病毒性細(xì)菌性皮膚病ViralDermatoses課件

1、Viral DermatosesDepartment of DermatologyXiao Sheng-Xiang第1頁，共62頁。General DescriptionDefinition Viral dermatoses are the cutaneousdiseases resulting from viral infections.第2頁，共62頁。Classification of Viral dermatosesHerpesvirus groupHerpes simplesx Varicella ( Chickenpox )Herpes Zoster Roseala Infantu

2、m ( Sixth disease)Kaposis sarcoma第3頁，共62頁。Classification of Viral dermatosesPoxvirus group Molluscum contagiosum, milkers nodulesPapovavirus group Warts(common warts, Flat warts, plantar warts, genital warts)第4頁，共62頁。Classification of Viral dermatosesParvovirus Erythema infectiosum( fifth disease) (

3、B19 virus)Paramyxovirus group Measles, rubella第5頁，共62頁。Classification of Viral dermatosesPicornavirus group (enteroviruses) Hand-fooot mouth disease (coxackie virus)Retroviruses AIDS第6頁，共62頁。Herpes Simplex第7頁，共62頁。EtiologyHerpes Simplex Virus ( HSV ): DNA VirusTwo antigenic types: HSV-1, HSV-2 HSV-1

4、: lesions on the lips, face HSV-2: genital herpes Lesions anywhere may be caused by either antigenic type.Transmission: Intimate contact ( direct inoculation through traumatized skin )第8頁，共62頁。Primary infection and recurrent infection Primary infection: first infection After primary infection virus

5、migrates to the neuronal cells in ganglion latent infection latent virus to reactivate by triggering factors virus particles move on the nerve replicate in the epithelial cells recurrent infectionTriggering factors: fever, trauma, emotional stress, menstruation第9頁，共62頁。Epidemiology85% of adults worl

6、dwide are seropositire for HSV-1. Seroprevalence for HSV-2 is lower, appear at the age of onset of sexual activity. USA: 23% of adults are infected with HSV-2 Developing countries: 6095% of infection rates of HSV-2Incubative or subclinical infection: 90% of all infected 第10頁，共62頁。Clinial manifestati

7、onFeatures of the lesion: multiple small papules, vesicles, clusted together. Mature lesion: grouped vesicles and / or pustules on an erythematous edematous baseCommon site for lesions: face, lips, mouth, neck, anogenital areaHeal within 1-2 weeks第11頁，共62頁。第12頁，共62頁。第13頁，共62頁。第14頁，共62頁。第15頁，共62頁。第16

8、頁，共62頁。第17頁，共62頁。第18頁，共62頁。Diagnosis Clinical Diagnosis Laboratory TestTzanck smear: take a smear of cells from the base of the skin lesion spread the cells on a glass slide stain with wright or Giemsa Stain look for multinucleated giant cellsNon specific: HSV VZVAccuracy rate: 6090%False positive r

9、ate: 312%第19頁，共62頁。Detection of virus antigen of the lesion Materials:vesicular fluid ,cells from the base of skin lesion Methods: direct fluorescent antibody test immunoperoxidase tchniquesVirus culture第20頁，共62頁。Emphasis Serologic tests (detection of anti-HSV antibody of the blood) are generally no

10、t used in determining whether a skin lesion is due to HSV infection. A positive result to a serologic test indicates only that the individual is infected with that virus, not that the viral infection is the cause of the current lesion.第21頁，共62頁。ThreatmentTherapeutic principle To shorten disease dura

11、tion To prevent bacterial infection To prevent recurrence第22頁，共62頁。ThreatmentAnti-HSV therapy Primary infection: Acyclovir: 0.2g, five times/day7-10days Valaciclovir: 0.3g, bid 7-10days Famcyclovir: 0.25g, tid 7-10days Recurrent infection: treatment duration 5 days第23頁，共62頁。ThreatmentSevere recurren

12、t cases acyclovir 04g bid valacyclovir 0.3g qid famcyclovir 0.25g bid 4M to 1Y第24頁，共62頁。ThreatmentOther antiviral agents like IFN- or may be applied Topical therapy 1% pencyclonir cream, 1% acyclovir cream, topical antibiotics第25頁，共62頁。Varicella & herpes zoster第26頁，共62頁。EtiologyVaricela-zoster virus

13、 (VZV): human herpes virus-type 3Tranmmission: direct contact respiratory routeA very communicable disease第27頁，共62頁。Primary infection: varicella or subclinical infectionVirus reactivation: herpes zosterCellular immunity and herpes zoster90% cases of varicela 10 years of age第28頁，共62頁。Clinical manifes

14、tationVaricellaSkin lesion: macules vesicles (within 24hs) successive fresh vesicles (within 4 days)Hemorrhagic, necrotic or bullous lesion第29頁，共62頁。第30頁，共62頁。第31頁，共62頁。第32頁，共62頁。第33頁，共62頁。The site of lesions: trunck, face, oral mucosaOther symptoms: fever (moderate ) pruritus, secondary infection第3

15、4頁，共62頁。Herpes zosterFeatures of the lesions: Occurs unilateraly within the distribution of a cranial or spinal sensory nerve Skin lesions: papules, plaques of erythema, blisters in the dermatomePain associated with herpes zosterDisease duration: 2-3weeks in the younger, 6 weeks or more in the elder

16、ly第35頁，共62頁。第36頁，共62頁。第37頁，共62頁。第38頁，共62頁。第39頁，共62頁。第40頁，共62頁。第41頁，共62頁。第42頁，共62頁。Diagnosis , differential diagnosisHerpes zoster and herpes simplex In the early stages of herpes zoster, if the number of lesions of zoster is limited, it can be relatively indistinguishable from herpes simplex. Herpes

17、 zoster: more painfull, progress to involve more area over 24hs第43頁，共62頁。TreatmentVaricella Antiviral therapy acyclovir 20mg/kg/d 5days ,not routinly recommendedTopical antipruritic lotions第44頁，共62頁。Herpes ZosterGeneral therapyRestrict physical activitiesLocal applications of heatTopical anesthetics

18、, antipruritic lotion, topical antiviral agentsVesicular stage: cool compress第45頁，共62頁。Antiviral therapy: reduce the duration of pain Start preferably within the first 3 or 4 daysSevere cases: intravenous therapy (acyclovir, 5mg/kg, tid)Refrence dosesAcyclovir 0.8g 5times/day 7 daysValaciclovir 1.0g

19、 tid 7 daysFamciclovir 0.5g tid 7 days第46頁，共62頁。Zoster associated painDrug therapy: simple analgesics like aspirin Tricyclic antidepresants like amitriptyline anticonvulsants like carbamarepineLocal anesthetics: 10% lidocain gel or patchesNerve blocks第47頁，共62頁。Bacterial DermatosesImpetigo第48頁，共62頁。E

20、tiology5070% of cases: staphylococcus aurensThe reminder: streptococcus or a combinationOccur frequently in children in hot, humid weatherSources of infection for children: pets, dirty fingernails, crowded housing areas第49頁，共62頁。Clinical manifestationNonbullous impetigo Begins with 2-mm erythematous

21、 macules vesicles or bullae seropurulent discharge golden yellow crusts spread by scratching and autoinoculation第50頁，共62頁。第51頁，共62頁。第52頁，共62頁。Bullous impetigo occurs in new-born infants (4th-5th day of life) bullae in the face, hand and other sites later weakness, fever or subnormal temperature Diar

22、rhea Bacteremia, pneumonia or meningitis第53頁，共62頁。第54頁，共62頁。DiagnosisClinical diagnosisBacterial examination: gram stain or culture第55頁，共62頁。TreatmentTopical agents Rivanol ( Compound Ethacridine Solution) 2% mupirocin ointment other topical antibiotic agents第56頁，共62頁。Systemic agentsAntibioticsSemisynthetic penicillin (penicillinase-resistant) like dicioxacillinCephalosporinErythromycine, azithromycineClindamycine第57頁，共62頁。Staphylococcal