treatment: - Live attenuated vaccine. - Hyperimmune globulins: in immune-compromised & non-vaccinated individuals. Topical: Antiseptics as Gentian violet 2 % paint. Systemic: Antiviral drugs: Acyclovir (given within 72 hours): - Children: (severely ill or immune-compromised) 20 mg/kg with a max 800 mg per dose 4 times per day for 5 days. - Adults: 800 mg given 5 times /day for 5 days Herpes Zoster It is an acute, self-limiting, vesicular eruption on an erythematous base, occurring in a dermatomal distribution. The vesicles contents dry up in 1-2 weeks forming crusts and healing usually by scarring It is caused by reactivation of latent varicella-zoster virus present in dorsal root or cranial nerve ganglion that travels to the skin through cutaneous nerve. Clinical picture Pain varies from mild to severe. It may accompany or usually precedes the attack. It is strictly unilateral, if bilateral or generalized it indicates that the patient is immunocompromised. The regional lymph nodes are usually enlarged and tender. Complications Post-herpetic neuralgia (persistence of pain after healing of cutaneous lesions). Secondary infection. Scarring of the skin. Gangrene of the skin. Affection of the eye (herpes zoster ophthalmicus). Affection of the geniculate ganglion (Ramsay Hunt syndrome). Treatment: Topical: Antiseptics e.g. gentian violet paint or potassium permanganate solution. Systemic: - Antiviral: Acyclovir 800mg/5times/7-10 days or famcyclovir or valacyclovir. - Pain killers are indicated whenever there is pain. Molluscum Contagiosum (POX VIRUS) - Highly contagious lesions. - The primary lesion is painless, shiny, pearly white papule, usually umbilicated in the center. - Any areas can be involved but more on the face, genitalia and trunk. - Multiple lesions are usually present. Molluscum Contagiosum Treatment Mechanical methods: Expressing the content of the papule by squeezing it with forceps or curettage followed by cauterizing the base. Concentrated phenol paint. Electric cautery. Cryotherapy. Laser.