DERMATOVIROLOGI

VIRUS
• Viruses form a diverse group of infectious,
acellular organisms that share a distinctive
composition and a unique mode of
replication
• Because their replication depends on the
host cell that viruses are often refferd to as
obligate intracellular parasites
• Classification : size, shape, structure of the
virion, type of viral nucleic acid within it.
 Type of viral nucleic acid

• DNA • RNA
– Retrovirus : HIV
– Herpesvirus : HSV, VZV – Paramyxovirus: measles
– Papillomavirus : HPV – Togavirus : rubella
– Picornavirus : Coxsackie 
– Poxvirus: Variola, MK, orf, HFMD
milker’s nodule
– Bunyavirus
– Parvovirus : EI – Arenavirus
– Hepadnavirus : HBV – Coronavirus
– Orthomyxovirus
– Adenovirus – Rhabdovirus
– Reovirus
Human Herpes Virus
(HHV)
• HHV-1 : herpes simplex 1
• HHV-2 : herpes simplex 2
• HHV-3 : Varicella-zoster
• HHV-4 : Epstein-Barr virus
• HHV-5 : Cytomegalovirus
• HHV-6 : Exantema subitum
• HHV-7 : Roseola infantum
• HHV-8 : Sarkoma Kaposi terkait virus
 Varicella
• Etiology: Varicella-zoster virus (VZV)
• Clinical entities : chickenpox and herpes
zoster
• Varicella  an acute, highly contagious
exanthem that occurs most often in
childhood, is the result of primary infection
of a susceptible individual
 Pathogenesis
• Entry : the mucosa of the upper respiratory tract
and oropharynx
• Initial multiplication at this portal 
dissemination of small amounts of virus via the
blood and lymphatics (the primary viremia)
• This virus is cleared by RES, the major site of
virus replication during the remainder of the
incubation period
• 2 wks after infection  secondary viremia 
larger viremia and associated symptoms and
lesions occur
 Clinical findings
• Prodrome :
– Young children : uncommon
– Older children : the rash is often preceded by 2-
3 days fever, chills, malaise, sore throat and
cough
• Rash :
– Begins on the face and scalp  spreads rapidly
 trunk with relative sparing of the extremities
• Rapid progression, in 12 hours  rose colored
macules to papules, vesicles, pustules and crusts
• Vesicle  2-3mm, elliptical, superficial, thin-
walled and is sorrounded by an irregular area of
erythema  “dewdrop on a rose petal”
 DD/
– Impetigo vulgaris
– Insect bites
– Contact dermatitis
– Disseminated herpes simplex
– Scabies
 Laboratory test
• Tzanck smears  multinucleated giant cells and
epithelial cells containing intranuclear inclusion
bodies
• histoPA  punch biopsies
• Definitive  isolation of virus in cell cultures
inoculated with vesicle fluid, blood, CSF 
identification of VZV antigens
• IF, Immunoperoxidase, PCR
• Serologic test
 Management
• In normal children  benign and self
limited  cool compresses or calamine
lotion locally, oral antihistamines,
antipyretics may be needed
Management
 Herpes Zoster
• Is characterized by unilateral, dermatomal
pain and rash as the result of the
reactivation of endogenous VZV that had
persisted in latent form within the sensory
ganglia after an earlier attack of varicella
• Older adults and immunosuppresed
individuals
 Pathogenesis
• During varicella  VZV passes to the contigous ending of
sensory nerves and is transport centripetally up to the
sensory ganglia
• In the ganglia  the virus establishes a latent infection that
persists for life
• HZ occurs more often in dermatomes which the rash of
varicella achieves the highest density
• Re-activation  immunosupresion, emotional stress, etc
 decline in VZV specific cellular immunity that occurs
with increasing age
• Damage to neurons in the spinal cord and ganglion and to
the peripheral nerve post herpetic neuralgia (PHN)
 Clinical findings
• Prodrome :
– Pain, paresthesia in the involved dermatome
– Constant or intermittent
– Tenderness and hyperestesia
– Majority  > 60 years
• Rash :
– Unilateral, limited to the area of skin innervated by a
single sensory ganglion (trigeminal nerve, T1-L2)
– Erythematous macules and papules  12-24 hours
vesicles and pustules  7-10 days  crust (2-3 weeks)
Management
 Herpes Simplex
• Types: HSV 1 and 2
• HSV 1  orofacial disease
• HSV 2  genital infection
• But both can infect oral and genital areas
• Acute and/or recurrent infection
 Cinical findings
• Herpetic ginggivostomatitis  primary
– Location : may resemble aphtous stomatitis; hard &
soft palate, tongue, buccal mucosa
– Efl : ulcerative lesion
– Assc finding: fever, malaise, myalgia, pain,
swallowing, cervical adenopathy
• Herpes labialis  re-activation
– Location : periorofacial (lips, with outer one-third of
the lower lips, two-third labial lesion; vermilion border)
– Efl : vesicles, ulcer, hard crust (disease stages)
Residual swelling (resolution stages)
– Prodrome : pain, burning, itching
 Laboratory test
• Dx/ history + clincal
findings  sufficient
• Tzanck smear 
multinucleated cells with
intranuclear eosinophilic
inclusion bodies
• Cell culture
• PCR
• Serologic testing
Management
 Warts / Veruka
• Benign proliferations of the skin and mucosa that
are caused by infection with human papilloma
virus (HPV)
• Etiology :
– Type 1 : deep plantar/palmar warts
– Type 2, 4, 27, 29 : common warts/ veruka vulgaris
– Type 6,11,16,18  anogenital warts/ condylomata
acuminata
 Pathogenesis
• HPV infection occurs through inoculation
of virus into viable epidermis through
defects in the epithelium
 Clinical findings
• History of a newly
acquired, slowly expanding,
persistent, and often scaly
lesion of the skin
• Variation :
– Veruka vulgaris : scaly,
rough, spiny papules or
nodules that can be found on
any cutaneous surface 
hands, fingers
• Verruca plana : 1-4
mm, slightly elevated,
flat topped papules,
minimal scales 
face, hand and lower
legs
Palmar and plantar warts
• Thick, endophytic, hyperkeratotic papules
which maybe painful with pressure
 Treatment
• Physical destruction of the infected cells
• The choice of treatment depends on:
– Location
– Size
– Number
– Type of wart
– Age and cooperation of patient
 Treatment
• Children  spontaneous regression
• Cryotherapy
• Electrodessication and curretage
• Surgical excision
• Topical podophyllin resin
• Salicyl acid
• Trichloroacetic acid
 Molluscum Contagiosum
• Benign, but nonetheless frequently
troublesome viral infection that generally
affects young children
• Smooth, dome-shaped discrete papule,
surround by area of scale and erythema
• Prolonged course, may persists for months
to years
• Etiology : Poxvirus
 Clinical findings
• Extremely small, pink, pearly or flesh colored
papules that then enlarges to 3 cm (giant
molluscum)
• The lesion : a central dell or umbilication within
which a white-curd like substance that can be
expressed with pressure.
• Multiple; discreet
• Location : intertriginous sites (axillae, popliteal,
groin), genital and perianal
 Treatment
• Enukleasi
• Curretage
• Cryotherapy
• Topical cantharidin 0,7-0,9%