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Viral dermatoses,
Epizoonosis- Dermatologic Parasitology
Dr Szabó Éva
Virus diseases
Herpes simplex
Kaposi’s varicelliform eruption
Smallpox, vaccinia, cowpox (Pox virus family)
Warts (Human Papilloma Virus)
Molluscum contagiosum (Pox virus family)
Exanthematous disease: measles, German measles
(Rubella), erythema infectiosum
Herpes viruses
Herpes simplex
• Fever blister
• Primary lesion: a group of vesicles around the mouth or the genitalia
(2-3 days)
• primary form: high fever, reg. lymphadenopathy, the vesicular lesions
involve the mouth: gingivostomatitis herpetica and the pharynx or the
• most persons undoubtedly go through their primary infectoin and than
they have the most common recurrent form
• Secondary lesions: erosions, secondary bacterial infection (5-7 days)
• Etiology: DNA virus: HSV (type1: non genital, type2: STD)
• Treatment: Acyclovir
• Differential diagnosis: Aphthous stomatitis: only one or two painful,
eroded lesions in the mouth not in a circumscribed area
Kaposi’s varicelliform eruption
• Uncommon but severe complication in children
who have atopic ekzema (it results from selfinoculation by scratching, due to the virus
herpes simplex (ekzema herpeticum)
• High fever, generalized chickenpox –like skin
• Treatment: systemically Acyclovir and
antibiotics, locally: zink oxide containing shake
lotion for vesicules, desinfection solutions,
creams ex. sol Betadine for erosions
• Shingles is a common viral disease, cosed by herpes
• Primary lesions: multiple groups of vesicles or crusted
lesions. Unilateral eruption follows a nerve distribution,
frequently in the thoracic region, the face, the neck (3-5
• Secondary lesions: erosions and secondary bacterial
infection. Rarely progressing to hemorrhagic gangrenous
ulcers and scarring.
It takes 1-3 weeks.
● Postherpetic pain can persist for month or years in aged
● Treatment: Acyclovir or Famciclovir systemically, shake
lotion for vesicles, desinfection solution, creme for
erosions locally.
• Common viral disease of childhood
• The disease occurs 10 to 14 days after exposure
to another child with chickenpox or to an adult
with zoster
• Primary lesions: Tense vesicles first on the trunk
and then spreading to the whole body (3-5 days)
• Secondary lesions: pustules,erosions, crusted
lesions (7-10 days)
• Treatment: usually nothing, or locally white
shake lotion, immunocompromised patients
need acyclovir systemically.
Smallpox, vaccinia
Eradicated viral disease, cosed by poxvirus
Incubation period: 1-3 weeks
Prodromal symptoms: high fever, various aches
Primary lesions: papule progress to vesicle,
pustule, haemorrhagic lesions
• Secondary lesions: erosions, ulcers, scars
• Complications: pneumonia, secondary bacterial
skin infection, encephalitis
• Prophylactic treatment: vaccination: inoculation
of the vaccinia virus (attenuated virus) into the
Cowpox- nodus mulgentium
• Paravaccinia virus
• Viral disease of the cows, human can get
the disease from infected teats and udders
• A solitary nodule appears, usually on the
hand, which suppurates and heals in 4 to
8 weeks.
Warts (Verrucae)
• Human papillomavirus- DNA virus
• 50 types of HPV have been identified by
immunocytologic and molecular biologic
techniques. Several of the types can
cause clinically similar warts
• Some types of HPV has been associated
with genital and nail-bed cancer
• There are various clinical types with
different appearance and localisation
Common warts (Verruca vulgaris)
• HPV 1,2,4,7
• The appearance is a papillary groth, raised
above the skin surface
• Most commonly on the hand
• Treatment:
Antiviral solution ex.: Verumal
Cryotherapy: liquid nitrogen
After local anesthesia remove it with a special
surgical instrument (‘Volkmann’ spoon)
Periungual, subungual warts
• HPV type 16 has been associated with
periungual squamous cell carcinoma
• In this localisation removed wart has to
examine histologicaly, and caracterisalion
of the virus is required
Verruca plantaris
HPV 1,2,4
2-5 mm hyperkeratotic deeply penetrating papules on the sole
Single or multiple lesions can be present
Mosaic wart is a special form, when the warts have coalesced into
larger patches
• It can be very painfull
• Treatment:
After local anaesthesia surgical removal ( before this therapy 10-20
% salicylic acid cream is suggested for skin softening)
For small single lesions antiviral liquid can be enought or liquid
Moist warts (Condylomata Acuminata)
• HPV 6, 11, 16, 18, 31
• Types 16, 18 are associated with cervical cancer,
bowenoid papulosis, anogenital cancer
• Single or multiple, soft, nonhorny masses that appear in
the anogenital areas
• STD disease
• Treatment:
Podofilox (Condylox) 0,5% is applied by the patient twice
a day for 3 days, followed by 4 days of rest. This
regimen is repeated for 2 to 4 weeks
In local or general anaesthesia electrosyrgical removal
● Histological examination is required
Verruca plana juvenilis
• HPV 3
• Mostly children affected
• Small (1-2 mm),light brown,plain papules
on the face
• Treatment:
spontaneous healing is possible
liquid nitrogen
Molluscum contagiosum
Pox virus (DNA virus) family
Usually in children
One or multiple small skin tumors
Primary lesion: an umbilicated, firm, waxy, skin-colored, raised
papule varies in diameter from 2 to 5 mm and rarely is larger
• Secondary lesion: the skin is inflamed from bacterial infection
• Distribution: most commonly the papules appear on the trunk, face,
• Treatment:
Exanthematous diseases I.
• Measles: common childhood disease
Incubation period: 14 days
Prodromal stage: fever, conjunctivitis, running nose,
Koplik spots (1-3 mm bluish white on the red base, occur
bilaterally on the mucous membrane around the parotid
duct and on the lower lip), red rash (behind the ears, on
the forehead, an then on the whole body). Red rash is a
patchy eruption, occasoinally papula. Scaling occurs in
the end stage
Complications: bacterial infection, encephalitis
Profilactic treatment: measles virus vaccine
Active treatment: supportive therapy, bed rest, antibiotic
for superinfections
Exanthematous diseases II.
• German measles (Rubella)
A benign disease in childhood, it is serious if it
develops in a pregnant woman during the first
trimester, it causes anomalies of newborns
Incubation period: 18 days
Prodromal stage: fever
Symptoms: rash on the face and then spreades,
enlargement of the cervical and the
postauricular nodes
Treatment: profilactic: Rubeola virus vaccine
active: γ-globulin
Exanthematous diseases III.
• Erythema infectiosum (‘Fifth disease’)
Parvovirus infection
Red macular rash, arms, face are involved,
joint pain, low fever is in the prodromal
stage, than it is persis for a few days
Traetment usually not necessary
● Roseola: coxakievirus, high fever, red
maculas on the trunk
Exanthematous diseases IV.
• Herpangina
high fever, headache, sore throat, nausea,
stiff neck
Blisters in the throat, erythema
Differential diagnosis: aphthous stomatitis,
primary herpes gingivostomatitis
Epizoonosis- Dermatologic Parasitology
• Protozoal dermatoses: tripanosomiasis
● Helminthic dermatoses: filariasis
● Arthropod dermatoses: caused by
arachnids (spiders, scorpions, ticks, mites)
and insects (lice, bugs, flies, bees, fleas)
Cutaneous leishmaniasis
• Pathogen: Leishmania tropica
Endemic to mediterranean region and the Orient
● Route of the infection: the vector for the
transmission is the sandfly
● Clinical features: a small red tumour at the site
of the sandfly bite, than ulcerates, and scar
● Treatment: Pyrimethamine, antibiotic, excision or
cryotherapy in early phase
• Pathogen: Human scabies mite (Acarus or
Sarcoptes scabiei
• Transmission by skin-to-skin contact
• Route of infection: The female mite burrows into
the epidermis, fotming tunnels, in which eggs
are deposited
• Clinical features: the burrows are seen as
darkish lines, it is itching. Pyoderma.
• Therapy:benzyl benzoate (topical),
antihistamine, bath, disinfection of clothing and
Sarcoptes scabiei mite
Pediculosis I.
• Infection with lice
• Head louse (Pediculus capitis)
Found on the scalp
The eggs are in the form of nits, attached
to the hair shaft
Itchig, scratching can lead to impetigo,
Pediculus humanus capitis
Nits on scalp hair
Pediculosis II.
• Body louse (Pediculus humanus
• Its habitat is clothing, eggs are attached to
cloth fibers
• Pruritis, scratching, impetigo
Pediculosis III.
• Pubic or crab louse (Phthirus inguinalis)
• In the pubic hair
• The bite leaves blue-grey spots (maculae
ceruleae), itching
Treatment of pediculosis
• Permethrin
• Removal of the nits with vinegar solution
• Sterillization of clothes and bedding