3. HerpeS SiMplex ViruS
HSV is a double stand DNA virus
There are two types of HSV.
HSV type 1, associated with facial
and oral infection.
HSV type 2, affecting the genitalia.
HSV infection is one of the commonest
infections throughout the world.
HSV1 infection commonly affecting children.
HVS2 infection mainly occur after puberty
Close contact is required for HSV infection.
Contact must involve mm or abraded skin.
After an I.P (2-20days) , the primary attack will
occur which is asymptomatic in 90% of cases.
Following the 1ry attack there will be a latency
period where the virus remain dormant in on of
Reactivation of the virus will lead to recurrence of
9. )Herpetic Gingivostomstitis (1ry herpes
Most cases occur between 1-5 years.
After constitutional symptoms which
may be sever the stomatitis began.
The gums swollen, red and bleed easily.
Vesicles presents as white plaques which seen
on tongue, pharynx, palate and buccal mucosa.
Regional L.N may be enlarged and tender.
Fever subside after 3-5 days and recovery is
completed in 2 weeks.
12. )Herpes Labialis (cold sores, fever blisteres
The most common variety .
Often occurred in childhood.
Affecting the lips, but nose and cheeks
Commonly caused by HSV type 1.
1/3 of patients will experience a recurrence.
Of these 50% will experience at least 2
Post herpetic E.M may occur.
15. Herpetic whitlow
Occur as a direct inoculation of the
. virus from oral or genital lesions
Painful, grouped, confluent vesicles
on an erythematous & edematous
The disease is a common
occupational hazard for medical and
dental personnel, who work in and
.around the mouth
17. .Herpes Genitalis
Most commonly caused by HSV type II.
Age of onset: Young (sexually active adult).
Risk increases with multiple sex partners.
1ry infections mostly asymptomatic but mild
fever, headache, and local pain is noted.
Male: glans, shaft or sulcus of penis, scrotum
Female: both labia, perinum and thigh.
19. Eczema Herpeticum
Also known as Kaposi varicelliform eruption.
It is a HSV infection occurring in atopic dermatitis
Characterized by systemic symptoms e.g. fever,
malaise, irritability and lymphadenopathy.
Clinical examination reveals generalized vesicles
which often becomes heamorrhagic and crusting.
Commonly affecting the face, neck and trunk.
The primary attack is sever but the recurrence tend
to be milder.
23. Disseminated HSV in immuncompromized patient note the heamorrhagic and
.necrotic skin lesions also this patient has infection of liver, lung and brain
24. 1. Direct Microscopy Examination:
2. Viral culture:
It’s the most reliable way to make the diagnosis.
Polymerase Chain Reaction (PCR).
Useful in the diagnosis of culture –ve. or atypical lesion.
26. Most HSV infections are self-limited. However antiviral therapy
shorten the course of the disease, prevent dissemination, and
Treatment of 1ry attack
.Acyclovir (Zovirax) 200mg orally 5 times for 7 days
Treatment of recurrence
Acyclovir 400mg twice daily for one year suppresses
recurrence by 75%
28. It’s acute localized viral infection caused by
reactivation of varicella-zoster virus and
characterized by unilateral pain and
vesicular eruption limited to a dermatome
innervated by a corresponding sensory
The causative virus is VZV ( varicella-zoster virus)
The same virus causes varicella (chickenpox).
During varicella the virus travel the sensory
nerves to the sensory ganglion where it remain
dormant and establish the latency.
When immunity to the virus decreased the virus
replicate within the ganglion then travel back the
sensory nerve to skin resulting in dermatomal pain
and skin lesion.
AGE AND SEX:
There is no racial or sex predilection.
Most cases are older than 50 years .
1. Diminished immunity with ageing.
32. CLiniCaL piCtURE
PRODROMAL STAGE DAYS 3-5
ACUTE VESICULATION DAYS 3-5
CRUST FORMATION WEEKS 2-3
POST HERPETIC NEURALGIA MONTHS-YEAR
33. sKin LEsions
Closelygrouped vesicles & pustules.
On an erythematous base.
They may appear umbilicated.
Segmental ( dermatoml ) distribution.
New lesions continue to appear for a week.
34. sitEs of pREDiLECtions
Thoracicregion ( >50% of cases )
Trigeminal region ( 10 - 20%)
Lumbosacral and cervical ( 10 - 20%)
The disease is self limited.
The goals of treatment are.
1. Minimize the pain.
2. Speeding the healing.
(Topical & systemic antibiotic if 2ry bacterial infection)
3. Prevention of dissemination.
(Acyclovir 800mg / 6 hourly for 7-10 days)
It is a common, discrete benign
epidermal hyperplasia induced
by different types of human
papilloma virus (HPV)
Warts are very common infection allover the world.
Both sexes are equally affected.
All ages but rare in infancy & common in school years.
The highest incidence of common warts is between
the age of ( 9 – 16 years).
While for genital warts between 20 - 40 years.
Warts more common in immuncompromized patients.
47. mode of
Major mode is skin-to-skin contact.
Minor trauma with breaks in the skin facilitates
Habitual nail bitter or children who suck their hand
are at risk of auto-inoculation
Shaving may spread warts over the beard.
Genital wart is the commonest STD.
Warts caused by human papilloma vrius.
There are over 80 subtypes of HPV.
It is a double stand DNA virus belong to
The incubation period range from 1-6 months.
Different subtypes of HPV are more or less
causing specific clinical mainfestation.
Some subtypes are oncogenic ( e.g cervical
carcinoma caused by HPV 16 &18 ).
50. common Warts (verruca
HPV subtypes 1, 2, 4, 26, 27
Papules / nodules with rough surface.
They may occur singly or in groups.
Can occur any where but most commonly over
dorsal aspect of fingers & hands.
Characteristic by black dots on the surface which
represents thrombosed capillaries.
New warts may appear at sit of trauma (koebner
Periungual warts and filiform warts are variants of
55. plane Warts (verruca
HPV subtypes 3, 10, 27, 38.
Slightly elevated papule with smooth surface.
The number range from few to many hundreds.
Skin-colored, light brown, pink, or hypopigmented.
Shape may be round, oval, polygonal, or linear
lesions ( auto-inoculation by scratching ).
Common sit is the face or beard area, but may be
seen on dorsa of hands
56. Verruca plana (flat warts( : Flat-topped, smooth surface, skin-color
. numerous papules on the face
57. Verruca plana (flat warts( : Flat-topped, smooth surface, and
.erythematous numerous papules on the dorsum of right hand
58. planter Warts ( verruca
HPV subtypes 2, 4.
Rough hyperkeratotic surface studded with black
dots ( thrombosed capillaries ).
Usually single but may be multiple.
Affecting the planter aspects of feet or hands.
When multiple warts coalesce into large flat plaque
it is called mosiac wart.
Paring using surgical scalpel will produces pinpoint
D.D : Callosities and Corns.
59. Verruca plantaris (planter warts ): Hyperkeratotic surfaces involving the planter
aspects of right foot with coalesce forming mosaic warts
60. ) callositis (d.d of planter Wart
Callositis are circumscribed plaque of hyperkeratosis
induced by repeated friction or trauma.
Commonly seen over weight bearing area.
The surface is somewhat smooth and the epidermal
ridges continue without interruption.
Paring using surgical scalpel will not produces the
pinpoint bleeding spots
62. genital Warts (condyloma
HPV subtypes 6, 11, 16, 18.
Cauliflower papules, nodules or plaques.
Can occur solitary, multiple or in large masses.
It is the most common STD.
Seen in external genitalia of both sexes , perianal
region and in anal canal .
May affects the urethral meatus, urethra, vagina
Huge warts at risk of malignant changes.
Important D.D is condyloma lata (2 ry syphilis).
67. COURSE AND
Immuno-competent individuals, cutaneous HPV infections
usually resolve spontaneously.
- 50% of warts will resolve within 1 year.
- 70% of warts will resolve within 2 years.
Immuno-compromised patients, cutaneous HPV infections may
be very resistant to all modalities of therapy.
1. History and examination:
2. Acetowhitening test:
Acetic acid 3.5% causes some cubclinical
warts to develop shiny white surface color.
4. Pap smear: For cervical and anal warts.
Treatment depend on no. of lesions, site of wart and
Using liquid nitrogen ( -196 Co ).
The procedure is minimally painfull.
Heals without scarring.
Can be used for all warts.
71. Mark the lesion 2 mm. Start freezing
Maintain freezing for 10 sec. weeks later 3
75. PODOPhyllIN 20%
is a cytotoxic agent that arrest mitosis.
The treatment most commonly used for
Contarindicated during pregnancy.
Molluscum contagiosum is a self-limited
viral skin infection, characterized
clinically by skin-colored papules that are
often umbilicated, occurring in children &
sexually active adults.
Molluscum contagiosum virus (MCV).
It’s a large double strand DNA virus belong
to pox virus family. ( The largest virus known )
Skin-to-skin contact is essentials for
transmission of the infection.
MC is a common disease in children and
Both sexes are equally affected.
In children occur on exposed skin.
In adults may occur in genital skin (STD).
80. ClINICAl PICTURE
Incubation period 4 - 8 weeks.
The lesion is asymptomatic.
The charactarestic skin lesion is a PAPULE :
1. Size : Ranging from 2 – 10 mm.
2. Number : Single to hundred. (no specific distribution)
3. Color: Pearly white, translucent or skin-colored.
4. Surface: Smooth surface with umbilicated center.
5. Squeezing of lesion will extruded milky - white material.