Viral Skin Diseases

Verruca Vulgaris After Treatment

Verruca vulgaris on the left thumb immediately posttreatment with pulsed dye laser, 590 nm wavelength, 7 mm spot size, 10 J/cm2, with pulse stacking.

Verruca Vulgaris

Verruca vulgaris. The common wart is a benign growth caused by localized infection with one of the many types of human papillomavirus. These small DNA viruses are part of the papovavirus group. Warts are especially common among children and adolescents and may occur on any mucocutaneous surface. The hands are a particularly frequent location. The typical wart is a roughsurfaced nodule that may be either lighter or darker than the surrounding skin.

Verruca Plana

Verruca plana. Scattered flat-topped papules increasing in number on the dorsum of a child's hand.

Hand-Foot-and-Mouth Disease on Hand 2

Hand-foot-and-mouth disease. Multiple, discrete, small, vesicular lesions on the fingers and palms; similar lesions were also present on the feet. Some vesicles are typically linear.

Hand-Foot-and-Mouth Disease on Hand 1

Hand-foot-mouth disease. This common and benign viral disease of childhood is usually caused by the A16 strain of coxsackievirus, although other strains of the same virus have been implicated. It most often occurs in late summer and early fall. The prodrome consists of low-grade fever and malaise. Shortly thereafter, vesicular lesions arise on the soft palate, tongue, buccal mucosa, and uvula. The lips are usually spared. Occasionally, these lesions may be painful and cause some difficulty in eating. The cutaneous lesions develop 1 or 2 days after those in the mouth. They consist of asymptomatic round or oval vesiculopustules that evolve into superficial erosions. The edges of the palms and soles are a favored location.

Hand-Foot-and-Mouth Disease on Foot

Hand-foot-mouth disease. This common and benign viral disease of childhood is usually caused by the A16 strain of coxsackievirus, although other strains of the same virus have been implicated. It most often occurs in late summer and early fall. The prodrome consists of low-grade fever and malaise. Shortly thereafter, vesicular lesions arise on the soft palate, tongue, buccal mucosa, and uvula. The lips are usually spared. Occasionally, these lesions may be painful and cause some difficulty in eating. The cutaneous lesions develop 1 or 2 days after those in the mouth. They consist of asymptomatic round or oval vesiculopustules that evolve into superficial erosions. The edges of the palms and soles are a favored location.

Hand-Foot-and-Mouth Disease in Mouth 2

Hand-foot-mouth disease. This common and benign viral disease of childhood is usually caused by the A16 strain of coxsackievirus, although other strains of the same virus have been implicated. It most often occurs in late summer and early fall. The prodrome consists of low-grade fever and malaise. Shortly thereafter, vesicular lesions arise on the soft palate, tongue, buccal mucosa, and uvula. The lips are usually spared. Occasionally, these lesions may be painful and cause some difficulty in eating. The cutaneous lesions develop 1 or 2 days after those in the mouth. They consist of asymptomatic round or oval vesiculopustules that evolve into superficial erosions. The edges of the palms and soles are a favored location.

Hand-Foot-and-Mouth Disease in Mouth 1

Hand-foot-and-mouth disease. This common and benign viral disease of childhood is usually caused by the A16 strain of coxsackievirus, although other strains of the same virus have been implicated. It most often occurs in late summer and early fall. The prodrome consists of low-grade fever and malaise. Shortly thereafter, vesicular lesions arise on the soft palate, tongue, buccal mucosa, and uvula. The lips are usually spared. Occasionally, these lesions may be painful and cause some difficulty in eating. The cutaneous lesions develop 1 or 2 days after those in the mouth. They consist of asymptomatic round or oval vesiculopustules that evolve into superficial erosions. The edges of the palms and soles are a favored location.

Erythema Multiforme Minor

Erythema multiforme minor (EM minor). Polycyclic target lesions with alternating rings of erythema and dusky desquamation on the arm.

Kaposi’s Sarcoma Ecchymotic

Classic Kaposi's sarcoma. Ecchymotic purple-brownish macule and a 1-cm nodule on the dorsum of the hand of a 65-year-old male of Ashkenazi-Jewish extraction. The lesion was originally mistaken for a bruise as were similar lesions on the feet and on the other hand. The appearance of brownish nodules together with additional macules prompted a referral of this otherwise completely healthy patient to a dermatologist who diagnosed Kaposi's sarcoma, which was verified by biopsy. Note also onychomycosis of all fingernails.

Rubella 2

Rubella. Petechiae on the hard palate of the same individual (Forchheimer's sign).

Rubella 1

Rubella syndrome: The constellation of abnormalities caused by infection with the rubella (German measles) virus before birth. The syndrome is characterized by multiple congenital malformations (birth defects) and mental retardation. The individual features of the syndrome include growth retardation, microcephaly (abnormally small head), cataracts, glaucoma, microphthalmia (abnormally small eyes), cardiovascular malformations, hearing loss, and mental retardation. Deafness is common. After birth the child may develop diabetes due to gradual destruction of the pancreas by the rubella virus. The child has a 50% risk of being born with the congenital rubella syndrome, if the mother is infected with rubella in the first trimester (the first third) of pregnancy. Risks still exist with infection in the second trimester The discovery of the congenital rubella syndrome by the Australian ophthalmologist (eye doctor) NM Gregg in 1941 is of historic importance. It provided the first evidence that the placental barrier between the mother and the fetus does not fully protect the fetus from teratogens (agents that can cause birth defects). The rubella epidemic of 1963-1965 resulted in 1,800,000 infected individuals, approximately 20,000 fetal deaths and about 30,000 infants born with congenital rubella syndrome. Since the introduction of the rubella vaccine in 1969 there are less than 120 cases of congenital rubella syndrome reported each year. The condition also goes by the name of fetal rubella effects.

Measles

Measles: An acute and highly contagious viral disease characterized by fever, runny nose, cough, red eyes, and a spreading skin rash. Measles, also known as rubeola, is a potentially disastrous disease. It can be complicated by ear infections, pneumonia, encephalitis (which can cause convulsions, mental retardation, and even death), the sudden onset of low blood platelet levels with severe bleeding (acute thrombocytopenic purpura), or a chronic brain disease that occurs months to years after an attack of measles (subacute sclerosing panencephalitis). During pregnancy, exposure to the measles virus may trigger miscarriage or premature delivery. Treatment includes rest, calamine lotion or other anti- itching preparations to soothe the skin, non-aspirin pain relievers for fever, and in some cases antibiotics. Measles can often be prevented through vaccination. Also known as hard measles, seven-day measles, eight-day measles, nine-day measles, ten-day measles, morbilli. See also measles encephalitis; measles immunization; measles syndrome, atypical; MMR.

Infectious Mononucleosis

Infectious mononucleosis: A specific viral infection (with the Epstein-Barr virus) in which there is an increase of white blood cells that are mononuclear (with a single nucleus) "Mono" and "kissing disease" are popular terms for this very common illness caused by the Epstein-Barr virus (EBV). By the time most people reach adulthood, an antibody against EBV can be detected in their blood meaning they have been infected with EBV. The illness is less severe in young children. The infection can be spread by saliva. The incubation period for infectious mononucleosis is 4 to 8 weeks. Symptoms include fever, fatigue, sore throat, and swollen lymph glands. "Mono" can cause liver inflammation (hepatitis) and spleen enlargement. Vigorous contact sports should be avoided to prevent spleen rupture.

Warts

Wart: A local growth of the outer layer of the skin (the epidermis) caused by a virus. The virus of warts (a papillomavirus) is transmitted by contact. The contact can be with a wart on someone else or one on oneself (autoinoculation). Warts that occur on the hands or top of the feet are called "common warts." A wart on the sole (the plantar surface) of the foot is a plantar wart (and can be quite painful). Genital (venereal) warts are located on the genitals and are transmitted by sexual contact; they are a form of STD (sexually transmitted disease). Warts are nothing new. The word "wart" is from Old English. As far back as the 8th century, a "wart" was, well, a wart. The medical name for a wart is "verruca", the Latin for wart. A common wart is a "verruca vulgaris". A wart in medicine is also sometimes called by its Spanish name, "verruga".

Plantar Warts

Plantar warts: Warts that grow on the soles of the feet. Plantar warts are different from most other warts. They tend to be flat and cause the buildup of callus (that has to be peeled away before the plantar wart itself can be seen. Plantar warts may attack blood vessels deep in the skin. They can be quite painful. Plantar warts are caused by human papillomavirus (HPV) type 1 and tend to affect teenagers. By contrast, common warts on the skin of the fingers and hands appear as little mounds of overgrown skin with a rough dry surface. They do not as a rule grow down much and they do not tend to hurt. They are usually caused by HPV types 2 and 4 and by preference affect young children before their teens. To avoid plantar warts, a child should be taught never to wear someone else's shoes. If a child gets plantar warts, they should be treated by a doctor. Plantar warts can be far more of a problem than common warts.

Erythema Infectiosum

Fifth disease is an oddly named disease caused by a virus called parvovirus B 19. (In the pre-vaccination era, fifth disease was frequently the "fifth disease" that a child contracted.) . Symptoms include low-grade fever, fatigue, a "slapped cheeks rash," and a rash over the whole body. While the illness is mild in most children, some children with immune deficiency (such as those with AIDS or leukemia) or with certain blood disorders (such as sickle cell anemia or hemolytic anemia) may become seriously ill with fifth disease. Parvovirus B19 can temporarily decrease or halt the body's production of red blood cells, causing anemia. Moreover, fifth disease is of consequence in many adults. About 80% of adults with fifth disease have joint aches and pains (arthritis) which may become long-term with stiffness in the morning, redness and swelling of the same joints on both sides of the body (a "symmetrical" arthritis), most commonly involving the knees, fingers, and wrists. Pregnant women (who have not previously had the illness) should avoid contact with patients who have fifth disease. The fifth disease virus can infect the fetus prior to birth. And, while no birth defects have been reported as a result of fifth disease, it can cause the death of the unborn fetus. The risk of fetal death is 5-10% if the mother becomes infected. A sometimes-used Latin name for fifth disease is erythema infectiosum.

Cold Sores (Fever Blisters)

Cold sores, sometimes called fever blisters, are groups of small blisters on the lip and around the mouth. The skin around the blisters is often red, swollen, and sore. The blisters may break open, leak a clear fluid, and then scab over after a few days. They usually heal after several days to 2 weeks. Cold sores are caused by the herpes simplex virus (HSV). There are two types of herpes simplex virus: HSV-1 and HSV-2. Both virus types can cause lip and mouth sores and genital herpes. The herpes simplex virus usually enters the body through a break in the skin around or inside the mouth. It is usually spread when a person touches a cold sore or touches infected fluid-such as from sharing eating utensils or razors, kissing an infected person, or touching that person's saliva. A parent who has a cold sore often spreads the infection to his or her child in this way. Cold sores can also be spread to other areas of the body.

Molluscum Contagiosum

Molluscum contagiosum: A contagious disease of the skin marked by the occurrence of rounded soft tumors of the skin caused by the growth of a virus (one that belongs to the virus family called the Poxviridae). The disease is characterized by the appearance of a few to numerous small, pearly, umbilicated downgrowths called molluscum bodies or condyloma subcutaneum. Molluscum contagiosum is mainly seen in children. In teenagers and adults it is often transmitted sexually and so may be considered a sexually transmitted disease (STD). It is a benign disorder that usually clears up by itself. The Latin "molluscus" means soft.

Herpetic Whitlow

Herpetic whitlow. Painful grouped red-blue vesicles on the middle finger of a child.

Herpes Zoster

Herpes zoster. Also called shingles, zona, and zoster. The culprit is the varicella-zoster virus. Primary infection with this virus causes chickenpox (varicella). At this time the virus infects nerves (namely, the dorsal root ganglia) where it remains latent (lies low) for years. It can then be reactivated to cause shingles with blisters over the distribution of the affected nerve accompanied by often intense pain and itching.

Varicella Chicken Pox

Varicella Chickenpox is caused by a virus of the herpes group. The disease is highly contagious and is spread by droplet or direct contact. The incubation period for chickenpox ranges from 11 to 21 days. Prodromal symptoms consist of low-grade fever, headache, anorexia, and malaise. On the following day, the characteristic rash begins to appear. The lesions evolve from erythematous macules to form small papules. Quickly, a clear vesicle arises on this erythematous base. The classic lesion of chickenpox has been poetically described as a “dewdrop on a rose petal.” Over the next several days, the vesicles rupture and then crust. The rash begins on the chest and back and spreads centrifugally to involve the face, scalp, and the extremities. New lesions of chickenpox arise in crops over a period of several days.

Varicella-Zoster Virus Infection (Face)

Varicella-zoster virus infection: varicella. Multiple, very pruritic, erythematous papules, vesicles (“dewdrops on a rose petal”), and crusted papules on erythematous, edematous bases on the face and neck of a young female. The spectrum of lesions, arising over 7 to 10 days, is typical of varicella.

Varicella-Zoster Virus Infection Close-Up

Varicella-zoster virus infection: herpes zoster with cluster of grouped vesicles. Grouped and confluent vesicles surrounding erythema on the chest wall.

Varicella-Zoster Virus Infection on Chest Wall

Varicella-zoster virus infection: herpes zoster in T8 to T10 dermatomes. Typical grouped vesicles and pustules with erythema and edema of three contiguous thoracic dermatomes on the posterior chest wall.

Shingles

Shingles: An acute infection caused by the herpes zoster virus, the same virus as causes chickenpox. Shingles is most common after the age of 50 and the risk rises with advancing age. Shingles occurs because of exposure to chickenpox or reactivation of the herpes zoster virus. The virus remains latent (dormant) in nerve roots for many years following chickenpox. Shingles is an extraordinarily painful condition that involves inflammation of sensory nerves. It causes numbness, itching or pain followed by the appearance of clusters of littles blisters in a strip pattern on one side of the body. The pain can persist for weeks, months or years after the rash heals and is then known as post-herpetic neuralgia. People with shingles are contagious to persons who have not had chickenpox and can catch chickenpox from close contact with a person who has shingles. The term shingles has nothing to do with a shingle on a roof or the small signboard outside the office of a doctor but is derived from the Latin cingulum meaning girdle, the idea being that shingles often girdles part of the body.

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