Topic 10. Skin Diseases Caused by Varicella Zoster Virus
Transcript of Topic 10. Skin Diseases Caused by Varicella Zoster Virus
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7/28/2019 Topic 10. Skin Diseases Caused by Varicella Zoster Virus
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Efi. Gelerstein 2011
Topic 10. Skin diseases caused by varicella zoster virus
Cause
Spread by respiratory route; its incubation period is ~ 14 days. Second infection or reactivationPresentation and course
Sensory ganglions are affected dermatomes, nerve segments Unilateral spread of painful vesicles on red base Papules + Slight malaise papules turn rapidly into clear
vesicles w/ pustular content lesions crust and then clear,
sometimes leaving white depressed scars
Prodromal stage, provoking agents Special localizations:
1. nerves V/1comeal ulcers2. V/2,3aptha, deafness3. N. facialis paresis = Ramsay-Hunt syndrome.
Lesions appear in crops, are often itchy, and are most profuse on the trunk and least profuse on theperiphery of the limbs (centripetal
Varicella can be fatal in those who are immunologically compromisedComplications
Pneumonitis, with pulmonary opacities on X-ray. Secondary infection of skin lesions. Scarring.Differential diagnosis
Smallpox, mainly centrifugal anyway, has beenuniversally eradicated, and the diagnosis of chickenpox
is seldom in doubt.
Treatment
Acyclovir, famciclovirand valaciclovirshould be reservedfor severe attacks and for immunocompromised patients (prophylactic acyclovir)
A live attenuated vaccine is now available
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7/28/2019 Topic 10. Skin Diseases Caused by Varicella Zoster Virus
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Efi. Gelerstein 2011
Herpes zoster (Shingles)
Reactivation for no obvious reason of virus that has remaineddormant in a sensory root ganglion since an earlier episode of
chickenpox (varicella).
Incidence of shingles is highest in:1. Old age2. Hodgkins disease3. AIDS4. Leukaemia (weak defense)
Presentation and course
Attacks usually start with a burning pain followed by erythemaand grouped, sometimes blood-filled, vesicles scattered over a
dermatome.
The clear vesicles quickly become purulent, and over the space of afew days burst and crust. Scabs usually separate in 23 weeks,sometimes leaving depressed depigmented scars.
Zoster is characteristically unilateral. It may affect more than oneadjacent dermatome.
Complications
Secondary bacterial infection is common. Motor nerve involvement (uncommon) paralysis of ocular muscles, facial muscles, diaphragm and
the bladder.
Ophthalmic division of the trigeminal nerve corneal ulcers and scarring. Persistent neuralgic pain, after the acute episode is over, is most common in the elderly. Other complications:
1. Zoster hemorrhagicus2. Zoster gangrenous3. Zoster ophtalmicus4. Zoster generalisatus5. Zoster post-herpetic neuralgia
Therapy:
Antiviral (acyclovir, valacyclovir, famcyclovir) Vitamin B NSAID Glucocorticoids