DERMATOLOGY
HERPESETIOLOGY
■ Herpes simplex virus is transmitted through direct contact or infected secre-
tions (saliva or genital).
■ Patients with eczema are at elevated risk for widely disseminated eruptions
of HSV.
■ Neonatal herpes is acquired during delivery.
SYMPTOMS/EXAM
■ Small, thin-walled, grouped vesicleson an erythematous base
■ HSV-1 primarily causes oral lesions throughout the mouth (unlike her-
pangina, which are posteriorly located); after primary infection a recurrence
of lesions usually occur on the lower lip triggered by local trauma, sunburn,
or stress. Prodrome of local LAD, pain, and tingling may occur with lesions
appearing within 2 days.
■ HSV-2 mainly causes genital lesions.
■ ATzancksmear may be used to confirm the diagnosis. Tzanck smears are
also positive with varicella/herpes zoster.
TREATMENT
■ Oral acyclovir can shorten duration of symptoms. Topical penciclovir is
not effective.
■ For sexually transmitted HSV, abstinence is the only method for absolute
prevention, condoms are only effective if they cover all lesions; asympto-
matic viral shedding still occurs with suppressive drug therapy.
■ Herpes simplex virus keratitis (usually due to HSV 1) is a leading cause of
corneal blindness. It most commonly presents with a dendriticcorneal
ulcer. Topical or oral antivirals with or without topical steroids are used,
depending on location of infection within the cornea.
HERPETIC WHITLOW■ Herpetic whitlow is a primary or recurrent HSV-1 or HSV-2 infection of
the finger causing painful vesicles on a digit that coalesce and may appear
to contain pus, but instead contain necrotic epithelial cells.
■ It must not be misdiagnosed as a paronychia and incised, which can delay
healing and allow secondary infection.
■ Treat with local wound care and pain control.
CHICKENPOX (VARICELLA-ZOSTER VIRUS, HUMAN HERPES VIRUS 3)SYMPTOMS/EXAM
■ Prodrome of 1–2 days of low-grade fever and malaise is followed by
appearance of clear vesicles on an erythematous base, described as “dew
drops on a rose petal.”
■ The vesicles, which can be anywhere on the body including the mucous
membranes, then scab over in various stages. The rash moves from the
trunk out to the extremities. Multiple stages of lesionson the same body
part is characteristic of chickenpox.
■ Chickenpox may cause congenital defects if infects pregnant woman in first
trimester.