A8. Skin diseases caused by varicella zoster virus

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Varicella

  • Varicella (chickenpox)
    • Primary infection during childhood
    • Lasts 6 days in immunocompetent persons
    • Transmission
      • Highly contagious
      • Airborne transmission
      • Incubation period 2 weeks
    • Clinical features
      • Lesions covering the entire body
      • Severe pruritus
      • Macules -> papules -> vesicles with erythematous base -> crusts
        • All of these stages are present simultaneously, which is a hallmark for the disease
      • Fever
    • Virus remains latent in sensory ganglia
    • Diagnosis
      • Clinical -> characteristic rash
      • Tzanck smear, PCR
    • Treatment
      • For pruritus
        • Calamine lotion
        • Pramoxine gel
        • Oral antihistamines
      • Therapy
        • Only for severe cases or high-risk groups (adults, immunosuppressed)
        • Acyclovir
        • Post-exposure prophylaxis
          • Active immunization (vaccine)
          • Passive immunization (immunoglobulins)
    • Prevention
      • Vaccination
    • Complication
      • Bacterial superinfection
        • Impetigo
        • Phlegmon
      • Scarring
      • Congenital varicella syndrome (if chickenpox during pregnancy)

Shingles

  • Shingles (herpes zoster)
    • Reactivation
    • Older patients
    • Triggers
      • Immunosuppression
      • Advanced age
      • Malignancy
      • Malnutrition
    • Clinical features
      • Erupts in dermatome pattern
      • Severe pain
      • Erythematous maculopapular rash -> vesicles -> rupture
    • Complications
      • Herpes zoster oticus
        • Herpes in facial and vestibulocochlear nerve
        • Blindness
      • Herpes zoster ophthalmicus
        • Herpes in ophthalmic part of trigeminal nerve
        • Facial paresis
        • SN hearing loss
      • Post-herpetic neuralgia
      • Herpes zoster encephalitis
    • Diagnosis
      • Clinical -> characteristic rash
    • Treatment
      • Wet dressing with aluminium acetate
      • 5 x 800mg acyclovir for 10 days
      • NSAIDs