Herpes simplex virus infection of the hand. A profile of 79 cases

Bipolar herpes simplex infection in an human immunodeficiency virus-infected individual

Herpes simplex infection is the most common infection among the human immunodeficiency virus-infected individuals. However, the atypical manifestations of herpes simplex virus may confound even an astute physician. Hand involvement is rarely associated with genital herpes infection and the involvement of widespread areas healing with debilitating scarring is uncommon.

[Diagnostic and therapeutic Problems in Paronychia and Felons]

The infections of the terminal phalanx are always special. Diseases, tumors or virus infections can look very similar and can show similar symptoms. Many require a radiological, dermatological, histological or general physical clarification, some need no surgery and in some surgery is contraindicated. If surgery is necessary, the exact incision is particularly important. A surgical approach set only a few millimeters wrong, can have catastrophic consequences at the fingertip. Differential diagnoses and the consequences of wrong incisions are shown.

Recurrent extragenital herpes simplex type 2 occurring in a distal location of the same dermatome

Herpes simplex infection (HSV) is a common infectious disease, which the main clinical manifestations are mucocutaneous infection. Extragenital infections are reported in both type 1 and type 2 of herpes simplex virus. We report a case of a 33-year-old female with recurrent extragenital HSV type 2 infection on the right medial wrist. The patient had history of the previous infection site locating on the right posterior deltoid however both of two sites are the same dermatomal distribution. This report demonstrates the recurrent herpes simplex infection can develop in another area of the dermatomal distribution.

Acral manifestations of viral infections

Viruses are considered intracellular obligates with a nucleic acid RNA or DNA. They have the ability to encode proteins involved in viral replication and production of the protective coat within the host cells but require host cell ribosomes and mitochondria for translation. The members of the families Herpesviridae, Poxviridae, Papovaviridae, and Picornaviridae are the most commonly known agents for cutaneous viral diseases, but other virus families, such as Adenoviridae, Togaviridae, Parvoviridae, Paramyxoviridae, Flaviviridae, and Hepadnaviridae, can also infect the skin. Herpetic whitlow should be considered under the title of special viral infections of the acral region, where surgical incision is not recommended; along with verruca plantaris with its resistance to treatment and the search for a new group of treatments, including human papillomavirus vaccines; HIV with maculopapular eruptions and palmoplantar desquamation; orf and milker's nodule with its nodular lesions; papular-purpuric gloves and socks syndrome with its typical clinical presentation; necrolytic acral erythema with its relationship with zinc; and hand, foot, and mouth disease with its characteristics of causing infection with its strains, with high risk for complication.

Herpetic whitlow during immunosuppressive therapy for Wegener's Granulomatosis

Skin involvement may occur in patients with Wegener's granulomatosis (polyangiitis with granulomatosis; WG) and is more frequent in the generalised form. However, when a patient with vasculitis develops digital ulceration, in addition to disease activation, other pathologies should be considered. One of them may be the herpetic whitlow mimicking paronychia. Here, we present a patient who developed herpetic whitlow during the course of immunosuppressive therapy due to WG. Just before the third course of cyclophosphamide therapy, she was re-admitted to the outpatient clinic with the above-mentioned ulcerated lesions. On physical examination, there was erythema and a painful, crusted ulceration in the distal phalanx of the right index finger involving the proximal nail fold. Similar lesions were also present in her lower lip. Due to the absence of clinical and laboratory findings suggesting the activation of WG and the Tzanck smear result, which is compatible with herpes virus infection, we do not believe that WG was responsible for our patient's complaints. All of the patient's lesions completely disappeared following the interruption of immunosuppressive therapy.

Benign acquired superficial skin lesions of the hand

Numerous dermatologic conditions may be visualized by the hand surgeon during office hours, including when examining patients for an alternative chief problem. Although the primary focus of the visit may be unrelated to a skin lesion, it is important for the hand surgeon to be familiar with these lesions to address patient inquiries and determine which lesions may require some form of treatment. This article reviews some of the most common benign acquired superficial skin lesions of the hand. Particular attention will be paid to epidermal lesions, pigmented lesions, vascular lesions, dermal fibrous/fibrohistiocytic lesions, and infections that can be confused with skin neoplasms or tumor-like conditions. Diagnostic clues, including photographs, will be provided for each lesion described, as well as the recommended treatment.

[Surgical managing of current cutaneous infections in children]

The cutaneous infectious pathology of the child is varied and frequent. Authors deal with surgical infections seen in current pediatrics, which often have to appeal to a plastic pediatric surgeon for their treatment. Superficial infections of skin and pilo-sebaceous follicles are common in big children. The folliculitis and the boil are the most frequent. Their treatment is medical and surgical and does not require an antibiotic treatment in most of the cases. The primitive abscesses or following an anterior lesion recover from a similar treatment. Some localizations or risky context need a particular follow-up. The whitlow is a particular example and needs to have a particular follow-up because of the risk of hand cellulitis. Nails embodied of the child require a specialized notice because of their numerous clinical forms, which must be distinguished according to the age. Finally the necrotizing cellulitis and fasciitis are surgical emergencies and have a well-codified treatment. These infections in children must benefit from an attentive care because when they are badly treated, they can involve the aesthetic, functional and vital forecast.

Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management

Eight of the more than 80 known herpesviruses are human pathogens. Human herpes simplex virus (HSV) is a contagious infection with a large reservoir in the general population. It has a potential for significant complications in the immunocompromised host. In addition, psychological distress caused by the negative stigma associated with genital herpes and visible facial lesions in those experiencing frequent outbreaks renders it a challenging clinical dilemma. This article reviews the epidemiology, pathogenesis, and diagnostic features of HSV infections, providing the clinician with an up-to-date understanding of the available management strategies for mucocutaneous HSV-induced disease.

Recurrent herpes simplex virus type 2 infection of the hand complicated by persistent lymphoedema

A 33-year-old, immunocompetent woman had recurrent herpes simplex virus reactivation of the right hand presenting with a cellulitis-like picture. She continued to have monthly debilitating recrudescences for more than 3 years until an adequate dosage of prophylactic antiviral therapy was achieved. After 2 years of repeated episodes she had chronic dull pain and developed persistent acquired lymphoedema of the left hand and forearm, which is an extremely rare complication. This case highlights the need for herpes simplex infection of the hand to be included in the differential diagnosis of bacterial cellulitis in order for appropriate and prompt therapy to be achieved.

Treatment of mucocutaneous presentations of herpes simplex virus infections

Infections by herpes simplex virus (HSV) types I and II are diverse and quite frequent. After primary infection, the virus establishes a life-long latency in the sensory ganglia and recrudescences may occur at an unpredictable rate. Recurrent labial and genital herpes infections represent the majority of clinical manifestations of HSV infections. Their management is currently well established using evidence-based medicine data. Primary labial herpes is generally not treated with antivirals in otherwise healthy children, although intravenous aciclovir may be offered in severe primary infections, particularly in the immunocompromised patient. The decision whether or not to treat recurrent labial herpes should be evaluated individually and depends on the frequency and severity of relapses, the impairment of the quality of life, and the cost of therapy. Patients with mild disease may benefit from topical therapy, and those with severe and frequent recurrences may be considered for intermittent or long-term oral antiviral therapy. Primary genital herpes is treated with oral or intravenous antivirals, depending on the severity of the infection and associated symptoms. Recurrent genital herpes can be managed with episodic short courses of oral antivirals in patients whose recurrences are moderate to severe and rare, and have a clear prodrome. Patients with >5 episodes/year, severe recurrences or unrecognisable prodromes may be best managed with long-term suppressive antiviral prophylaxis. HSV is also responsible for a variety of other clinical manifestations, including herpetic whitlow, neonatal infection, disseminated and atypical cutaneous infections, traumatic herpes, eczema herpeticum, and HSV-associated erythema multiforme. HSV infection may also represent a complication following cosmetic procedures of the oro-facial region, surgical and dental interventions, sun exposure and burns. Precise treatment guidelines for these HSV infections are not firmly established.

Herpetic whitlow with bacterial abscess

The herpetic whitlow should be treated nonoperatively. However, a difficult therapeutic dilemma occurs when a whitlow is seen with an established bacterial abscess. We report a case of an adult whose first herpetic whitlow was complicated by secondary periungual abscesses that progressed despite intravenous antimicrobial therapy. Surgical drainage of these periungual abscesses was successfully done in conjunction with intravenous acyclovir with no adverse effects.

Oral acyclovir therapy of recurrent herpes simplex virus type 2 infection of the hand

Acyclovir was evaluated as treatment of recurrent herpes simplex virus type 2 infection of the hand in a double-blind, placebo-controlled crossover study. In nine fully evaluable patients, oral acyclovir (2 g/day in three doses for 10 days) initiated during the earliest phase of a recurrence reduced the mean durations (+/- standard deviation) of clinical symptoms from 10.1 (+/- 3.6) to 3.7 (+/- 3.0) days (P = 0.008), signs from 11.1 (+/- 3.7) to 6.2 (+/- 3.3) days (P = 0.024), and viral positivity from 5.3 (+/- 3.8) to 0.6 (+/- 1.1) days (P = 0.011).

Cutaneous herpes simplex infections

OBJECTIVE

To review the clinical features and natural history of cutaneous herpes simplex infections associated with genital herpes.

DESIGN

A retrospective case note study of all patients presenting to James Pringle House with this condition between 1983-1987.

SUBJECTS

123 patients were identified.

RESULTS

The commonest sites involved were the buttocks 64/186 (34%), suprapubic area 28/186 (15%) and thigh 14/186 (7.5%). Thirty five of the 123 (28%) patients had more than one anatomical site involved. Genital and extragenital recurrences occurred with similar frequency.

DISCUSSION

Extragenital cutaneous herpes simplex is not uncommon. Lesions may occur virtually anywhere on the body. HSV should always be considered in the differential diagnosis of vesiculating skin lesions.

Herpes simplex virus infection of the hand

The first episode of herpes simplex virus (HSV) infection of the hand can occur in association with infection at another site, such as primary HSV-1 gingivostomatitis. Autoinoculation is the likely route of transmission. The attacks are usually solitary and last about 14 days. A first episode that results from exogenous inoculation may be severely inflammatory and may last up to 28 days. The majority of cases are recurrent infections and most often occur in adults with HSV-2 infection.