Herpes
Herpes
Herpes
but they may occur almost anywhere on the skin. There are two types of HSV: Type I (most often occurs on the face) and Type II (most often occurs in genital area). The virus is spread through direct contact with secretions or herpes skin lesions. Once the infection develops in the skin (primary), the virus travels down the nerve, where it remains latent until reactivation(recurrence). The virus can be reactivated by stress, ultraviolet light, fever, tissue damage, or immunosuppression.
Herpes Simplex
Complications:
Eye (Ophthalmic): When vesicles involve the eye, the infection can cause blindness if untreated.
ORAL HERPES
GENITAL HERPES
Clinical Features
HSV I: face (esp. around mouth), though can occur anywhere HSV II: buttocks, penis, vagina, or cervix Infections may be primary or recurrent (usually milder). If widespread or severe, consider HIV. Pain and burning may precede rash Multiple scattered umbilicated blisters with surrounding redness that can develop into pustules or ulcers Crusting and resolution in 2-6 weeks. Heals without scars.
Eczema Herpeticum: Patient with eczema can develop widespread infection. Newborn (Neonatal): Usually occurs when mother has active lesions near time of delivery. High morbidity and mortality if not treated with IV acyclovir.
OPTHALMIC HERPES
NEONATAL HERPES
Treatment:
Topical: once blisters have broken, apply 0.5% Gentian Violet paint to dry rash and prevent secondary infection Oral treatment for genital herpes (within 48 hours of onset of symptoms): First episode: Acyclovir 400 mg 3x/day for 10 days Recurrence: Acyclovir 400 mg 3x/day for 5 day
EZCEMA HERPETICUM
Herpes Zoster
Herpes Zoster (Shingles) is a viral infection caused by the same virus that causes chicken pox. Shingles is caused by a reactivation of the dormant virus in the nerves of people who have previously had chickenpox. A temporary weakness in immunity (due to illness, stress, trauma, or immunosuppression such as HIV) causes the virus to multiply and move along nerve fibers toward the skin. Viruses in the blister fluid of shingles can cause chickenpox.
Complications:
Eye: When vesicles involve the forehead, side of the nose, or eye, the infection can cause blindness if not treated
SHINGLES IN T1 DERMATOME SHINGLES IN C6/C7 DERMATOME
Clinical Features
Localized pain precedes rash by a few days Rash appears as grouped vesicles, usually confined to a unilateral dermatome which stops at midline (a few lesions may cross) Vesicles form pustules that crust and heal within 1-2 weeks May be presenting feature of HIV
Ear: When vesicles appear on the external ear or eardrum, hearing problems or facial paralysis may develop Sacrum: Involvement of the sacral nerves (S2-S4) can lead to retention of urine or constipation Post Herpetic Neuralgia: Pain in the affected area may persist for months to years after the rash is gone.
SHINGLES IN V3 DERMATOME
SACRAL ZOSTER
Treatment:
Topical: once blisters have broken, apply 0.5% Gentian Violet paint to dry rash and prevent secondary infection Oral: must be started within the first 48 hours: Acyclovir 800 mg 5x/day for 7 days Pain control: analgesics