Viral Skin

Diseases
Rabina panta
1701938
 Introduction

Virus

• Viruses are not cellular organism because they do not have functional
ribosome's or other cellular organelles.
• Viral infections of skin and mucosa produce wide range of clinical
manifestation.
Viral skin diseases

Herpes Simplex Virus

Infections
Varicella Zoster Virus Infections

Human Papilloma Virus Infections

Molluscum Contagiosum
 Herpes Simplex Virus
Infections
Incubation: 7-8 Days
Localization: On the face, on the lios,
on the wings of nose, in the oral cavity
and on the genitals .
Main morphological element: Bubble-
Bubble- Bubbles multiply- Begins
hyperemia of the skin- Ulcer- Crust-
Disappear without a trace
• HSV is a double stand DNA virus.
• There are two types of HSV: HSV type1: associated with
facial and oral infection commonly affecting children and
HSV type2: affecting the genitalia mainly occur after
puberty.
 Pathophysiology
• Close contact is required for HSV infection.
• Contact must involve abraded skin.
• After an incubation period, the primary attack will occure which is
asymptomatic in 90% cases. Following it there will be a latency
period where the virus remain dormant in on of sensory ganglion.
• Reactivation of the virus will lead to recurrence of the infection.

Clinically: Erythematous patch - Grouped umbilicated vesicles - Pustules

- Crusting(2-3 Weeks) - Post-inflammatory hyper or hypo-pigmentations
 Precipitating Factors

GIT distrubances
4
Ultraviolet rays
2 3
Stress, Febrile
1 Menstruation illness,
Immunosuppressions
 Herpetic
Ginvostomatitis(Primary
• herpes)
Most cases occur between 1-5years.
• The gums gets swollen, red and bleed
easily.
• Vesicles present as white plaques
which is seen on tongue, pharynx,
palate and buccal mucosa.
• Regional L.N may be enlarged and
tender.
• Fever subside after 3-5days and
recovery is completed in 2 weeks.
Herpes Labialis(Cold sore,
Fever blisters)
• The most common, occured
often in childhood.
• Affect lips; commonly caused
by HSV type1.
• Recurrence is possible.
 Herpetic whitlow
• Occur as a direct inoculation of the
virus from oral or genital lesions.
• Painful, grouped, confluent vesicles on
a erthematous and edematous base.
• It is common occupational hazard for
medical and dental personnel; who
work around and in the mouth

Herpes Genitalis
• Most commonly caused by HSV type2
• Age of onset: Young(Sexually active adult)
• Risk increases with multiple sex partners.
• First year symptoms mostly asymptomatic but
mild fever, headache and local pain is noted.
• Distribution:
1. Male: glans, shaft or sulcus of penis, scrotum
and buttocks.
2. Female: both labia, perinum and thigh
 Eczema Herpeticum
• Also known as Kaposi varicelliform erruption.
• It occurs in atopic dermatitis patient.
• Characterised by systemic symptoms e.g. fever,
malaise, irritability and lymphadenopathy.
• Clinical examination reveals generalised vesicles
which often becomes heamorrhagic and crusting.
• Commonly affect the face, neck and trunk.
• Primary attack is severe but the recurrence tend to
be milder.
Disseminated Herpes Simplex
• It is potentially fatal systemic HSV infection.
• Characterised by generalise mucocutaneous
vesicles, pustules and erosions along with
widespread vesceral involvement(lung, liver, GIT
and CNS).
• Risk factors:
1. Immunodeficiency e.g AIDS, drugs, malignancy, etc.
2. Malnutrition
3. Eczema herpeticum
 Diagnosis
1. Direct Microscopy Examination: Tzanck smear- It helps in rapid diagnosis
of Pemphigus and Herpes Infections(simplex and zoster) ; Sample is taken in
the glass slide and stained with Giemsa stain. Pemphigus - Rounded,
acantholytic cells and Herpes infections - Multinucleated giant cells
2. Viral Culture: Most reliable way of diagnosis.
3. Serology: Anibodies detection in serum of blood, Polymerase Chain
Reaction(PCR) Useful in the diagnosis of culture negative or atypical lesion

Treatment
Most HSV infections are self limited. However, antiviral therapy shorten the course
of the disease, prevent dissemination and recurrence.
• Treatment of primary attack : Acyclovir(Zovirax) 200mg orally 5times for
7days
• Treatment of recurrence : Acyclovir 400mg twice daily for one year
 Herpes Zoster/Shingles
• It is acute localized viral infection caused by
reactivation of varicella-zoster virus and
characterised by unilateral pain and
vesicular erruption limited to a dermatome
innervated by a corresponding sensory
ganglion.
• Causative virus: Varicella zoster virus(VZV),
it also causes varicella(Chicken pox)
• During varicella, the virus travel the sensory
nerves to the sensory ganglion where it
remain dormant and establish the latency.
• When immunity to the virus decreased the
virus replicate within the ganglion then travel
back the sensory nerve to skin resulting in
Incubation: 7-8 Days
Etilogical agent: Herpesviridae( Varicella-
zoster, Strongiloplasma zonae)
Location: Everywhere (On areas of the skin
to one or more neural segments)
Main morphological element: Bubble
Bubble- Bubbles multiply- Begins hyperemia
of the skin- ulcer- crust- disappear without a
trace.
 Epidemiolog
y
Clinical forms
1. Generalised herpes Age and Sex Risk Factors
zoster: rash locatedvon
• Diminished
large ares of skin • There is no racial or
immunity with
2. Hemorrhagic zoster: sex predilection.
ageing.
Bubble contains blood and • Most common in
• Immunosuppression
pus 50years older.
s
3. Abortive form: Easy form • HIV infection
4. Bullous form: Big bubbles

Clinically: Prodromal stage(3-5 Days), Acute vesiculation(3-5 Days),

Crust Formation(2-3Weeks), Post Herpetic Neuralgia(Months-Year)
 Differential Diagnosis
• Prodromal stage(Localised pain): Migraine, cardiac or pleural
disease, an acute abdomen.
• Cutaneous Erruption: Herpes Simplex Virus infection, Contact
dermatitis, Erysipelas, Bullous impetigo.

Diagnosis
• Clinically picture usually diagnose.
• Confirmed by Tzanck test
• Viral culture
 Treatment
• The disease is self limited.
• The goal of treatment are:
1. Minimize the pain(Analgesic)
2. Speeding the healing(Topical and systematic antebiotic of secondary
bacterial infection)
3. Prevention of dissemination(Acyclovir 800mg/ 6hourly for 7-10 days)
Complications
1. Post herpetic neuralgia
2. Opthalmic zoster
3. Ramsay Hunt syndrome
4. Disseminated zoster
5. Zoster encephalomyleitis
 Warts(Verruca)

It is a common, discrete benign epidermal

hyperplasia induced by different types of
human papilloma virus(HPV).
Mode of transmission:
1. Major mode skin to skin contact.
2. Minor trauma with breaks in the skin
facilities transmission.
3. Habitual nail bitter or children who suck
their hand are at high risk of auto
inoculation.
4. Shaving may spread warts over the beard.
5. Genital wart is the commeneat STD.
 Common warts

• Papules/Nodules with rough

surface
• They may occur singly or in
groups.
• Can occur anywhere but most
commonly over dorsal aspect of
fingers and hands.
• Characteristics by black dots on
the surface which represents
thrombosed capillaries.
 Planter warts

• Rough hyperkeratotic surface

studded with black
dots(thrombosed capillaries).
• Usually single but may be
multiple.
• Affecting the planter aspects of
feet or hands.
• When multiple warts coalesce
into large flat plaque it is called
mosaic warts.
 Plane warts
• Slightly elevated papule with smooth
surface.
• The number range from few to many
hundreds.
• Skin colored, light brown, pink or
hyperpigmented.
• Shape may be round, oval, polygonal
or linear lesions (auto inoculation by
scratching)
• Common site: on the face or beard
area but may be seen on dorsa of
hands.
 Genital warts

• Papules, nodules or plaques.

• Can occur solitary, multiple or in
large group masses.
• Most common STD.
• Seen in external genitalia of both
sexes, perianal region and in anal
canal.
• May affects the urethral meatus,
urethra, vagina or cervix.
• Huge warts at risk of mallignant
changes.
 Course and prognosis

Immuno-competent
individuals, cutaneous
HPV infections usually
resolve spontaneously.
Immuno-compromised
-50% of warts will
patients, cutaneous HPV
resolve within 1 year. infections may be very
-70% of warts will resistant to all modalities
resolve within 2 years. of therapy.
 Diagnosis

Pap smear
History and examination Acetowhitening test
Acetic acid 3.5% causes
some subclinical warts to For cervical and anal
develop shiny white surface warts.
color.
 Treatment

Treatment depend on no. of lesions, site of wart and cosmetic

disability
• Keratolytics
• Cryotherapy: Using liquid nitrogen
• Electrocautery
• Topical 5 Fluriracil
• Pedophyllin 20%: Cytotoxic agent that arrest mitosis.
• Imiquimod 5%
• Laser therapy
 Molluscum Contagiosum
It is a self-limited viral skin infection,
characterised clinically by skin-colored
papules that are often umbilicated occuring
in children and sexually active adults.
Etiology
• Molluscum contagious virus(MCV)
• It is a large double strand DNA virus
belong to pox virus family.
Skin to skin contact is essentials for
transmission of the infection. Both sexes
are euqually affected.

• Incubation period 4-8 weeks

• The lesion is asymptomatic. The main morphology is a papule.
 Treatment

1. Prevention: Avoid skin to skin

contact with infected individuals.
2. Curettage
3. Cyotherapy
4. Electrodessiction
5. Topical imiquinod(Aldara)
 Reference

1. https://www.healthline.com
2. https://www.webmd.com
3. https://www.news-medical.net
4. https://www.sciencedirect.com
THANK YOU

Cute Rabbit