Chapter 8 : Viral Infections of the Skin

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A wide spectrum of skin lesions can result from viral infections. Three groups of viruses represent most primary epidermal viral replications: human papillomaviruses (HPV), herpesviruses, and poxviruses. Several virus families, such as retroviruses, paramyxoviruses, togaviruses, parvoviruses, and picornaviruses, produce skin lesions secondarily. Other viruses, such as rhabdoviruses, orthomyxoviruses, and reoviruses, rarely induce skin lesions. Viruses that infect the skin by direct inoculation include primary herpes simplex virus (HSV), papillomaviruses, and most poxviruses (except smallpox). Among rapid diagnostic tests, perhaps the most frequently used for detection of viral infections of the skin is fluorescent-antibody detection of HSV-1, HSV-2, and varicella-zoster virus (VZV). Maculopapular lesions may also be seen in erythema multiforme, which is common for viral etiology (HSV) or may be associated with nonviral infections or drug eruptions. Condyloma acuminatum must be differentiated from condyloma latum, the skin lesion associated with secondary syphilis. While a variety of enteroviruses, particularly coxsackieviruses, cause mucocutaneous manifestations, the two most distinctive clinical syndromes are hand-foot-and-mouth disease (HFMD) and herpangina. Rubella is an acute viral illness typically seen in children, although all age groups are susceptible. Human immunodeficiency virus (HIV) carries an RNA-dependent DNA polymerase, which allows viral RNA to be converted into a proviral DNA sequence. Enzyme-linked immunosorbent assay (ELISA) is used to screen for HIV infection while the Western blot assay is used to confirm the diagnosis.

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8

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Image of FIGURE 1

Pathways of the cutaneous immune response to infection with HPV, HSV, and HIV.

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8
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Image of FIGURE 2

Photomicrograph of condyloma acuminatum showing acanthosis, papillomatosis, and parakeratosis.

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8
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Image of FIGURE 3

Variola major (smallpox)

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8
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Image of FIGURE 4

Photomicrograph of MC demonstrating central umbilication and epidermal hyperplasia containing intracytoplasmic inclusions (Henderson-Paterson bodies) compressing nuclei.

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8
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Image of FIGURE 5

Photomicrograph of erythema multiforme associated with HSV-1, showing subepidermal vesicles, necrotic keratinocytes, and balloon cell degeneration.

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8
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Image of FIGURE 6

Photomicrograph of an ulcer resulting from HSV-2, in which multinucleated giant cells with eosinophilic intranuclear inclusions can be seen.

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8
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Image of FIGURE 7

Photomicrograph of Kaposi’s sarcoma associated with HHV-8, demonstrating neovascularization, endothelial proliferation, and plump hyperchromatic atypical nuclei lining vascular spaces.

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8
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Generic image for table

Taxonomy of enteroviruses

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8
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Common mucocutaneous manifestations of enteroviruses

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8
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Associated manifestations of enteroviruses

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8
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Dermatologic findings of opportunistic diseases in HIV-infected patients

Citation: Bartlett B, Tyring S. 2009. Viral Infections of the Skin, p 109-131. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch8

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