Precipitating Factors
name types pathophysiology Incubation period for recurrent and clinical picture: Complications DDX investigation treatment
l- preventive measures .
1-orofacial herpes simplex (herpetic gingivostomatitis ) 2-topical antiviral :
•Inetial infection: HSV enters via small defect in skin o
2) Genital HS infection -Penciclovir 1%cream for H.S labialis
mucosa and starts to replicate locally in the epidermis
3) Herpetic whitlow DD: ORAL: -Acyclovir 5% cream.
•After resolution of the primary infection the virus remains complications: *History and clinical examination .
4)Herpes gladiatorum 1- apthous stomatitis -calamine lotion locally
latent in the sensory ganglion near 1)Secondary bacterial infection *Tzanck smear .
5)Herpetic keratoconjuctivitis 2- hand-foot-and mouth disease -zinc sulphat (Soaks),0.025 - 0.05 % in water to the site 2-4 times per month to prevent
the spinal cord . UV radiation , menstruation , 2)eczema herpeticum * culture.
6)Recurrent HSV infection rimary infection 2-20 days (average 7 days) 3-sever candidiasis recurrent
•Recurrent infection: reactivation of virus by some stimuli minor trauma , fever , common cold and stress 3)cutaneous or systemic dissemination in immunocompromised patient *PCR
4)Herpes gladiatorum 4-P.Vulgaris
such as 4)erythema multiform *ELISA
5)Herpetic keratoconjuctivitis 5-Bechcet's disease 3- oral antiviral :
UVlight , trauma lead seeding of the virus into area served 5)herpes encephalitis *Electron microscope
6)Recurrent HSV infection D.D: genital All aenital ulcers -Acyclovir (zovirax) 200 mg orally five times a day for 7-10 day
by
7)Eczema herpeticum (kaposivaricelliform) -Valacyclovir 1000 mg orally wo times a day
sensory ganglia and to recurrences .
8)Neonatal HSV infection •If patient have more than 6 recuences yearly consider Acyclovir 200- 400 mg bid or
valvacyclovir 1000mg p.o daily for one year
5)Herpetic keratoconjuctivitis
Hepes Simpex
common infection ,acute self -
limiting 1)orofacial herpes simplex (herpetic 7)Eczema herpeticum (kaposivaricelliform):
gingivostomatitis ): most •wide spread HSV cutaneous infection on
cases occur in (children 1-5 years) 2) Genital HS infection: abnormal skin occurs most commonly in atopic 8)Neonatal HSV infection :
•Incubation period (4-5 days) occur as clusters of inflammatory papules and vesicles . dermatitis the majority of infections are caused by HSV-2, HSV-1 is more virulent in the
•Lesion: begains with fever, malaise , there are vesicles as Which leading to small painful ulcers , bilateral enlarged 6)Recurrent HSV infection is the most •is Ch.Ch. By wide spread vesicles and erosions . newborn
white lymph nodes . common It may •Risk of transmission to a neonates is
•Patient has dysuria , urine retention , vaginal 3) Herpetic whitlow . 4)Herpes gladiatorum precipitating event in cases of recurrent
plaques on the tongue, pharynx , palate , and buccal occure as a primary or recurrent infection highest in women who develop herpes in the third
mucosa Which followed by ulcers. There is regional L. and uretheral discharge. erythema •associated with fever, malais , irritability and trimester
•In males lesions occur on the glans penis or penile shaft multiform
nodes enlargment with tenderness . lymphadenopathy •The risk of infection to the infant
Drinking and eating is very painful and the breath is foul and In females on vulva,perineum , vagina, or cervix • Also occur in Darier's disease thermal burns , delivered vaginally when the mother has primary
•Haeling after 2-3 weeks
•Recurrent orofacial(herpes labialis ) known as cold sores pemphigus vulgaris , bullous pemphigoid , and
or fever blisters cutaneous T-cell lymphoma
DNA
VIRUS
clinical picture: tratment:
skin colored 1-5 mm pearly, shining multiple umbilicated papules or avoid skin to skin contact
Molloscum it is highly contagious viral infection that affect caused by poxvirus (MCV1 causes most infections ) and
incubation period :
4-8 weeks with a range extending out to 6
nodules arranged in groups or linear fashion (Kobner phenomenon )
distributed on face ,neck,eyelids, axillae and extremitis in children . in Subtopic 1
D.D:
flat warts , condylomata acuminata , Diagnosis :clinical picture and histology
-Solitary lesion can be destroyed with curettage or sharp tweezers , Cryosurgery -In
Immunocompetent children the lesion can resolve spontaneously in 6-9months.
contagiousem: children and adults MCV2
months adults in genital regions . syringoma, keratoacanthoma , S.C.C and B.C.C -But wide spread'lesion removed by curettage
*In patients with HIV Liauid phenol (dilute)
\AIDS gaint M.contagiousem reaching 3-5 cm in size Local tretinoin
clinical picture:
firm papules with rough horny surface , size from1-10 mm , D/D: treatment : spontaneous disappear in months or a few years, so
hyperkeratotic Mollosum contagiousm in children clinically (Punctate bleeding when pared) not need aaaressive treatment . For small lesions 10 -20%
1)Verruca vulgaris (common warts) wrts are a hyperplastic tumor induced by HPV long because the virus replicate slowly Subtopic 1
-Ch.Ch. By loss of skin markings and intra lesional hemorrhagic dots Actinic keratosis , seb.keratosis , and Histopathology salicylic acid and lactic acid in collodion . For large lesions
-Common site acral (on back of hands , fingers , feet ) or any where , it keratoacanthoma in adults 40% SalicyIic plastel Cryosurgery (liquid nitrogen )
is symptomless
clinical picture : irregular papules with central loss of skin
rough solitary keratotic surface studded with multiple D/D:
markings , form plaque with hyperkeratotic rough surface treatment : 40% salicylic acid plaster for 1 week . Then
black dots . Often painful, tumor of soles , on pressure 1- corn: located at site of pressure on bony
2)Planter warts (verruca plantaris ) long because the virus replicate slowly May become large and when treatment resistant may Subtopic 1 Subtopic 1 apply salicylic acid , lactic acid in collodion
Human papilloma virus point as heal or meta-tarsl
evolve into verrucous squamous cell carcinoma
prominence, no punctate hemorrhage
Cryotherapy - electrosurgery - laser .
areas 2-Callus
(epithelioma cuniculatum).
viral infection it is a small, flat, slightly elevated papules , skin color or light brown ,
round
from 1-5mm in diameter . D\D: on face :
long because the virus replicate slowly *Most common on face ,dorsa of hands . Subtopic 1 syringomas , xanthelasma , Milia, dignosis: clinically treatment :
3)Plane warts (flat wart)
* Spread by autoinoculation , on face of men by shaving ( kobner M.contagiousm topical retenoids Cryotherapy- imiquimod cream - laser
phenomenon). Mostly
affected children , young adults
treatment :
It is an exophytic (cauliflower like ) papules, nodules Diagnostic approach : -podophyllotoxin 0.5% solution
It is sexually transmitted HPV of genital and perianal . It is tinea white which rapidly spread and enlarge . Bleeding easly, soft D/D: always examine sexual partners and exclude -Podophyllin tincture 5-20%apply by physician 1 - 2 per
virus : 4)Condyloma accuminata (genital warts): asymptomatic
4 weeks to 6months
,pink, multiple on moist surface. Growth enhanced during pregnancy
Subtopic 1
condylomata lata (sec.syphilis ). other STDs , in women must exam cervix to week until clear
and if there is infection . exclude infection in it -Topical 5-fluorouracil
-imiquimod 5%cream
chicken pox (Varicella)
due to Primary VZV infection
clinical picture:
RNA Virus DNA virus: it's acute highly contagious but self limiting desease •after a day or two of fever, malaise and headache
complications: 1)rest + analgesics
1)secondary bacterial infection 2)Symptomatic treatment with calamine lotion with antihistaminics for itching
Negative double stranded : Double stranded DNA : ch.ch by an exanthematous •the rash start as erythematous macules - papules - vesicles which is 3)Topical or systemic antibiotics for secondary bacterial infections .
1- Papova virus : papilloma virus • It is mild in children but may be very serious in adults and 2)Reye syndrome : fetal encephalopathy in association with varicella
1- para myxo virus – measles . itchy and rupture easily - pustules - crusts. mode of transmission :- 4)Antiviral therapy given early:
immuno compromised patients. 3)in pregnancy maternal varicella in the first trimester of pregnancy: -clinically
2-Retro virus – HIV1 and 2. 2-human herpes virus (HHVS): Incubation period : 10 -23 days •The rash begains on face,scalp but it is more numerous on the 1-air born
congenital varicella syndrome which ch.ch by: -Tzanck smear - immunofluorescent- PCR. * Acyclovir (Zovirax)800 mg 4 times daily for 5days
*HHV-1 (hepes simplex 1) •patients are infectious 2 days prior to the onset of the trunk . Crusts fall off leaving shallow pink depression , scaring 2-direct contact.
1- limb hypoplasia ,2-ocular defect ,3-zosteriform cutaneo scarring . *Varicella zoster immunoglobulin (VZIG)
All share a features of causing a primary *HHV-2(herpes simplex 2) vesicular occur when the lesion super infected'with bacteria .
•If the mother has varicella within 4 days before to 2 days after term the baby *live attenuated varicella virus vaccine (Varivax) is available
infection to be followed with life long latency *VZV(HHV-3) rash until all vesicles are crusted •lesions also can be found on the mucosa of pharynx , nose and *pregnant women : VZ immunoglobulin + antiviral therapy,Vaccine given after delivery.
in various tissues according to their tropism to *EBV (HHV-4) Varicella zoster (VZV) vagina.
will has sever varicella with mortality rate up to 30%.
be intermittently shed from *CMC(HHV-5)
*H.virus6(HHV-6 )Roseola infantum. infection
*H.virus 7(HHV.7)
*H.virus 8 (HHV-8) associated with Kaposis
sarcoma
RNA clinical picture : Distinct in 3 stages :
1- prodromal stage : pain, parasthesia. Pain as stubbing ,burning ,
complications:
1-post-herepetic neuralgia
therapy:
rest+ analgesia - local calamine lotion
VIRUS there is headache ,malaise . Without skin lesions. 2-secondary bacterial infection
3-scare formation, post inflammatory hyper or hypo pigmentation
Oral in sever infection and immursuppressed patients and must started within 48 hrs.
of presence of vesicles .
2- active infection : eruption of papules rapidly becoming vesicular 4- ocular involvement: *Acyclovir 800mg .5 times per day for 5-7days
following the initial varicella infection, vzv persists life- and •when first branch of trigeminal nerve(ophthalemic nerve )involved ,patient *Valvacyclovil 1000 .3time per day for 7 days
long in the then pustular , crust'formation days to2 to 3 weeks. The rash is had keratiti ,corneal erosions, conjunctivitis, optic neuritis ,double vision D.D:
herpes zoster(shingles) or girdle *Famciclovir 250-500 mg 3times per day for 7 days
sensory ganglia of the spinal cord and cranial nerves when Subtopic 1 unilateral. with headache and vomitin zosteriform HSV - contact dematitis - cinically- Tzanck smear
due to reacfivation of VZV *Foscarnet in cases of Acyclovir resistant
reactivated, the virus travels down the sensory nerves •vesicales on the tip of the nose( hutchinson sign)indicate nasolabial nerve erysipeals - bullous impetigo *chronic stage PHN: Analgesics in sever pain Gabapentin 300mg .3 times per day.
resulting in the dermatomal pain and skin lesions. 3- chronic pain ( PHN ): persistina after the lesions have healed involvement and greater likehood of eye involvement *Tricyclic antidepressants such as Doxepin 10-100 mg at bed time *Capsaicin cream
Necrotic and ganrenous lesions sometimes occure so H.Z may heal 5- Ramsayhunt syndrome : involvement of both 7th and 8th cranial nerves every 4 hrs
with scare formation leadina to facial paralysis with herpetic vesicles of the external ear * Topical anaesthetic such as EMLA or 5% lidocaine *opthalmic H.Z:opthalmic
•Site of predilection : thoracic > 50%, trigeminal 10-20% , lumbusacular ortympanic membrane with vertigo and hearing lose. consultation
and cervical 10 -20%. *nerve involvement can occur with out * Zoster in pregnancy no serious problem
cutaneous z0ster ( zoster sine eruption ) *disseminated H.Z in immunocompromised
clinical picture:
after an incubation period of about 10 days the prodromal symptoms
of fever, malaisea and respiratory catarrh as cough,
coryza,conjuunctivitis ( red eyes) and photo phobia
*People are infectious to others from 4 days *from the seconday the pathognomonic enanthn koplik's spots usually treatment:
is a highly contagious infection caused by measles occur in young children chronically ill and malenurshied patients : mood of transmission:
before to 4 days after the start of the rash. present on the buccul mucusa membrane opposite the premolar( history , URT symptoms as cough and Koplik's syptomatic as iboprofen for fever, antibiotics for Sec.infection
Measles (Rubeola ) virus which is RNA virus of the genus morbili virus within
*They usually don't get the disease more than bluish white spots with brith red areola)
pneumonia-bronchitis ;otitis media. air born through cough and sneezes.
sign. Viamive A 200.0001 to prevent blidness .
the family Paramyxoviridae * the most serious complication is encephalitis And contact with saliva and nasal secretion
once -the exantheme develop on the fourth day on *Meseals , Mumpus , Rubeola (MMR) vaccine given in 9months and 18 months with vit.A
forehead and behind the ears
thene spread within 24 hr to the rest of the face, trunk and limbs.
- the rash is maculopapular it is fde from the sixth tenth day to leave
browniesh fine desquamation
by fatema okoff
name types pathophysiology Incubation period for recurrent and clinical picture: Complications DDX investigation treatment
l- preventive measures .
1-orofacial herpes simplex (herpetic gingivostomatitis ) 2-topical antiviral :
•Inetial infection: HSV enters via small defect in skin o
2) Genital HS infection -Penciclovir 1%cream for H.S labialis
mucosa and starts to replicate locally in the epidermis
3) Herpetic whitlow DD: ORAL: -Acyclovir 5% cream.
•After resolution of the primary infection the virus remains complications: *History and clinical examination .
4)Herpes gladiatorum 1- apthous stomatitis -calamine lotion locally
latent in the sensory ganglion near 1)Secondary bacterial infection *Tzanck smear .
5)Herpetic keratoconjuctivitis 2- hand-foot-and mouth disease -zinc sulphat (Soaks),0.025 - 0.05 % in water to the site 2-4 times per month to prevent
the spinal cord . UV radiation , menstruation , 2)eczema herpeticum * culture.
6)Recurrent HSV infection rimary infection 2-20 days (average 7 days) 3-sever candidiasis recurrent
•Recurrent infection: reactivation of virus by some stimuli minor trauma , fever , common cold and stress 3)cutaneous or systemic dissemination in immunocompromised patient *PCR
4)Herpes gladiatorum 4-P.Vulgaris
such as 4)erythema multiform *ELISA
5)Herpetic keratoconjuctivitis 5-Bechcet's disease 3- oral antiviral :
UVlight , trauma lead seeding of the virus into area served 5)herpes encephalitis *Electron microscope
6)Recurrent HSV infection D.D: genital All aenital ulcers -Acyclovir (zovirax) 200 mg orally five times a day for 7-10 day
by
7)Eczema herpeticum (kaposivaricelliform) -Valacyclovir 1000 mg orally wo times a day
sensory ganglia and to recurrences .
8)Neonatal HSV infection •If patient have more than 6 recuences yearly consider Acyclovir 200- 400 mg bid or
valvacyclovir 1000mg p.o daily for one year
5)Herpetic keratoconjuctivitis
Hepes Simpex
common infection ,acute self -
limiting 1)orofacial herpes simplex (herpetic 7)Eczema herpeticum (kaposivaricelliform):
gingivostomatitis ): most •wide spread HSV cutaneous infection on
cases occur in (children 1-5 years) 2) Genital HS infection: abnormal skin occurs most commonly in atopic 8)Neonatal HSV infection :
•Incubation period (4-5 days) occur as clusters of inflammatory papules and vesicles . dermatitis the majority of infections are caused by HSV-2, HSV-1 is more virulent in the
•Lesion: begains with fever, malaise , there are vesicles as Which leading to small painful ulcers , bilateral enlarged 6)Recurrent HSV infection is the most •is Ch.Ch. By wide spread vesicles and erosions . newborn
white lymph nodes . common It may •Risk of transmission to a neonates is
•Patient has dysuria , urine retention , vaginal 3) Herpetic whitlow . 4)Herpes gladiatorum precipitating event in cases of recurrent
plaques on the tongue, pharynx , palate , and buccal occure as a primary or recurrent infection highest in women who develop herpes in the third
mucosa Which followed by ulcers. There is regional L. and uretheral discharge. erythema •associated with fever, malais , irritability and trimester
•In males lesions occur on the glans penis or penile shaft multiform
nodes enlargment with tenderness . lymphadenopathy •The risk of infection to the infant
Drinking and eating is very painful and the breath is foul and In females on vulva,perineum , vagina, or cervix • Also occur in Darier's disease thermal burns , delivered vaginally when the mother has primary
•Haeling after 2-3 weeks
•Recurrent orofacial(herpes labialis ) known as cold sores pemphigus vulgaris , bullous pemphigoid , and
or fever blisters cutaneous T-cell lymphoma
DNA
VIRUS
clinical picture: tratment:
skin colored 1-5 mm pearly, shining multiple umbilicated papules or avoid skin to skin contact
Molloscum it is highly contagious viral infection that affect caused by poxvirus (MCV1 causes most infections ) and
incubation period :
4-8 weeks with a range extending out to 6
nodules arranged in groups or linear fashion (Kobner phenomenon )
distributed on face ,neck,eyelids, axillae and extremitis in children . in Subtopic 1
D.D:
flat warts , condylomata acuminata , Diagnosis :clinical picture and histology
-Solitary lesion can be destroyed with curettage or sharp tweezers , Cryosurgery -In
Immunocompetent children the lesion can resolve spontaneously in 6-9months.
contagiousem: children and adults MCV2
months adults in genital regions . syringoma, keratoacanthoma , S.C.C and B.C.C -But wide spread'lesion removed by curettage
*In patients with HIV Liauid phenol (dilute)
\AIDS gaint M.contagiousem reaching 3-5 cm in size Local tretinoin
clinical picture:
firm papules with rough horny surface , size from1-10 mm , D/D: treatment : spontaneous disappear in months or a few years, so
hyperkeratotic Mollosum contagiousm in children clinically (Punctate bleeding when pared) not need aaaressive treatment . For small lesions 10 -20%
1)Verruca vulgaris (common warts) wrts are a hyperplastic tumor induced by HPV long because the virus replicate slowly Subtopic 1
-Ch.Ch. By loss of skin markings and intra lesional hemorrhagic dots Actinic keratosis , seb.keratosis , and Histopathology salicylic acid and lactic acid in collodion . For large lesions
-Common site acral (on back of hands , fingers , feet ) or any where , it keratoacanthoma in adults 40% SalicyIic plastel Cryosurgery (liquid nitrogen )
is symptomless
clinical picture : irregular papules with central loss of skin
rough solitary keratotic surface studded with multiple D/D:
markings , form plaque with hyperkeratotic rough surface treatment : 40% salicylic acid plaster for 1 week . Then
black dots . Often painful, tumor of soles , on pressure 1- corn: located at site of pressure on bony
2)Planter warts (verruca plantaris ) long because the virus replicate slowly May become large and when treatment resistant may Subtopic 1 Subtopic 1 apply salicylic acid , lactic acid in collodion
Human papilloma virus point as heal or meta-tarsl
evolve into verrucous squamous cell carcinoma
prominence, no punctate hemorrhage
Cryotherapy - electrosurgery - laser .
areas 2-Callus
(epithelioma cuniculatum).
viral infection it is a small, flat, slightly elevated papules , skin color or light brown ,
round
from 1-5mm in diameter . D\D: on face :
long because the virus replicate slowly *Most common on face ,dorsa of hands . Subtopic 1 syringomas , xanthelasma , Milia, dignosis: clinically treatment :
3)Plane warts (flat wart)
* Spread by autoinoculation , on face of men by shaving ( kobner M.contagiousm topical retenoids Cryotherapy- imiquimod cream - laser
phenomenon). Mostly
affected children , young adults
treatment :
It is an exophytic (cauliflower like ) papules, nodules Diagnostic approach : -podophyllotoxin 0.5% solution
It is sexually transmitted HPV of genital and perianal . It is tinea white which rapidly spread and enlarge . Bleeding easly, soft D/D: always examine sexual partners and exclude -Podophyllin tincture 5-20%apply by physician 1 - 2 per
virus : 4)Condyloma accuminata (genital warts): asymptomatic
4 weeks to 6months
,pink, multiple on moist surface. Growth enhanced during pregnancy
Subtopic 1
condylomata lata (sec.syphilis ). other STDs , in women must exam cervix to week until clear
and if there is infection . exclude infection in it -Topical 5-fluorouracil
-imiquimod 5%cream
chicken pox (Varicella)
due to Primary VZV infection
clinical picture:
RNA Virus DNA virus: it's acute highly contagious but self limiting desease •after a day or two of fever, malaise and headache
complications: 1)rest + analgesics
1)secondary bacterial infection 2)Symptomatic treatment with calamine lotion with antihistaminics for itching
Negative double stranded : Double stranded DNA : ch.ch by an exanthematous •the rash start as erythematous macules - papules - vesicles which is 3)Topical or systemic antibiotics for secondary bacterial infections .
1- Papova virus : papilloma virus • It is mild in children but may be very serious in adults and 2)Reye syndrome : fetal encephalopathy in association with varicella
1- para myxo virus – measles . itchy and rupture easily - pustules - crusts. mode of transmission :- 4)Antiviral therapy given early:
immuno compromised patients. 3)in pregnancy maternal varicella in the first trimester of pregnancy: -clinically
2-Retro virus – HIV1 and 2. 2-human herpes virus (HHVS): Incubation period : 10 -23 days •The rash begains on face,scalp but it is more numerous on the 1-air born
congenital varicella syndrome which ch.ch by: -Tzanck smear - immunofluorescent- PCR. * Acyclovir (Zovirax)800 mg 4 times daily for 5days
*HHV-1 (hepes simplex 1) •patients are infectious 2 days prior to the onset of the trunk . Crusts fall off leaving shallow pink depression , scaring 2-direct contact.
1- limb hypoplasia ,2-ocular defect ,3-zosteriform cutaneo scarring . *Varicella zoster immunoglobulin (VZIG)
All share a features of causing a primary *HHV-2(herpes simplex 2) vesicular occur when the lesion super infected'with bacteria .
•If the mother has varicella within 4 days before to 2 days after term the baby *live attenuated varicella virus vaccine (Varivax) is available
infection to be followed with life long latency *VZV(HHV-3) rash until all vesicles are crusted •lesions also can be found on the mucosa of pharynx , nose and *pregnant women : VZ immunoglobulin + antiviral therapy,Vaccine given after delivery.
in various tissues according to their tropism to *EBV (HHV-4) Varicella zoster (VZV) vagina.
will has sever varicella with mortality rate up to 30%.
be intermittently shed from *CMC(HHV-5)
*H.virus6(HHV-6 )Roseola infantum. infection
*H.virus 7(HHV.7)
*H.virus 8 (HHV-8) associated with Kaposis
sarcoma
RNA clinical picture : Distinct in 3 stages :
1- prodromal stage : pain, parasthesia. Pain as stubbing ,burning ,
complications:
1-post-herepetic neuralgia
therapy:
rest+ analgesia - local calamine lotion
VIRUS there is headache ,malaise . Without skin lesions. 2-secondary bacterial infection
3-scare formation, post inflammatory hyper or hypo pigmentation
Oral in sever infection and immursuppressed patients and must started within 48 hrs.
of presence of vesicles .
2- active infection : eruption of papules rapidly becoming vesicular 4- ocular involvement: *Acyclovir 800mg .5 times per day for 5-7days
following the initial varicella infection, vzv persists life- and •when first branch of trigeminal nerve(ophthalemic nerve )involved ,patient *Valvacyclovil 1000 .3time per day for 7 days
long in the then pustular , crust'formation days to2 to 3 weeks. The rash is had keratiti ,corneal erosions, conjunctivitis, optic neuritis ,double vision D.D:
herpes zoster(shingles) or girdle *Famciclovir 250-500 mg 3times per day for 7 days
sensory ganglia of the spinal cord and cranial nerves when Subtopic 1 unilateral. with headache and vomitin zosteriform HSV - contact dematitis - cinically- Tzanck smear
due to reacfivation of VZV *Foscarnet in cases of Acyclovir resistant
reactivated, the virus travels down the sensory nerves •vesicales on the tip of the nose( hutchinson sign)indicate nasolabial nerve erysipeals - bullous impetigo *chronic stage PHN: Analgesics in sever pain Gabapentin 300mg .3 times per day.
resulting in the dermatomal pain and skin lesions. 3- chronic pain ( PHN ): persistina after the lesions have healed involvement and greater likehood of eye involvement *Tricyclic antidepressants such as Doxepin 10-100 mg at bed time *Capsaicin cream
Necrotic and ganrenous lesions sometimes occure so H.Z may heal 5- Ramsayhunt syndrome : involvement of both 7th and 8th cranial nerves every 4 hrs
with scare formation leadina to facial paralysis with herpetic vesicles of the external ear * Topical anaesthetic such as EMLA or 5% lidocaine *opthalmic H.Z:opthalmic
•Site of predilection : thoracic > 50%, trigeminal 10-20% , lumbusacular ortympanic membrane with vertigo and hearing lose. consultation
and cervical 10 -20%. *nerve involvement can occur with out * Zoster in pregnancy no serious problem
cutaneous z0ster ( zoster sine eruption ) *disseminated H.Z in immunocompromised
clinical picture:
after an incubation period of about 10 days the prodromal symptoms
of fever, malaisea and respiratory catarrh as cough,
coryza,conjuunctivitis ( red eyes) and photo phobia
*People are infectious to others from 4 days *from the seconday the pathognomonic enanthn koplik's spots usually treatment:
is a highly contagious infection caused by measles occur in young children chronically ill and malenurshied patients : mood of transmission:
before to 4 days after the start of the rash. present on the buccul mucusa membrane opposite the premolar( history , URT symptoms as cough and Koplik's syptomatic as iboprofen for fever, antibiotics for Sec.infection
Measles (Rubeola ) virus which is RNA virus of the genus morbili virus within
*They usually don't get the disease more than bluish white spots with brith red areola)
pneumonia-bronchitis ;otitis media. air born through cough and sneezes.
sign. Viamive A 200.0001 to prevent blidness .
the family Paramyxoviridae * the most serious complication is encephalitis And contact with saliva and nasal secretion
once -the exantheme develop on the fourth day on *Meseals , Mumpus , Rubeola (MMR) vaccine given in 9months and 18 months with vit.A
forehead and behind the ears
thene spread within 24 hr to the rest of the face, trunk and limbs.
- the rash is maculopapular it is fde from the sixth tenth day to leave
browniesh fine desquamation
by fatema okoff
