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Body Part: Torso

  • Hidradenitis Suppurativa

    Hidradenitis Suppurativa

    Hiradentitis Suppurativa

    Definition: Hidradenitis SUppurativa (HS), also known as acne inversa,  is a chronic inflammatory skin condition that affects the apocrine-gland-bearing skin. It is characterized by painful, persistent deep-seated nodules, abscessed as skin tunnels that may develop purulent discharge and result in scarring.

    Etiology: HS development may have genetic, environmental and behavioural influences. There is an autosomal dominant transmission pattern of HS. A loss-of-function mutation of the y- y-secretase complex involved in the Notch signalling pathway has been identified as a cause of HS. Other mutations include the DCD, PSTP 1P1, SOX9 and KLF5 genes. Environmental and behavioural factors are also relevant as individuals with HS often have co-morbidities that may lead to increased skin friction, sweat overproduction and retention and hormonal changes, which can increase the progression and severity of HS.

    Epidemiology: The global prevalence of HS is variable, and may affect up to 4.1% of the population. In North American and European patients, HS is three times more women in females than males. In South Korea and Japan, HS is more common in males. HS typically manifests at puberty and is most active between 20 – 40 years of age. It may resolve at menopause in women. Risk factors include a family history of HS, obesity and metabolic syndromes, cigarette smoking, African ethnicity, IBD- particularly Crohn’s disease and other skin disorders.

    Signs: Characteristic primary HS nodules are deep nodules typically 0.5- 2cm in size and can persist for days to months. The lesions may resemble recurrent, rupture-prone boils and have a serosanguinous discharge which may become purulent. The affected areas include the axilla, neck, inframammary folds, inner upper thighs, and anogenital region. The characteristic features of HS also include double open-ended comedones, painful firm papules and nodules, pustules, abscesses, draining sinuses linked to inflamed lesions, and atrophic and hypertrophic scars. The scars or plaques may cause architectural distortion and “tombstone” comedones.

    Symptoms: Many patients report prodromal symptoms like burning, stinging, pain pruritus or hyperhidrosis which may precede a lesion by 12 hours. Triggers include menstruation, obesity, stress, heat, hormonal changes, and perspiration. 

    Differentials: Staphylococcal skin infection, cysts, Cutaneous Crohn’s disease, Anogenital Crohn’s disease.

    Diagnosis: HS may be diagnosed clinically. Three components of a triad must be met to diagnose HS: characteristic lesions, typical distribution and presence and recurrence of lesions. Skin biopsy can help confirm an HS diagnosis. Histopathological features include follicular occlusion and hyperkeratosis, infundibular follicular epithelial hyperplasia, keratin plugging, epidermal psoriasiform hyperplasia and plasmacytic infiltrate. 

    Treatment: General measures for treatment include smoking cessation, weight reduction, analgesics, loose-fitting clothing and improved hygiene. Specific medical treatment includes topical antibiotics or benzoyl peroxide, systemic antibiotics and oral hormonal therapies and immunomodulatory treatments. Procedural measures include incision and drainage of acute abesses and local excision of persistent nodules. Laser ablation of nodules, hair removal and radical excision of an affected area.

    References:

    1. Ballard K, Shuman VL. Hidradenitis Suppurativa. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 6, 2024.
    2. Hidradenitis Suppurativa (Acne Inversa): A Complete Picture – DermNet. dermnetnz.org. https://dermnetnz.org/topics/hidradenitis-suppurativa
    3. ‌Bukvić Mokos Z, Markota Čagalj A, Marinović B. Epidemiology of hidradenitis suppurativa. Clin Dermatol. 2023;41(5):564-575. doi:10.1016/j.clindermatol.2023.08.020
  • Hidradenitis Suppurativa

    Hidradenitis Suppurativa

    Hiradentitis Suppurativa

    Definition: Hidradenitis SUppurativa (HS), also known as acne inversa,  is a chronic inflammatory skin condition that affects the apocrine-gland-bearing skin. It is characterized by painful, persistent deep-seated nodules, abscessed as skin tunnels that may develop purulent discharge and result in scarring.

    Etiology: HS development may have genetic, environmental and behavioural influences. There is an autosomal dominant transmission pattern of HS. A loss-of-function mutation of the y- y-secretase complex involved in the Notch signalling pathway has been identified as a cause of HS. Other mutations include the DCD, PSTP 1P1, SOX9 and KLF5 genes. Environmental and behavioural factors are also relevant as individuals with HS often have co-morbidities that may lead to increased skin friction, sweat overproduction and retention and hormonal changes, which can increase the progression and severity of HS.

    Epidemiology: The global prevalence of HS is variable, and may affect up to 4.1% of the population. In North American and European patients, HS is three times more women in females than males. In South Korea and Japan, HS is more common in males. HS typically manifests at puberty and is most active between 20 – 40 years of age. It may resolve at menopause in women. Risk factors include a family history of HS, obesity and metabolic syndromes, cigarette smoking, African ethnicity, IBD- particularly Crohn’s disease and other skin disorders.

    Signs: Characteristic primary HS nodules are deep nodules typically 0.5- 2cm in size and can persist for days to months. The lesions may resemble recurrent, rupture-prone boils and have a serosanguinous discharge which may become purulent. The affected areas include the axilla, neck, inframammary folds, inner upper thighs, and anogenital region. The characteristic features of HS also include double open-ended comedones, painful firm papules and nodules, pustules, abscesses, draining sinuses linked to inflamed lesions, and atrophic and hypertrophic scars. The scars or plaques may cause architectural distortion and “tombstone” comedones.

    Symptoms: Many patients report prodromal symptoms like burning, stinging, pain pruritus or hyperhidrosis which may precede a lesion by 12 hours. Triggers include menstruation, obesity, stress, heat, hormonal changes, and perspiration. 

    Differentials: Staphylococcal skin infection, cysts, Cutaneous Crohn’s disease, Anogenital Crohn’s disease.

    Diagnosis: HS may be diagnosed clinically. Three components of a triad must be met to diagnose HS: characteristic lesions, typical distribution and presence and recurrence of lesions. Skin biopsy can help confirm an HS diagnosis. Histopathological features include follicular occlusion and hyperkeratosis, infundibular follicular epithelial hyperplasia, keratin plugging, epidermal psoriasiform hyperplasia and plasmacytic infiltrate. 

    Treatment: General measures for treatment include smoking cessation, weight reduction, analgesics, loose-fitting clothing and improved hygiene. Specific medical treatment includes topical antibiotics or benzoyl peroxide, systemic antibiotics and oral hormonal therapies and immunomodulatory treatments. Procedural measures include incision and drainage of acute abesses and local excision of persistent nodules. Laser ablation of nodules, hair removal and radical excision of an affected area.

    References:

    1. Ballard K, Shuman VL. Hidradenitis Suppurativa. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 6, 2024.
    2. Hidradenitis Suppurativa (Acne Inversa): A Complete Picture – DermNet. dermnetnz.org. https://dermnetnz.org/topics/hidradenitis-suppurativa
    3. ‌Bukvić Mokos Z, Markota Čagalj A, Marinović B. Epidemiology of hidradenitis suppurativa. Clin Dermatol. 2023;41(5):564-575. doi:10.1016/j.clindermatol.2023.08.020
  • Herpes Zoster

    Herpes Zoster

    Herpes Zoster

    Definition: Herpes zoster, also known as shingles, is a localized, painful, blistering rash that is caused by a reactivation of the varicella-zoster virus.

    Etiology: The varicella-zoster virus (VZV) is a member of the Herpesvirales order of double-stranded DNA viruses, that causes chickenpox. The VZV establishes latency in the dorsal root ganglia nerve cells of the spinal cord after primary infection. Once reactivated, the virus replicates in neuronal cell bodies and migrates down sensory nerves to the skin, causing herpes zoster. Pain associated with zoster is due to inflamed nerves that are affected by the virus. The virus can be transmitted via skin-to-skin contact or droplet inhalation.

    Epidemiology: The incidence of herpes zoster is 1.2- 3.4 per 1000 persons per year in individuals younger than 65 years. In individuals older than 65 years, the incidence is 3.9- 11.8  per 1000 persons per year. Recurrences are often seen in immunocompromised patients. 

    Signs: The dermatological involvement of herpes zoster is centripetal and follows a dermatomal distribution pattern. This is typically unilateral and may vary depending on the affected dermatome, age and health of the patient. Following the onset of pain, the rash that erupts is a crop of red papules that is painful, erythematous and blistering. On dark skin, the “shingles band” may appear as gray, dark brown or violaceous papules. The rash then develops forming vesicles which can cause discolouration of the surrounding skin depending on skin tone.The lesions continue to erupt and become pustular and crust over. 

    Symptoms: Early symptoms include localized or widespread pain without tenderness or skin changes. The zoster rash is painful within the associated area of skin. Individuals may feel unwell with a fever and headache. In uncomplicated cases, pain and general symptoms subside as the eruption disappears.

    Differentials: Herpes simplex, dermatitis herpetiformis, impetigo, contact dermatitis, candidiasis.

    Diagnosis: Herpes zoster is diagnosed clinically with pain, characteristic morphology and dermatomal distribution. The rash may form a pattern called the zosteriform herpes simplex. Diagnostic tests include direct fluorescent antibody, PCR and Tzanck smear of vesicular fluid or blood.  

    Treatment: Several antiviral drugs are available to treat shingles such as acyclovir and valacyclovir. They shorten the length and severity of illness. Over-the-counter pain relief medication can also aid in the pain caused by shingles. The CDC recommends 2 doses of the recombinant zoster vaccine to prevent shingles and its complications in individuals 50 years and older. Vaccination is also recommended in younger, immunocompromised patients.

    References:

    1. Nair PA, Patel BC. Herpes Zoster. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 4, 2023.
    2. Ayoade F, Kumar S. Varicella-Zoster Virus (Chickenpox). In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 15, 2022.
    3. Herpes zoster | DermNet NZ. dermnetnz.org. https://dermnetnz.org/topics/herpes-zoster
    4. ‌CDC. Shingles. Centers for Disease Control and Prevention. Published 2019. https://www.cdc.gov/shingles/about/index.html
  • Herpes Simplex

    Herpes Simplex

    Herpes Simplex

    Definition: The Herpes Simplex Virus (HSV) is a virus that causes herpes. Herpes is a common infection that can cause painful ulcers or blisters that may recur over time. The virus will remain dormant throughout a person’s life with the number of outbreaks decreasing with age. Two subtypes can cause infection: Herpes Simplex virus type 1 (HSV-1), and Herpes Simplex virus type 2 (HSV-2).

    Etiology: The HSV is a member of the Herpesvirales order of double-stranded DNA viruses. Both HSV subtypes affect the skin and mucous membranes. HSV is transmitted from oral or skin surfaces affected by the virus. Rarely, herpes can be transmitted vertically, causing neonatal herpes.

    While HSV-1 is associated with oral and facial infections, HSV-2 is associated with genital and rectal infections. Unique features of HSV include latency and reactivation. Following primary exposure there is a viral invasion of epithelial cells and intracellular replication at the site. HSV then ascends through the periaxonal sheath of sensory nerves to the host sacral ganglia- which acts as a reservoir for future outbreaks. As the virus replicates, it is dormant and can be reactivated by various stimuli.

    Epidemiology: As of 2016, the WHO estimates that 3.7 billion people under 50, (67% of the global population) had an HSV-1 infection, causing oral or genital herpes. It is estimated that 491 million people aged 15-49 worldwide were affected by HSV-2-causing genital herpes. Prevalence of HSV infection increases with age. The highest number of new infections is seen in adolescents. Women are affected by HSV-2 twice as often as men due to a more efficient route of sexual transmission.

    Signs: HSV infections are characterized by recurrent blisters that can rupture and become painful. Initial presentation can appear as painful genital ulcers, inguinal lymphadenopathy and fever. Areas that can become affected by clustered vesicles are the genitalia, perineum, buttocks, upper thigh, and perianal areas. The vesicles are small, umbilicated, and closely grouped with an erythematous base in recurrent herpes. They may have a zosteriform distribution when affecting the lower chest or lumbar region. In darker skin tones, scarring at the site of recurrent HSV attacks is more prominent and hyperpigmented. 

    Symptoms: Symptoms may vary between the initial outbreak and subsequent infections. Prodromal symptoms can appear up to 48 hours before an outbreak. These include fever, tender lymph nodes, myalgia, itching and tingling of the skin. Primary HSV-1 often presents as gingivostomatitis in children under 5 years. Primary HSV-2 usually presents as genital herpes following sexual activity.

    Differentials: Herpes Zoster, Syphilis, Cytomegalovirus, Chancroid, Hand foot and mouth disease

    Diagnosis: HSV diagnosis can be confirmed by culture or PCR of a viral swab taken from fresh vesicles.

    Treatment: HSV cannot be cured, so treatment is aimed at decreasing symptoms associated with first or recurrent episodes of herpes. Antiviral medication is commonly given in low daily doses to prevent outbreaks. NSAIDS can be given to help with pain related to sores.

    References:

    ‌Herpes simplex | DermNet NZ. dermnetnz.org. https://dermnetnz.org/topics/herpes-simplex

    Cole S. Herpes Simplex Virus: Epidemiology, Diagnosis, and Treatment. Nurs Clin North Am. 2020;55(3):337-345. doi:10.1016/j.cnur.2020.05.004

    World Health Organization. Herpes simplex virus. Who.int. Published April 5, 2023. https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

  • Herpes Simplex

    Herpes Simplex

    Herpes Simplex

    Definition: The Herpes Simplex Virus (HSV) is a virus that causes herpes. Herpes is a common infection that can cause painful ulcers or blisters that may recur over time. The virus will remain dormant throughout a person’s life with the number of outbreaks decreasing with age. Two subtypes can cause infection: Herpes Simplex virus type 1 (HSV-1), and Herpes Simplex virus type 2 (HSV-2).

    Etiology: The HSV is a member of the Herpesvirales order of double-stranded DNA viruses. Both HSV subtypes affect the skin and mucous membranes. HSV is transmitted from oral or skin surfaces affected by the virus. Rarely, herpes can be transmitted vertically, causing neonatal herpes.

    While HSV-1 is associated with oral and facial infections, HSV-2 is associated with genital and rectal infections. Unique features of HSV include latency and reactivation. Following primary exposure there is a viral invasion of epithelial cells and intracellular replication at the site. HSV then ascends through the periaxonal sheath of sensory nerves to the host sacral ganglia- which acts as a reservoir for future outbreaks. As the virus replicates, it is dormant and can be reactivated by various stimuli.

    Epidemiology: As of 2016, the WHO estimates that 3.7 billion people under 50, (67% of the global population) had an HSV-1 infection, causing oral or genital herpes. It is estimated that 491 million people aged 15-49 worldwide were affected by HSV-2-causing genital herpes. Prevalence of HSV infection increases with age. The highest number of new infections is seen in adolescents. Women are affected by HSV-2 twice as often as men due to a more efficient route of sexual transmission.

    Signs: HSV infections are characterized by recurrent blisters that can rupture and become painful. Initial presentation can appear as painful genital ulcers, inguinal lymphadenopathy and fever. Areas that can become affected by clustered vesicles are the genitalia, perineum, buttocks, upper thigh, and perianal areas. The vesicles are small, umbilicated, and closely grouped with an erythematous base in recurrent herpes. They may have a zosteriform distribution when affecting the lower chest or lumbar region. In darker skin tones, scarring at the site of recurrent HSV attacks is more prominent and hyperpigmented. 

    Symptoms: Symptoms may vary between the initial outbreak and subsequent infections. Prodromal symptoms can appear up to 48 hours before an outbreak. These include fever, tender lymph nodes, myalgia, itching and tingling of the skin. Primary HSV-1 often presents as gingivostomatitis in children under 5 years. Primary HSV-2 usually presents as genital herpes following sexual activity.

    Differentials: Herpes Zoster, Syphilis, Cytomegalovirus, Chancroid, Hand foot and mouth disease

    Diagnosis: HSV diagnosis can be confirmed by culture or PCR of a viral swab taken from fresh vesicles.

    Treatment: HSV cannot be cured, so treatment is aimed at decreasing symptoms associated with first or recurrent episodes of herpes. Antiviral medication is commonly given in low daily doses to prevent outbreaks. NSAIDS can be given to help with pain related to sores.

    References:

    1. Cole S. Herpes Simplex Virus: Epidemiology, Diagnosis, and Treatment. Nurs Clin North Am. 2020;55(3):337-345. doi:10.1016/j.cnur.2020.05.004
    2. World Health Organization. Herpes simplex virus. Who.int. Published April 5, 2023. https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus
    3. ‌Herpes simplex | DermNet NZ. dermnetnz.org. https://dermnetnz.org/topics/herpes-simplex
  • Herpes Simplex

    Herpes Simplex

    Herpes Simplex

    Definition: The Herpes Simplex Virus (HSV) is a virus that causes herpes. Herpes is a common infection that can cause painful ulcers or blisters that may recur over time. The virus will remain dormant throughout a person’s life with the number of outbreaks decreasing with age. Two subtypes can cause infection: Herpes Simplex virus type 1 (HSV-1), and Herpes Simplex virus type 2 (HSV-2).

    Etiology: The HSV is a member of the Herpesvirales order of double-stranded DNA viruses. Both HSV subtypes affect the skin and mucous membranes. HSV is transmitted from oral or skin surfaces affected by the virus. Rarely, herpes can be transmitted vertically, causing neonatal herpes.

    While HSV-1 is associated with oral and facial infections, HSV-2 is associated with genital and rectal infections. Unique features of HSV include latency and reactivation. Following primary exposure there is a viral invasion of epithelial cells and intracellular replication at the site. HSV then ascends through the periaxonal sheath of sensory nerves to the host sacral ganglia- which acts as a reservoir for future outbreaks. As the virus replicates, it is dormant and can be reactivated by various stimuli.

    Epidemiology: As of 2016, the WHO estimates that 3.7 billion people under 50, (67% of the global population) had an HSV-1 infection, causing oral or genital herpes. It is estimated that 491 million people aged 15-49 worldwide were affected by HSV-2-causing genital herpes. Prevalence of HSV infection increases with age. The highest number of new infections is seen in adolescents. Women are affected by HSV-2 twice as often as men due to a more efficient route of sexual transmission.

    Signs: HSV infections are characterized by recurrent blisters that can rupture and become painful. Initial presentation can appear as painful genital ulcers, inguinal lymphadenopathy and fever. Areas that can become affected by clustered vesicles are the genitalia, perineum, buttocks, upper thigh, and perianal areas. The vesicles are small, umbilicated, and closely grouped with an erythematous base in recurrent herpes. They may have a zosteriform distribution when affecting the lower chest or lumbar region. In darker skin tones, scarring at the site of recurrent HSV attacks is more prominent and hyperpigmented. 

    Symptoms: Symptoms may vary between the initial outbreak and subsequent infections. Prodromal symptoms can appear up to 48 hours before an outbreak. These include fever, tender lymph nodes, myalgia, itching and tingling of the skin. Primary HSV-1 often presents as gingivostomatitis in children under 5 years. Primary HSV-2 usually presents as genital herpes following sexual activity.

    Differentials: Herpes Zoster, Syphilis, Cytomegalovirus, Chancroid, Hand foot and mouth disease

    Diagnosis: HSV diagnosis can be confirmed by culture or PCR of a viral swab taken from fresh vesicles.

    Treatment: HSV cannot be cured, so treatment is aimed at decreasing symptoms associated with first or recurrent episodes of herpes. Antiviral medication is commonly given in low daily doses to prevent outbreaks. NSAIDS can be given to help with pain related to sores.

    References:

    1. Cole S. Herpes Simplex Virus: Epidemiology, Diagnosis, and Treatment. Nurs Clin North Am. 2020;55(3):337-345. doi:10.1016/j.cnur.2020.05.004
    2. World Health Organization. Herpes simplex virus. Who.int. Published April 5, 2023. https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus
    3. ‌Herpes simplex | DermNet NZ. dermnetnz.org. https://dermnetnz.org/topics/herpes-simplex
  • Herpes Simplex

    Herpes Simplex

    Herpes Simplex

    Definition: The Herpes Simplex Virus (HSV) is a virus that causes herpes. Herpes is a common infection that can cause painful ulcers or blisters that may recur over time. The virus will remain dormant throughout a person’s life with the number of outbreaks decreasing with age. Two subtypes can cause infection: Herpes Simplex virus type 1 (HSV-1), and Herpes Simplex virus type 2 (HSV-2).

    Etiology: The HSV is a member of the Herpesvirales order of double-stranded DNA viruses. Both HSV subtypes affect the skin and mucous membranes. HSV is transmitted from oral or skin surfaces affected by the virus. Rarely, herpes can be transmitted vertically, causing neonatal herpes.

    While HSV-1 is associated with oral and facial infections, HSV-2 is associated with genital and rectal infections. Unique features of HSV include latency and reactivation. Following primary exposure there is a viral invasion of epithelial cells and intracellular replication at the site. HSV then ascends through the periaxonal sheath of sensory nerves to the host sacral ganglia- which acts as a reservoir for future outbreaks. As the virus replicates, it is dormant and can be reactivated by various stimuli.

    Epidemiology: As of 2016, the WHO estimates that 3.7 billion people under 50, (67% of the global population) had an HSV-1 infection, causing oral or genital herpes. It is estimated that 491 million people aged 15-49 worldwide were affected by HSV-2-causing genital herpes. Prevalence of HSV infection increases with age. The highest number of new infections is seen in adolescents. Women are affected by HSV-2 twice as often as men due to a more efficient route of sexual transmission.

    Signs: HSV infections are characterized by recurrent blisters that can rupture and become painful. Initial presentation can appear as painful genital ulcers, inguinal lymphadenopathy and fever. Areas that can become affected by clustered vesicles are the genitalia, perineum, buttocks, upper thigh, and perianal areas. The vesicles are small, umbilicated, and closely grouped with an erythematous base in recurrent herpes. They may have a zosteriform distribution when affecting the lower chest or lumbar region. In darker skin tones, scarring at the site of recurrent HSV attacks is more prominent and hyperpigmented. 

    Symptoms: Symptoms may vary between the initial outbreak and subsequent infections. Prodromal symptoms can appear up to 48 hours before an outbreak. These include fever, tender lymph nodes, myalgia, itching and tingling of the skin. Primary HSV-1 often presents as gingivostomatitis in children under 5 years. Primary HSV-2 usually presents as genital herpes following sexual activity.

    Differentials: Herpes Zoster, Syphilis, Cytomegalovirus, Chancroid, Hand foot and mouth disease

    Diagnosis: HSV diagnosis can be confirmed by culture or PCR of a viral swab taken from fresh vesicles.

    Treatment: HSV cannot be cured, so treatment is aimed at decreasing symptoms associated with first or recurrent episodes of herpes. Antiviral medication is commonly given in low daily doses to prevent outbreaks. NSAIDS can be given to help with pain related to sores.

    References:

    1. Cole S. Herpes Simplex Virus: Epidemiology, Diagnosis, and Treatment. Nurs Clin North Am. 2020;55(3):337-345. doi:10.1016/j.cnur.2020.05.004
    2. World Health Organization. Herpes simplex virus. Who.int. Published April 5, 2023. https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus
    3. ‌Herpes simplex | DermNet NZ. dermnetnz.org. https://dermnetnz.org/topics/herpes-simplex
  • Herpes Simplex

    Herpes Simplex

    Herpes Simplex

    Definition: The Herpes Simplex Virus (HSV) is a virus that causes herpes. Herpes is a common infection that can cause painful ulcers or blisters that may recur over time. The virus will remain dormant throughout a person’s life with the number of outbreaks decreasing with age. Two subtypes can cause infection: Herpes Simplex virus type 1 (HSV-1), and Herpes Simplex virus type 2 (HSV-2).

    Etiology: The HSV is a member of the Herpesvirales order of double-stranded DNA viruses. Both HSV subtypes affect the skin and mucous membranes. HSV is transmitted from oral or skin surfaces affected by the virus. Rarely, herpes can be transmitted vertically, causing neonatal herpes.

    While HSV-1 is associated with oral and facial infections, HSV-2 is associated with genital and rectal infections. Unique features of HSV include latency and reactivation. Following primary exposure there is a viral invasion of epithelial cells and intracellular replication at the site. HSV then ascends through the periaxonal sheath of sensory nerves to the host sacral ganglia- which acts as a reservoir for future outbreaks. As the virus replicates, it is dormant and can be reactivated by various stimuli.

    Epidemiology: As of 2016, the WHO estimates that 3.7 billion people under 50, (67% of the global population) had an HSV-1 infection, causing oral or genital herpes. It is estimated that 491 million people aged 15-49 worldwide were affected by HSV-2-causing genital herpes. Prevalence of HSV infection increases with age. The highest number of new infections is seen in adolescents. Women are affected by HSV-2 twice as often as men due to a more efficient route of sexual transmission.

    Signs: HSV infections are characterized by recurrent blisters that can rupture and become painful. Initial presentation can appear as painful genital ulcers, inguinal lymphadenopathy and fever. Areas that can become affected by clustered vesicles are the genitalia, perineum, buttocks, upper thigh, and perianal areas. The vesicles are small, umbilicated, and closely grouped with an erythematous base in recurrent herpes. They may have a zosteriform distribution when affecting the lower chest or lumbar region. In darker skin tones, scarring at the site of recurrent HSV attacks is more prominent and hyperpigmented. 

    Symptoms: Symptoms may vary between the initial outbreak and subsequent infections. Prodromal symptoms can appear up to 48 hours before an outbreak. These include fever, tender lymph nodes, myalgia, itching and tingling of the skin. Primary HSV-1 often presents as gingivostomatitis in children under 5 years. Primary HSV-2 usually presents as genital herpes following sexual activity.

    Differentials: Herpes Zoster, Syphilis, Cytomegalovirus, Chancroid, Hand foot and mouth disease

    Diagnosis: HSV diagnosis can be confirmed by culture or PCR of a viral swab taken from fresh vesicles.

    Treatment: HSV cannot be cured, so treatment is aimed at decreasing symptoms associated with first or recurrent episodes of herpes. Antiviral medication is commonly given in low daily doses to prevent outbreaks. NSAIDS can be given to help with pain related to sores.

    References:

    1. Cole S. Herpes Simplex Virus: Epidemiology, Diagnosis, and Treatment. Nurs Clin North Am. 2020;55(3):337-345. doi:10.1016/j.cnur.2020.05.004
    2. World Health Organization. Herpes simplex virus. Who.int. Published April 5, 2023. https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus
    3. ‌Herpes simplex | DermNet NZ. dermnetnz.org. https://dermnetnz.org/topics/herpes-simplex
  • Acne Vulgaris

    Acne Vulgaris

    Acne Vulgaris

    Definition: Acne Vulgaris is a common, chronic, inflammatory condition affecting the pilosebaceous unit and is caused as a result of increased sebum production, hyperkeratinization of the follicle, bacterial colonization and inflammation. It mostly affects the face but can spread to other parts of the body. In the skin of colour, acne vulgaris typically shows less noticeable redness and more post-inflammatory hyperpigmentation, resulting in pigmented macules that persist long after the acne lesions have resolved.

    Epidemiology: Acne Vulgaris typically develops during puberty with a reduction with increased age. In adolescence, acne is more prevalent in males, especially in its severe forms. Conversely, in adulthood, the condition occurs more frequently in women than in men.

    Signs:  The disease begins with the formation of a comedone, a clogged follicle that can be closed (whitehead) or open (blackhead). A whitehead appears as a white or flesh-coloured dome-shaped papule without visible inflammation. It is flask-shaped and connected to the skin surface. As the follicle opening enlarges due to keratin and sebum buildup, it becomes an open comedo, or blackhead, which is a flat or slightly raised black lesion with a central dilated orifice.

    Symptoms:  Symptoms include skin lesions that can be tender or painful, red, and hyperpigmented, particularly with nodular or cystic acne. Patients may also experience psychological distress due to cosmetic concerns.

    Differentials: The differential diagnosis includes acne cosmetica, drug-induced acne, folliculitis, hidradenitis suppurativa, Miliaria, Perioral dermatitis, Pseudofolliculitis barbae, Rosacea and seborrheic dermatitis.

    Diagnosis: Diagnosis is mainly clinical, relying on the appearance and distribution of the lesions.

    Treatment: Acne Vulgaris can be treated with oral, topical, and procedural therapy as well as good skin care. For mild-to-moderate acne, topical medications are the primary line of treatment. For more severe cases of acne, combination therapy may be employed. When topical medications fail to control moderate-to-severe acne, systemic medicines are typically recommended as a first line of treatment. 

    References: (AMA)

    1. Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context. 2021;10:2021-8-6. Published 2021 Oct 11. doi:10.7573/dic.2021-8-6
    2. Jiao R, Zhai X, Zhang X, Xiong Z, Liu Z. Efficacy of acupuncture in improving symptoms and quality of life of patients with acne vulgaris: a randomized sham acupuncture-controlled trial. Acupuncture in Medicine. Published online April 18, 2022:096452842210765. doi:https://doi.org/10.1177/09645284221076506
    3. Ogé LK, Broussard A, Marshall MD. Acne Vulgaris: Diagnosis and Treatment. American Family Physician. 2019;100(8):475-484. https://www.aafp.org/pubs/afp/issues/2019/1015/p475.html#afp20191015p475-t1
    4. Yin NC, McMichael AJ. Acne in Patients with Skin of Color: Practical Management. American Journal of Clinical Dermatology. 2013;15(1):7-16. doi:https://doi.org/10.1007/s40257-013-0049-1
  • Pityriasis Rosea

    Pityriasis Rosea

    Pityriasis Rosea

    Pityriasis Rosea is an acute, self-limiting skin condition characterized by an initial herald patch followed by a widespread rash on the trunk and proximal extremities. It commonly affects individuals aged 10 to 35 years, with a slight female predominance. The exact cause is unknown, but it is believed to be associated with the reactivation of human herpesvirus 6 or 7.

    Clinically, the condition begins with a single large, scaly, pink patch (herald patch), typically on the chest, back, or abdomen. This is followed by smaller, oval, scaly patches that appear in a “Christmas tree” pattern. Some patients may experience mild prodromal symptoms such as headache, fever, or malaise before the rash appears. Diagnosis is primarily clinical, and possible differentials include tinea corporis, secondary syphilis, and psoriasis, among others. Treatment is usually unnecessary as the condition resolves on its own within 6–8 weeks. However, symptomatic management may include topical corticosteroids, oral antihistamines, and moisturizers to alleviate itching. The prognosis is excellent, with most cases resolving without complications. Recurrences are rare, but the condition can occasionally lead to prolonged skin discoloration​.

    References

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