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Common viral skin infections
• is a common viral infection that presents with grouped
• There are two main types of herpes simplex virus
• 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.
• 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.
Primary herpes simplex
• Itching or burning is followed an hour or two
later by small, closely grouped vesicles on
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
• After an incubation period of 4 to 5 days the symptoms
begin with fever
• Drinking and eating are painful . The gums are swollen and
• 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.
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.
Recurrent herpes simplex
Recurrences can be triggered by:
• Minor trauma to the affected area
• Other infections including minor upper respiratory tract
• 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.
• Chronic oral or genital ulceration.
• 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
is the primary infection with the virus shingles (varicella
• During widespread infection multiple vesicular
eruption which usually occurs on the trunk in
• 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.
• Due to reactivation of varicella zooster virus.
• Commonly occurs in immunosuppressed
• 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)
• Post-herpetic neuralgia is defined as
persistence or recurrence of pain more than a
month after the onset of shingles.
• Secondary bacterial super infection.
• Acyclovir 800 mg 5 times daily for 7 days
• Oral antibiotics may be needed for secondary
infection, usually flucloxacillin or erythromycin
• Tricyclic antidepressant medications such as
• 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.
• 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
• Molluscum contagiosum may arise in areas
that have been injured,. The papules are
centrally umbilicated .
• Warts are caused by Human Papillomavirus
• More than 100 HPV subtypes are known.
• Sexual contact. This is the most common way
• Vertical (mother to baby) transmission.
• Auto (self) inoculation from one site to another.
• Fomites (i.e. from objects like bath towels
• Warts are particularly common in childhood
• Often, warts will appear three to six months after
• 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.
• 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.
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.
• 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
• Electrosurgery (curettage & cautery
• Podophyllotoxin(purified podophylline)
• Podophylline should not be used during
• 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
• Cervarix is effective against HPV types 16 and
• HPV vaccination is most effective when
offered at a young age, before the onset of