00:01
If one looks at the clinical manifestations,
one sees localized pain,
tenderness, burning or tingling,
which may precede the
lesions. Then, painful grouped vesicles
appear
on an erythematous base.
00:18
Do note, though, that in dark skin,
erythema tends to be dusky red
or skin colored, depending on the
pigmentation of the individual.
00:29
This then progresses to pustules.
00:32
Pustules rupture to form erosions and
ulcerations with a
characteristic scalloped border.
00:42
Herpes labialis is the most common
manifestation of recurrent HSV-1
infection. It's also known as cold sores.
00:50
The classical hepatic lesion is preceded by
the prodrome of pain,
burning and tingling,
so you can see the grouped vesicles on that
picture with an erythematous base.
01:01
But do remember that in dark skin this may be
more dusky or skin colored.
01:06
Eczema herpeticum is an extensive cutaneous
vesicular eruption that
arises from preexisting skin disease,
most common with
atopic dermatitis and sometimes seborrheic
dermatitis.
01:20
There is a higher risk in children you can
see in this picture.
01:25
Patches of atopic eczema in the background
and isolated lesions of
vesicles, that is, secondary infection with
herpes virus infection,
which we call eczema herpeticum.
01:39
Genital herpes. Most genital acquisitions
occur in more than
85%, and they are due to oral to genital
transmission
through oral sex. The classical herpetic
lesions
with additional features such as dysuria and
mucous discharge
are seen in patients with genital herpes.
02:02
So you can see on the left genital herpes in
males
isolated vesicles. Some of them are denuded
because
the roof has been removed spontaneously.
02:16
On the right hand side,
you can see the female genital area
and genital herpes with grouped lesions just
below
the clitoris. One can also see lesions around
the
anus, and these are grouped painful lesions
depending
on the mode of sexual contact.
02:41
Hepatic proctitis is seen in persons that
engage in
anal intercourse. So we need to remember to
examine and ask patients
about these as well.
02:55
The complications of herpes simplex virus
infection are usually seen in
immunocompromised patients,
and one can get encephalitis
and Bell palsy, as you can see on this
picture.
03:09
One can also see hepatitis as a complication
of HSV
infection. The diagnosis of
HSV is usually clinical,
and of course physical examination may also
assist. Laboratory studies include culture,
which is viral
culture, and PCR, which is more sensitive
than viral culture.
03:34
Antibody testing using zinc smear and direct
fluorescent
antibodies are less sensitive and less
specific.
03:45
So what is the differential diagnosis of oral
herpes?
Oral candida can be easily confused with oral
herpes,
but it tends to be more superficial and the
lesions are pustules rather than vesicles.
03:58
Herpes zoster. In herpes zoster,
you see vesicles and pustules,
which are usually arranged in a dermatomal
pattern following the dermatome,
and usually appear for the first time in
older individuals or those who are infected
with HIV or those patients on chemotherapy
for cancer.
04:18
We've just looked at oral herpes and its
differential.
04:21
Now we want to speak about genital herpes and
its differentials.
04:26
The main primary differential for genital
herpes is primary syphilis.
04:31
This is a painless, indurated clean based
ulcer,
which is called a chancre,
which we spoke about in our lectures.
04:39
The next differential is the chancroid.
04:41
This lesion is deep undermined purulent ulcer
that may
be associated with painful inguinal
lymphadenitis.
04:51
So how do we manage these patients?
We use antivirals oral or intravenous ,
as well as
topical. The therapy helps to reduce the
duration of illness
by more than 50% . For frequent and recurrent
severe
relapses, you may consider prophylactic
antivirals.
The lecture Herpes Simplex Virus Infection in Darker Skin: Diagnosis and Management by Ncoza Dlova is from the course Viral Skin Infections in Patients with Darker Skin.
What is the typical progression of herpes simplex virus lesions after the prodromal phase?
Which preexisting skin condition is most commonly associated with the development of eczema herpeticum?
What is the key feature that differentiates primary syphilis from genital herpes?
5 Stars |
|
5 |
4 Stars |
|
0 |
3 Stars |
|
0 |
2 Stars |
|
0 |
1 Star |
|
0 |