皮肤性病学课件：05 Viral Dermatosis

ViralDermatosisUsual

skin

lesions

of

viralinfectionn

blister

/

vesicleherpes

simplex,

herpes

zoster,

vericellahand-foot-mouth

diseasen

Neoplasmawart

(verruca),

molluscumn

Exanthesismeasles,

rubellaHerpes

SimplexA

worldwide

infection

caused

by

twoclosely

related

types

of

HSV,

usuallymanifests

as

a

single

cluster

of

vesicles

onskin

or

mucosa.

It

is

self-limited

and

easyto

recur.Pathogenn

HSV-1n

HSV-2oral-facial

infectiongenital

and

perigenital

infectionInfection

sourcen

Viral

shedding

from

symptomatic

orasymptomatic

patients

(especiallyHSV-2)Transmission

routen

Direct

skin

inoculationClinical

manifestationn

Incubation

period2-12

days,

average

6

daysn

Primary

infectiongingiva-gingivostomatitispharynx-pharingitiscornea

&

conjunctiva-keratoconjunctivitisn

Recurrent

episodeProdromal

stage:

itch

or

burningdevelopmental

stage:

erythema,

papulesdisease

stage:

vesicle,

ulcer,

hard

crustresolution

stage:

dry

flaking,

residual

swelling5

–

15

daysTrigger

factors

for

recurrencen

Emotional

stress,

fatiguen

Illness,

trauman

Strong

solar

exposuren

Mensesn

Excessive

drinkingTreatment

for

herpes

simplexn

Neucleosides:

acyclovir,

valacyclovirprimary

infection:

10

daysrecurrent

infection:

5

daysfrequent

recurrenceHerpes

zosterHerpes

zoster

is

a

viral

dermatosiscaused

by

varicella-zoster

virus(VZV),and

clinically

manifests

clusters

ofblister

along

the

peripheral

nerveaccompanied

by

obvious

neuritic

pain.The

passage

of

VZV

in

human

body:natural

infectionrespiratory

tract

→

circulation

system→

skin

→

varicella

(70%),

orrecessive

infection

(30%)latent

stageskin

→

sensory

ganglion

cell

of

spinal

orcranial

nerve

→

incubatory

carriersecondary

attacksensory

ganglion

cell

→

skin

→herpes

zoster

→

permanent

immunityClinicle

manifestation

of

varicellan

Susceptible

people:

children

or

adultswithout

immunity

to

this

virusn

Prodromal

stage:1-2

daysn

Skin

lesion:

scattered

erythema,

papule,vesicle,

crustn

Lesion

position:

centripetal

distributionn

Course:

2

weeksvaricellaClinicle

manifestation

of

herpes

zoster1.Susceptible

people:normal

peoplefatigue,emotion

attack,senilityabnormal

peoplemalignancyAIDSpatients

accepting

chemotherapy

andradiotherapy

(patients

with

auto-immunedisease,

malignancy

,organ

transplantation)prodromal

period:

1-4

daysskin

lesion:clusters

of

blister,

bullae,

gangrene4.lesion

position:unilateralthoracic

N.

53%cranial N.

15%cervical

N.

20%lumbar

&

sacral

N.

11%5.subjective

sensation6.course7.specific

types:

abortive

herpes

zosterdisseminated

herpes

zosterrecurrent

herpes

zosterRamsey-Hunt

syndromeRamsey-Hunt

syndrome:If

VZV

infects

the

geniculateganglion

which

contains

bothsensory

and

motorial

neuralfiber,

the

patient

willmanifests

facioplegia,

earpain,

and

herpes

in

externalauditory

meatus.Diagnosis

&

differential

diagnosis

withherpessimplexclinical

features:unilateral

clusters

of

blister

lining

athe

peripheral

nerveobvious

neuralgia,

which

may

continuefor

several

months

or

years

–

postherpeticneuralgia

(PHN)usually

form

a

permanent

immunityTreatment:antiviral

agent: acyclovir,

valacyclovir,immune

regulator:

thymic

peptide3.analgesic

therapy:glucocorticosteroid

hormonnon-steroid

analgesicsneural

nutrient:VitB1,6,12Chinese

medicineacupuncturephysiotherapy4.topicaltherapyHPV

infectionPapillomavirus

causes

benign

cutaneousand

mucosal

epithelial

proliferationcommonly

called

warts

or

verrucae.PV

infections

do

not

produce

acute

localor

systemic

symptoms

but

induce

slow,focal

accumulation

of

keratinocytes,

whichcan

persist

for

years.Verruca

vulgarisAcquired,

slowlyexpanding,

persistentscaly,

rough,

spinypapules

or

nodulesVerruca

vulgarisVerruca

plantarisVerruca

planaSelf

inoculationVerruca

planaCondyloma

Acuminatum(genitalwarts/vernereal

warts)n

Pathogen:

HPV-6,11,16,18n

Incubation

period:

1-8

months,

average3

monthsn

Exophytic,

cauliflower-like

warts

atgenital,

perianal

area

or

oral

cavityn

Growth

rate

is

much

faster

than

verrucavulgarisn

Oncogenic

potentialCondyloma

acuminatumCondyloma

acuminatumMolluscum

contagiosumCaused

by

MCV

infectionSmall

pink

or

pearlydome-shaped

papuleswith

umbilicationsometimes.Scattered,

or

grouped

incluster,

or

appear

in

alinear

array.Treatmentn

Clampingn

cryotherapyKey

pointsn

C