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SKIN DISEASES: Herpes


Dermatlas: Herpes simplex
Herpes simplex

Dermatlas: Herpes varicella-zoster
Varicella-zoster virus
(chicken pox)


Dermatlas: Herpes varicella-zoster
Varicella-zoster virus
(shingles)


Dermatlas: Roseola infantum
Roseola infantum

Dermatlas: Kaposi's sarcoma
Kaposi's sarcoma


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HHV-1 (cold sores), HHV-2 (genital herpes)
Location: HHV 1 (herpes simplex virus 1, herpes labialis) is a recurrent viral disease that generally involves the lip (producing what are commonly known as cold sores) or the mouth area (producing canker sores), but can involve face and the genital area. HHV-2 (herpes simplex virus 2, herpes genitalis) mailnly involves the genitals, but may involve the mouth.

Symptoms: is characterized by the eruption of one or more painful, itching vesicles filled with clear fluid. Some people may experience prodromal symptoms: tingling, pain, burning, or itching in the area a few days before the blisters appear. The period from the time the blisters appear until the sores heal is known as an active outbreak. Type 2 herpes, or genital herpes, is a sexually transmitted disease. Newborns exposed to active herpes in the mother's birth canal can contract a serious form of the disease. The herpes simplex virus can be spread by an infected but asymptomatic person.

Prevention and Treatments: Treatment for recurrent herpes includes elimination of the precipitating conditions, local antibiotic treatment to prevent bacterial infection, and treatment with antiviral drugs such as acyclovir, although some resistant strains (see drug resistance) have developed. There is no cure. When one partner has herpes simplex infection and the other doesn't, the use of valaciclovir, in conjunction with a condom, has been demonstrated to decrease the chances of transmission to the uninfected partner.



HHV-3 (varicella-zoster virus = VZV)
Location: Herpes zoster usually affects persons past middle life, most often involving the area of the upper abdomen and lower chest, but may appear along other nerve pathways including that leading to the eye; serious ocular complications can lead to blindness.

Symptoms: infection of a nerve center (ganglion) with severe pain as the first simpthom. Then 2-3 crops of red lesions develop, which gradually turn into small blisters filled with serous fluid in the area of the nerve distribution, a condition called shingles. The rash and pain usually subside within 3 to 5 weeks. Sometimes serious effects including partial facial paralysis (usually temporary), ear damage, or encephalitis may occur. Shingles on the upper half of the face (the first branch of the trigeminal nerve) may result in eye damage and require urgent ophthalmological assessment. As long as the blisters have not dried out, HZ patients may transmit the virus to others.

Most people are infected with this virus as a child, as it causes chickenpox. Generally, the immune system suppresses re-activation of the virus. In the elderly, whose immune response generally tends to deteriorate, as well as in those patients whose immune system is being suppressed, this process fails. The virus starts replicating in the nerve cells, and newly formed viruses are caried down the axons to the area of skin served by that ganglion (a dermatome). Here, the virus causes local inflammation in the skin, with the formation of blisters.

Treatments: Aciclovir (an antiviral drug) is used both as prophylaxis (e.g. in patients with AIDS) and as therapy for herpes zoster. Other antiviral drugs used for herpes zoster therapy are valaciclovir and famciclovir. Steroids are often given in severe cases. The long term complication postherpetic neuralgia may cause persistent pain that lasts for years. Pain management is difficult as conventional analgesics may be ineffective. Alternative agents are often used, including tricyclic antidepressants, anticonvulsants, and/or topical agents.



HHV-6, HHV-7 (roseola infantum, sixth disease)
Symptoms: HHV-6 and HHV-7 are the cause of Exanthem subitum (roseola infantum, sixth disease), meaning "sudden rash", affecting infants and young children under 3 years of age. It is characterized by a sudden high fever of 39-40 degrees celsius that lasts several days. In some cases it can cause febrile convulsions - due to the suddenness of the rise in body temperature. In a few days shortly after the fever has subsided, spotty pinkish rash appears. This usually begins on the trunk, spreading to the limbs but usually not affecting the face. It disappears again in a matter of hours to a day or so.

Prevention and Treatments: There is no specific vaccine against or treatment for, Exanthem subitum, and most children with the disease are not seriously unwell. The child with fever should be given plenty of fluids to drink, and acetaminophen or ibuprofen to reduce the temperature. He or she should also be kept more lightly clothed than normal if he or she is very hot. The rash is not particularly itchy and needs no special lotions or creams.



HHV-8 (rhadinovirus = KSHV = Kaposi's sarcoma herpesvirus)
Location: starts with spots on the feet and legs and spreads from the skin to lymph nodes and internal organs. KS lesions are nodules or blotches that may be red, purple, brown, or black, usually painless but sometimes painful and swollen. They most often appear under the surface of the skin or on mucous membranes, where they are only dangerous if they cause enough swelling to obstruct circulation, breathing, or eating. They may also be found in internal organs, particularly the respiratory system or gastrointestinal system; internal lesions are most commonly seen in epidemic KS, and can cause fatal bleeding.

Symptoms: HHV-8 produces a usually fatal cancer characterized by numerous bluish-red nodules on the skin, usually on the lower extremities. Kaposi's sarcoma is found mainly in older men of Mediterranean or African origin (classic KS) or patients with severely weakened immune systems, such as after an organ transplant (immunosuppressive treatment related KS). It was considered rare until its appearance in a particularly virulent form in people with AIDS (epidemic KS). Kaposi's sarcoma appears in three forms and is characterized by vascular skin tumors. In AIDS, Kaposi's presents as barely raised pink or red papules or plaques that become widely disseminated on the skin and in the gastrointestinal and respiratory tracts, where they may cause extensive bleeding.

Prevention and Treatments: No known cure for KS exists. Treatment that is focused on eliminating the existing lesions, does not prevent new lesions from developing (existing lesions are treated by means of chemotherapy drugs such as paclitaxel and bleomycin, radiation therapy, or surgical removal). Treatment with drugs such as ganciclovir that target the virus causing Kaposi's sarcoma may prevent new tumors but do not adequately treat existing lesions. Treating the cause of the immune system dysfunction can slow or stop the progression of KS (in cases when KS is associated with immunodeficiency or immunosuppression). The current clinical practice for AIDS or organ transplant patients is usually to avoid treating KS lesions directly, unless they are causing pain, disfigurement, or internal organ damage.


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