1.1.2. viral infections of skin [compatibility mode]

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  • 1. COMMONVIRAL INFECTION OF SKIN DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 2. Common viral infections of skin1. Warts: different types2. Molluscum Contagiosum3. Herpes Simplex4. Herpes zoster5. Opthalmic Zoster6. Other Viral infections: - Rubeola (Red Measles) - Rubeola (German Measles) - Chicken Pox - Eczema Herpeticum DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 3. 1. Wart (Verruca)Caused by Human Papilloma virus (80 types) –Age group: childhood –Incubation period – 1 to 20 months (average 4months) DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 4. Different types of warts 1. Verruca vulgaris 2. Verruca plana 3. Filiform warts 4. Digitate warts 5. Planter warts 6. Mosaic warts 7. Genital warts (condyloma acuminta) DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 5. 1. Verruca vulgaris: – Painless, elevated, circumscribed – Hyperkeratotic papules and plaques – Common sites – extremities2. Verruca plana: Flat papules over face Common sites – face, back of hands3. Filiform warts: Occurs at angle of mouth DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 6. Verruca vulgaris DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 7. Verruca vulgaris DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 8. Verruca plana (flat warts) DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 9. Filiform wartsDR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 10. WartHPV (DNA)Common wart• Hand• Child DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 11. 4. Digitate warts :- site: scalp5. Planter warts:– Painful– Site – planter surface of sole– Precipitating factor: Trauma– Associated with hyperhydrosis6. Mosaic wart :- plaque of grouped lesions7. Genital warts– Soft, pink, elongated, acuminate mass over glans penis & other mucocutaneous area DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 12. Verruca plantarisDR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 13. Condylomata acuminata - penis DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 14. Condylomata acuminata: vulva DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 15. Condylomata acuminata: uterine cervix DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 16. Genital wart DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 17. Genital warts DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 18. 8. Other type –Warts in buccal, gingival, labial, tongue –Oral condyloma acuminata –Respirating laryngeal papillomatosis DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 19. Treatment – Self limiting – Hypnotherapy & suggestion therapy – Electrocautery – Chemical cautery – TCA, salicylic acid, lactic acid – Cryotherapy – Laser therapy – 25% podophyllin & purified podophyllotoxin for genital warts – Immunotherapy (Interferon) DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 20. Warts: Treatment• Salicylic acid 25% ointment twice daily followed by cutting or scraping• Preparation of salicylic acid 5-20%• Electrodessication and curettage• Freezing with liquid nitrogen if available. DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 21. Rx Genital warts• Podophyllin 10-25% solution. Protect the skin around the wart with Vaseline apply the podophyllin with a match stick carefully on the top of the war and wash after 6 hours. Repeat every week. It is contraindicated in pregnancy.• Phenol 80% can be used in the same fashion to Podophyllin.• Cauterization• Topical 5% 5-fluoro-uracil cream (efudex)• Cryotherapy with liquid nitrogen DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 22. Rx. Summary DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 23. 2. Molluscum contagiosum –Water blister, common in childhood. –Etiology: Pox virus –Incubation period : 2-7 weeks –Age group: childhood –Sex: Male > Female –Way of spread – skin to skin contact, fomites, sexual transmission DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 24. • Clinical manifestations –Asymptomatic, smooth, pearly to flesh coloured, dome shaped papules with central unbilication –Size: 3-6 mm Size: –Number: Multiple –Site: Any area, usually extremities –Immuno-compromised patient: Severe –Adult age: big growth DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 25. Molluscum contagiosum DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 26. Molluscum contagiosum DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 27. Treatment: Molluscum contagiosum• In children not touching, is probably the best approach.• Cryosurgery - Using liquid nitrogen to freeze the lesion• Salicylic Acid (Compound ) - A solution applied to the lesion with or without tape occlusion• Self limiting DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 28. 3. Herpes simplex• Etiology- Herpes simplex virus (HSV) I & II• Incidence increasing in developed country• It is either primary or recurrent• Clinical types: Facial oral herpes (HSV) Genital herpes (HSV II & I) DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 29. • Primary facial oral herpes –Incubation period: 5-10 day –Onset with fiver, sore throat –Painful grouped blister, ulcerative erosion on tongue, palate, lips, gingival and buccal mucosa –Lymphadenopathy DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 30. Primary gingivostomatitis DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 31. • Primary genital herpes – Source of infection – sexual exposur (95%) – Incubation period 3-14 days – Multiple painful grouped vesicles with painful inguinal lymphadenopathy – Newer lesions continue to occur till 1 week – May last for 18-21 days – Few cases: develop aseptic meningitis – In female - cervicitis DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 32. Genital herpes: primary vulvar infection DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 33. Herpes infection: Treatment• Lips: Gentian violet 0.5% is effective and if available sunblocks reduces recurrence. Eg. Zinc oxide paste , zinc oxide ointment or zinc oxide and topical antiseptic or antibiotic e.g betadine ointment 3 times daily for bacterial super infection.• For recurrent infections : Acyclovir 200mg PO for 5 days can be given. DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 34. Genital herpes• Betadine or potassium solutions sitz baths 3 times daily.• Gentian violet 0.5%, Zinc oxide and castor oil to sooths.• Alternatively betadine ointment or oxytetracycline ointment 3 times daily.• Acyclovir cream can also be given 5 times daily.• Severe infections or infection in immunodeficient patients: if available give acyclovir 200 -400 mg 5 times daily for 5-10 days OR• Famciclovir 250mg orally three times a day for 7--10 days, OR• Valacyclovir 1 g orally twice a day for 7--10 days. DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 35. Other type of herpes simplex infection – Herpetic whitlow, herpetic glandorium – Keratoconjunctivities, Herpes simplex encephalitis – Risk factor for acquiring HIVDiagnosis1. Culture, Tzanck preparation2. Serology by using monoclonal antibodies DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 36. Herpetic whitlowDR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 37. •Treatment–Recurrent genital and facial oral herpes • Oral Acyclovir of any form – limited success • Topical Acyclovir – little value–To suppress recurrency • Acyclovir 400 mg BD x 1 years (recurrence > 6 years) DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 38. 4. Herpes zoster –Virus: Varicella zoster virus (VZV) –Prodromal symptoms + –Multiple painful vesicles in a dermatomal distribution –Pain – papule – vesicles – pustules – crusting – healing –Healing within 3 weeks –Regional lymphadenopathy + –Pain persists till 30 days from the onset of skin lesions DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 39. Herpes Zoster………………….• Localized eruption, unilateral, typically confined to one dermatome• Prodromal paraesthesia and pain in the area supplied by affected nerve are common before skin lesions develop• Post herpetic neuralgia –Most common complication of zoster –50% risk in patients aged over 60 years –pain persisting for 1 month or more after the rash DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 40. Herpes Zoster •Local desinfection •Acyclovir 800 mg 5x/day, 7-14 days •Analgetics •Amitriptyllin DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 41. Herpes Zoster DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 42. Herpes zoster with cluster of grouped vesicles DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 43. DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 44. DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 45. herpes zoster (shingles) DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 46. Diagnosis – Culture, Tzanck smearTreatment – Self limiting – Symptomatic treatment: Analgesia, drying agent – Tab Acyclovir 800 mg 5 times daily x 5-7 day DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 47. 5. Ophthalmic zoster–Involvement of ophthalmic division of the trigeminal nerve–corneal ulceration–permanent scarring and loss of sight DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 48. Laboratory Diagnosis• Early vesicular lesions are the best diagnostic material• Virus isolation takes from 5 days to 3 weeks• More rapid detection is possible with centrifugation-enhanced cultures• Direct immunofluorescence• DNA amplification by PCR DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 49. Treatment• Acyclovir DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 50. 6. Other Viral Infections DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 51. Rubeola (red measles) DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 52. Rubella (german Measles) DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 53. Chicken Pox Clinical Features• Incubation period: 14 – 15 days• The patient is infectious for 2 days before and up to 5 days after onset• The rash is most dense on the trunk and head• Macules ---- Papules ---- Vesicles ---- Pustules DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 54. Varicella (chickenpox) DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 55. Chicken PoxDR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 56. Complications• Secondary bacterial infection (commonest)• Pneumonia• CNS –cerebellar syndrome –acute encephalitits DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 57. Eczema herpeticum(kaposi varicelliform eruption) DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 58. Management: Summary1. Local disinfection2. Acyclovir 800 mg 5times/day x 7-14 days3. Analgesics4. Amitrptyllin5. Topical 5% Acyclovir 4 times x 7 days DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 59. Prevention and control of Viral skin infection1. Early detection and treatment2. Enforcing the practice of good personal hygiene, such as regular bathing, laundering clothes, not sharing towels, soaps and wearing sandals in communal showers.3. Avoid contact with vesicles.4. Herpes lesions must be completely dry and crusted and should be covered until completely resolved. DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 60. Prevention and control ……………..5. Cover all warts until completely resolved.6. Care providers should wear gloves.7. Educating the people about prevention strategies is an important task.8. Warm showers are recommended in herpes simplex in order to cleanse the infected area. Afterwards, towel dry gently, or dry the area with a hair dryer on a low or cool setting. DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 61. Practice in BPKIHS: D-OPD• COMMON VIRAL INFECTIONS ARE: – CHICKEN POX – HERPES ZONSTER – HERPES SIMPLEX – VIRAL EXANTHIN ( RASHES) – WARTS (HPV): GENITAL , VERICA VULGARIS – MOLLOUSCUM CONTAGISUM DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 62. Rx prescribed1. Antiviral: Acyclovir2. Symptomatic3. Teaching: prevent transmission and care DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 63. Summary: 1. Warts: different types 2. Molluscum Contagiosum 3. Herpes Simplex 4. Herpes zoster 5. Opthalmic Zoster 6. Other Viral infections: - Rubeola (Red Measles) - Rubeola (German Measles) - Chicken Pox - Eczema Herpeticum 7. Management Summary 8. Prevention and control of viral skin infection 9. Practices in BPKIHS D-OPD DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 64. Thank You DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 65. Extra Slides DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 66. • Recurrent herpes –Less severe –Follows primary infection –Short duration –2 type : Facial oral herpes infection Genital herpes infection DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 67. • Recurrent facial oral infection (Cold sore) –Triggering factors – Photoexposure, trauma, infection –Recurrence rate – 3 to 4 year –Itching & burning at lip – papules – vesicles – ulcers – crusting – healing –Healing in 8 – 9 days DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 68. Recurrent herpes labialis DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 69. • Recurrent Genital herpes –More in male –Recurrence rate: 3-4 years –Severity, duration, symptoms: less Severity, –Burning/tingling-vesicles DR. Ram Sharan Mehta, MSND, CON, BPKIHS
  • 70. Genital herpes: recurrent infection of the penis DR. Ram Sharan Mehta, MSND, CON, BPKIHS