Herpetic skin lesions: causes, symptoms, diagnosis, treatment

Herpetic lesions of the skin include simple bladder and shingles.

A simple bubble lichen is caused by a herpes simplex virus type I or II, characterized by severe dermatoneurotropic symptoms. Infection with type I virus usually occurs in early childhood (the possibility of intrauterine penetration of the virus into the body is allowed), and type II after puberty. Type I virus often causes the damage to the face and skin of other areas of the body, type 11 virus - the mucous membranes of the genital organs. Antibodies against type I virus are found in most adults, against type II much less often. Infection with type II virus often occurs sexually.

In places where the virus penetrates, a primary lesion of the skin or mucous membranes of the vesicle, less often bullous, develops, sometimes proceeding according to the type of aphthous stomatitis, keratoconjunctivitis, vulvovaginitis. Framegesiform changes are described. Often, as a result of viremia, general reactions are observed in the form of visceral manifestations, of which the most dangerous is encephalitis. When infecting children during childbirth with type II herpes simplex virus, 5-50% of them develop disseminated infection with frequent lethal outcome. In the future, the course of infection is usually latent, the virus remains in the ganglia, relapses occur, as a rule, under the influence of factors that reduce the resistance of the organism, especially cooling. In the mechanisms of the recurrence of herpes simplex, an important role is played by suppression of cellular immunity.

Clinically, the disease is characterized by the precipitation of small grouped vesicles, usually with clear contents that dry up or open with the formation of erosions, less often - erosive and ulcerative lesions. Rashes regress for several days, usually without leaving scars. The defeat of the eyes is more severe, can lead to loss of vision. There is evidence of the role of type II virus in the development of cervical cancer. Of atypical variants of the disease, zosteriiform, abortive, rupioid, edematous are isolated. In case of persistent and unusual course, HIV infection should be excluded. Herpes simplex virus is considered one of the frequent agents provoking the development of multiforme exudative erythema. Herpes infection of patients with eczema or diffuse neurodermatitis develops herpetic eczema, which is more often observed in childhood, characterized by a severe current with a high temperature.

Pathomorphology. The main morphological element is the intraepidermal vesicle, formed as a result of edema and destructive changes in epidermal cells (ballooning dystrophy), resulting in the formation of multi-chambered vesicles in the upper parts of the epidermis, surrounded by sites of reticular dystrophy. Typical for this disease is the presence in ballooning cells of intranuclear inclusions (eosinophilic bodies). In the dermis, morphological changes can range from small inflammatory infiltration to a significant one with the involvement of vessel walls. Infiltrates consist mainly of lymphocytes and neutrophilic granulocytes.

Histogenesis, In nuclei of infected cells, DNA replication of the virus takes place. A characteristic feature is the early migration of the virus, devoid of the outer shell, into the trunks of the sensory nerves, through which it enters the ganglion, where it multiplies and again migrates into the skin. Mechanisms of reactivation of the virus in relapses of the disease have been studied little. This process is affected by the weakening of immune control, increased susceptibility to the virus of epithelial cells, reduced synthesis of interferon.

Shingles, like chicken pox, are caused by a neurotropic virus - Herpesvirus varicella zoster. Development of the disease is facilitated by a decrease in immunity, severely current diseases, especially malignant, lymphoproliferative, radiation exposure and other factors that reduce immunity, including HIV infection. It occurs more often in persons over 50 years of age, infection usually occurs in childhood, which leads to the development of chicken pox. Tinea in adults is seen as a consequence of the reactivation of the virus, which persists in the posterior roots of the spinal cord or nodes of the trigeminal nerve. Clinically, it is characterized by erythema-vesicle, rarely bullous eruptions, located, as a rule, on the one hand, in the zone of nerve damage accompanied by severe pain, especially when the first branch of the trigeminal nerve is involved. Sometimes, in a more severe course, there may be scattered rashes. They are smaller in size than the main focus, morphologically similar to those of chicken pox. The contents of the bubbles and blisters are usually transparent, but can be cloudy or hemorrhagic. In weakened patients, especially when localized on the face, necrotic changes can occur with the formation of long-lasting non-healing ulcers. Sometimes facial, auditory and trigeminal nerves are affected at the same time. When the eyes are affected, which is observed in about 1/3 of patients, loss of vision is possible, and meningoencephalitis develops occasionally. In some patients, postherpetic neuralgia may persist for a long time.

Pathomorphology. Morphological changes in the skin are similar to those with a simple bubble deprivation, but more pronounced. In the epithelial cells of the basal layer, ballooning dystrophy due to acute intracellular edema and nuclear changes are observed. Affected nuclei contain inclusions in the form of eosinophilic bodies. Intracellular edema is combined with intercellular edema, this leads to the formation of vesicles in the upper parts of the growth layer. In the dermis, weak infiltration is detected by neutrophilic granulocytes, which then migrate to the epidermis. In addition, the nerve trunks and the corresponding roots of sensitive ganglia are affected. In the nuclei of the affected ganglion cells, eosinophilic bodies are found, and in the case of electron microscopy, the herpes virus. Particles of the virus are also found in skin capillary endotheliocytes and axons.

Histogenesis. The appearance of rashes on the skin is preceded by viremia. A few days after the formation of the vesicles in the serum of patients, antibodies to the virus, represented by immunoglobulins G, A and M, are detected, some of them (IgG) persist for life. Within a few days from the onset of the disease, cellular immunity remains depressed.

Molluscum contagiosum (syn: epithelial mollusk, contagious molluscum, epithelioma contagious) - disease caused by DNA-containing smallpox virus. The introduction of the virus contributes to the traumatization of the skin, its lymphohematogenous spread is allowed. Infection is accompanied by the formation of antibodies, mainly IgG. Clinically manifested yellowish-white or reddish lenticular papules of rounded outlines, hemispherical shape with a shiny surface, an umbilical impression in the center, a dense consistency. When pressing on the papule from the side surfaces of it from the central hole is released curd. Rashes are scattered or grouped, mainly on the face, chest, genitals, in homosexuals - perianal. They can be single, but more often - multiple, especially with immunodeficiency, including those caused by the human immunodeficiency virus. With localization on the eyelids, conjunctivitis, spot keratitis may develop. Children are mostly ill, the course is long, often the disease spontaneously cures sometimes there are scars.

Pathomorphology. In the region of the element there are pear-like outgrowths of the epidermis, the cells of which, especially the upper layers, contain large intracellular inclusions-shellfish. They initially have the form of ovoid eosinophilic structures, and when enlarged they become basophilic. In the center of the lesion at the level of the horny and granular layers, there is a crateral depression completely filled with mollusc bodies containing a large number of viral particles. With a superficial arrangement of mollusc bodies in the epidermis, changes in the dermis are insignificant, in cases of the spread of epithelial cell destruction to the basal layer and penetration of the process into the dermis, a pronounced inflammatory reaction develops in it. The infiltrate consists of lymphocytes, neutrophilic granulocytes, macrophagocytes and giant cells of foreign bodies.

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