0071643192.pdf

DERMATOLOGY

TREATMENT

■ Oral acyclovir

■ Chickenpox is highly contagious from 5 days before the appearance of the

rash to five days after the appearance of the vesicles.

■ Susceptible pregnant women should be given varicella-zoster immune

globulin within 96 hours of exposure to prevent first and second trimester

effects to the fetus, which include limb atrophy, scarring, and CNS, and

ocular manifestations.

SHINGLES

ETIOLOGY

■ Reactivation of the latent VZV

■ Key risk factor is advanced age (>75 years old).

SYMPTOMS/EXAM

■ Identical to chickenpox in appearance but lesions have a unilateral der-

matomaldistribution, with thoracic and lumbar areas being most common

■ Lesions appear simultaneously and remain in congruent stages of

healing.

■ Infection begins as prodrome of headaches, photophobia, malaise, itching/

tingling/pain in the affected area for 1–3 days followed by maculopapular

rash→vesicular rash →pustules→ulcers→crusting. The course of the

disease is approximately 2 weeks.

■ Cranial nerve involvement may cause herpes zoster ophthalmicus if involv-

ing the ophthalmic branch of CN V and is a vision-threatening condition

that requires ophthalmology consult.

■ Occasionally lesions on the tip of the nose (Hutchinson sign) may be seen

before ocular involvement.

■ Ramsay Hunt syndromeor herpes zoster oticus classically presents with

ear pain, facial paralysis (due to CN VII inflammation), and herpetic

lesions of the ear canal or auricle. The presentation may mimic Bell

palsy, the pathophysiology for Bell palsy may involve VZV, and both Bell

palsy and Ramsay Hunt syndrome are treated with oral acyclovir and

steroids.

TREATMENT

■ Systemic analgesia, antivirals, and steroids

EXANTHEMS

Exanthems are skin eruptions that occurs as a symptom of a general disease.

Of those mentioned here, RMSF and scarlet fever are treated with antibiotics;

the rest are viral and are treated supportively (see Table 17.2).

Rocky Mountain Spotted Fever

■ Caused by Rickettsia rickettsii,which is harbored in tick saliva and trans-

mitted during a tick bite

Hutchinson sign =VZV

reactivation of ophthalmic

branch of CN V, lesion on tip

of nose.

Ramsay Hunt syndrome =VZV

reactivation of CN VII, lesion

in ear canal