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  • 1. Common viral skin infections Shimelis Nigussie Dermatovenereologist
  • 2. Herpes simplex • is a common viral infection that presents with grouped blistering • There are two main types of herpes simplex virus (HSV). • Type 1, which is mainly associated with facial infections (cold sores ) • Type 2, which is mainly genital (genital herpes) • Both type 1 and type 2 herpes simplex viruses reside in a latent state in the nerves which supply sensation to the skin. During an attack, the virus grows down the nerves and out into the skin or mucous membranes where it multiplies, causing the clinical lesion.
  • 3. • Type 1 infection occur mainly at childhood. • Type 2 infections occur mainly after puberty, often transmitted sexually. • The virus is shed in saliva and genital secretions, during a clinical attack.
  • 4. Primary herpes simplex • Itching or burning is followed an hour or two later by small, closely grouped vesicles on erythmatous base.
  • 5. Primary herpes simplex • Herpetic gingivostomatitis (mouth infection) is the most common clinical manifestation of primary Type 1 infection. • Most cases occur in children between the 1 and 5 years of age. • After an incubation period of 4 to 5 days the symptoms begin with fever • Drinking and eating are painful . The gums are swollen and red . • Vesicles (little blisters) occur in white patches on the tongue, throat, palate and insides of the cheeks. The white patches are followed by ulcers with a yellowish coating.
  • 6. Genital herpes • Infection with Type 2 HSV occurs after the onset of sexual activity . • Penile ulceration from herpetic infection is the most frequent cause of genital ulceration . • In the female, ulceration occur on the external genitalia and the mucosae of the vulva, vagina and cervix. Pain and difficulty passing urine are common.
  • 7. Recurrent herpes simplex Recurrences can be triggered by: • Minor trauma to the affected area • Other infections including minor upper respiratory tract infections • Ultraviolet radiation (sun exposure) • Hormonal factors (in women) • Emotional stress • Operations or procedures performed on the face • Dental surgery • In many cases no reason for the eruption is evident.
  • 8. complication • Chronic oral or genital ulceration.
  • 9. Treatment • • Mild uncomplicated eruptions of herpes simplex require no treatment. • Severe infection may require treatment with an antiviral agent. • aciclovir – 400mg three times daily for 7 days
  • 10. Chickenpox is the primary infection with the virus shingles (varicella zoster.) • During widespread infection multiple vesicular eruption which usually occurs on the trunk in childhood • virus is then seeded to nerve cells in the spinal cord, usually of nerves that supply sensation to the skin. • The virus remains in a resting phase in these nerve cells for years before it is reactivated and grows down the nerves to the skin to produce herpes zoster.
  • 11. Herpes zooster • Due to reactivation of varicella zooster virus. • Commonly occurs in immunosuppressed indviduals. • The first symptom is severe pain in the areas of one or more sensory spinal nerves. • Within one to three days of the onset of pain, a grouped blistering rash appears in the painful area of skin( dermatomal distrubution)
  • 12. complication • Post-herpetic neuralgia is defined as persistence or recurrence of pain more than a month after the onset of shingles. • Secondary bacterial super infection.
  • 13. treatment • Acyclovir 800 mg 5 times daily for 7 days • Oral antibiotics may be needed for secondary infection, usually flucloxacillin or erythromycin • Analgesics • Tricyclic antidepressant medications such as amitriptyline
  • 14. Molluscum contagiosum • is a common viral skin infection. It most often affects infants and young children but adults may also be infected. • If Molluscum contagiosum infection occurs in adults screen the patient for hiv. • Molluscum contagiosum is a harmless virus but it may persist for months or occasionally for a couple of years. •
  • 15. Molluscum contagiosum • can be spread from person to person (especially children) by direct skin contact • It can be very extensive and troublesome in patients with human immunodeficiency virus infection. • Molluscum contagiosum may arise in areas that have been injured,. The papules are centrally umbilicated .
  • 16. Treatment • Minor surgery, curettage • Cryotherapy • electrocauterization • Imiquimod cream • Wart paints containing salicylic acid or podophyllin
  • 17. Viral warts • Warts are caused by Human Papillomavirus (HPV). • More than 100 HPV subtypes are known. HPV transmission • Sexual contact. This is the most common way amongst adults. • Vertical (mother to baby) transmission. • Auto (self) inoculation from one site to another. • Fomites (i.e. from objects like bath towels
  • 18. • Warts are particularly common in childhood • Often, warts will appear three to six months after infection . • Warts have a hard verrucous surface. • a tiny black dot is seen in the middle of each scaly spot, due to a thrombosed capillary blood vessel. • There are various types of viral wart.
  • 19. • Common warts arise most often on the backs of fingers or toes, and on the knees. • Plantar warts occurs on the sole of the foot. • Plane( flat) warts can be very numerous and may be inoculated by shaving. • Periungual warts prefer to grow at the sides or under the nails and can distort nail growth. • Filiform warts are on a long stalk. • Oral warts can affect the lips and even inside the cheeks • Genital warts are often transmitted sexually and predispose to cervical, penile and vulval cancer.
  • 20. Genital warts & cancer • The HPV types that cause external visible warts (HPV Types 6 and 11) rarely cause cancer. • Other HPV types (most often Types 16, 18, 31, 33 and 35) are less common in visible warts but are strongly associated with penile and vulvar intra- epithelial neoplasia (pre-cancerous changes) and squamous cell carcinoma (SCC) of the genital area especially cervical cancer and less frequently invasive vulvar cancer.
  • 21. treatment • In children, even without treatment, 50% of warts disappear within 6 months; 90% are gone in 2 years. They are more persistent in adults but they clear up eventually • Cryotherapy • Electrosurgery (curettage & cautery • Podophyllotoxin(purified podophylline)
  • 22. • Podophylline should not be used during pregnancy. • Two vaccines are available to prevent HPV infection, Gardasil™ and Cervarix®. • Gardasil is a vaccine that is effective against HPV types 6, 11, 16 and 18; the 4 types of HPV that cause most cases of genital warts and cervical cancer
  • 23. • Cervarix is effective against HPV types 16 and 18. • HPV vaccination is most effective when offered at a young age, before the onset of sexual activity.