Integumentary System
Lesson 4: Common Skin Diseases
4-3
4-3. SKIN DISEASES PERTAINING TO VIRAL INFECTIONS
a. Herpes Simplex (Fever Blister).
(1) Description/characteristics. Herpes simplex is a recurrent acute viral infection characterized by the appearance on the skin or mucous membranes of single or multiple clusters of small vesicles. These vesicles are filled with clear fluid, and the vesicle base is slightly raised. The infectious agent is a relatively large virus which frequently accompanies febrile (fever causing) illnesses: colds, cases of overexposure, exhaustion, nervous tension, and menstruation. Herpes simplex is a benign disease and occurs in almost everyone at one time or another. It may appear anywhere on the skin or mucous membranes, but it most commonly appears on the face (especially around the mouth), conjunctiva, cornea, or genitals. At times, there is an associated stomatitis (inflammation of the mucous membrane of the mouth). Vesicles usually appear after a period of tingling discomfort or itching. The principle symptoms are burning and stinging. Neuralgia may precede and accompany attacks. Single vesicles or small groups may come together to form large lesions. The vesicles usually persist for a few days. Then, they begin to dry and form a yellow crust. Vesicles on the nose, ears, or fingers may be painful. Self-limiting healing usually occurs within seven to ten days. Vesicles usually recur in the same areas. The time between episodes varies from weeks to months. Do not confuse herpes simplex with herpes zoster or impetigo. Examine lesions in the genital area carefully to be sure the lesion diagnosed as herpes simplex is not syphilis, lymphogranuloma venereum (LGV), or chancroid.
(2) Treatment. There is no specific medication for herpes simplex, but there is a course of treatment to follow. Apply topical lotions. Drying lotions and liquids help; however, moisture aggravates the condition and delays healing. Treat stomatitis, if it occurs, with mild saline mouthwashes. Medications which can be applied to the skin lesion include vioform three percent; tincture of benzoin, ten percent spirits of camphor, and the commercial product Campho-Phenique®. To abort lesions, apply a moistened styptic pencil several times daily. For herpes of the eye, DO NOT use corticosteroids, systemic or local. Costicosteroids may cause the problem to progress to dendritic ulcer of the cornea (cornea ulcer that spreads in all directions).
b. Herpes Zoster (Shingles).
(1) Description/characteristics. These skin lesions are an infection of the central nervous system primarily involving the dorsal root ganglia (a collection of nerve cell bodies on the dorsal root of each spinal nerve). The lesions are characterized by a blister and pain in the affected areas. Shingles is most common after the age of fifty. With rare exceptions, one attack of zoster gives a person lifelong immunity. Early symptoms include chills, fever, malaise, and gastrointestinal disturbances. These symptoms may be present from three to five days before the skin lesions appear. Pain usually precedes the appearance of skin lesions by about 48 hours or more. Severe pain and burning are common but may not be present.
(2) Treatment. No specific therapy is known: however, the following treatment may help the condition. Give barbiturates to help control tension and nervousness associated with neuralgia. Apply soothing powders or lotions to the skin lesions. Calamine lotion may be applied liberally and covered with a protective layer of cotton. An analgesic or codeine may be given for pain.
c. Verrucae (Warts).
(1) Description/characteristics. These are common contagious, benign epithelial tumors that are classified by either shape or location. No age group is immune to these tumors. They are most frequently seen in children and young adults. Usually, there are no signs or symptoms.
(2) Treatment. Warts can be easily removed, but they often recur at the same or a different site. It is often better to leave a single inconspicuous wart alone. These treatment techniques can be followed. Apply trichloroacetic acid to the wart every three to four days. When the wart whitens, apply phenol neutralized by alcohol. Nitric acid and silver nitrate may also be applied to the wart. In some moist anogenital warts, applying 25 percent podophyllum resin in benzoin tincture at weekly intervals is effective. Cryotherapy is used. Chemosurgery (destruction of tissue through the use of chemicals) is sometimes performed. The wart can be removed surgically. Electric desiccation (drying up) of the wart is sometimes performed.
