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Molluscum Contagiosum on Penis- How common is it?

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Molluscum contagiosum on penis is quite commonly seen in sexually active individuals. The disease is generally mild and not much of concern when it comes to other areas. However, when it arises on the penis there will sure be lot of concern regarding it. Bumps in these area means that the molluscum contagiosum might have been spread through sexual contact, but this is not always the case. But it is wise for anyone who develops bumps on and around the penis to visit the doctor.

What is Molluscum Contagiosum?

Molluscum contagiosum is a common harmless skin disease that is caused by poxvirus called Molluscum Contagiosum virus (MCV). Molluscum contagiosum usually resolves on its own after few months. Treatment is generally not required for Molluscum contagiosum involving other areas, but for genital areas treatment may be necessary in order to prevent its spread and transmission.

How Molluscum contagiosum spreads?

Molluscum contagiosum virus can spread from person-to-person either with skin-to-skin contact or sharing items of infected person. Individuals with already existing molluscum contagiosum can spread to other areas of the body when the person scratches the bumps then touches on other parts of body immediately, this is called autoinoculation. So Molluscum contagiosum on penis may not always be due to sexual contact but could also be due to autoinoculation.

How does Molluscum contagiosum on penis look like?

Molluscum contagiosum on penis doesn’t differ from MC of any other areas. They are small white-pink or skin colored bumps with dimple in the center. These bumps are usually smooth, painless and firm and may commonly occur on the shaft of penis but other areas may also be involved. They may sometimes become red, inflamed and irritated. In individuals with weaken immune system these bumps may show different morphology and may not look like typical Molluscum contagiosum. They may often be large and increase in number and may not show typical central dimpling. In such case one should prompt for HIV and other tests for chronic disease that weakens immune system.

 

Pictures of molluscum contagiosum on penis
How is Molluscum Contagiosum Diagnosed?

Diagnosis of MC is straight forward. Your doctor can confirm the case just by looking at the characteristic lesion of MC. If there is any doubt, you doctor will scrape the skin from the infected area and view under microscope. In rare cases skin biopsy may be required.

How is Molluscum contagiosum on penis treated?

In a healthy individual with MC on other parts of body, no treatment may be needed as MC usually resolves on its own after few months (but in individual with weakened immune system it may take longer). When it comes to genital areas it is very important to get it treated because the chances of spreading MC to other individual are very high for sexually active individuals. As they are so contagious, early diagnosis and treatment can help prevent the spread of the infection.

There are several treatment options for Molluscum contagiosum on penis; these may range from topical applications to surgical destruction and extraction.

Topical applications

There are several topical applications that act as irritants, and immune response stimulators that have been used successively in the treatment of Molluscum contagiosum on penis. These agents either dissolve the lesion over time or create immune response as a result of inflammation that calls for your immune army troops to get them killed. Below are the lists:

Imiquimod cream 5%
Cantharidin
Tretinoin cream
Bichloracetic acid and Trichloroacetic acid
Silver nitrate
Podophylin
Salicylic acid
Lactic acid
Glycolic acid
Potassium hydroxide
Benzoyl peroxide

Surgical options

Several surgical options are available for treatment of MC. These may be either doctor performed or at home treatment. Some of the treatments are listed below:

Cryotherapy (freezing with liquid nitrogen)
Curettage
Electrodesiccation
Lasers (Pulsed dye laser)

Other at-office or at-home procedures for removal of Molluscum contagiosum

Expression of the central core with tweezers or squeezing it with forceps
Rupture of the central core with a needle or a toothpick
Shave removal
Duct tape occlusion

Note: If you are trying to extract yourself at home, always remember to strictly cover around the lesion with Vaseline, so the content of the bump won’t spread to the surrounding.

Repeat examination may often be necessary 2-5 weeks after treatment just to make sure the lesion have been completely cured. If not retreatment may be considered. Once the lesion have completely resolved Molluscum Contagiosum virus doesn’t remain in the body like other herpes virus. It can be completely cured. However, there is no permanent immunity to virus; so, one may get infected again upon contact to an infected person.

How can I prevent in near future

Abstinence from sex is the best way to prevent it from getting in near future. When u select your partner be careful in selecting. Good personal and genital hygiene is also very important in limiting the infection. Condoms may protect against several sexually transmitted diseases but it does not give total protection against MC or any other sexually transmitted infection.

Genital Warts in Pregnancy

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Genital warts in pregnancy is a common problem for every women. Genital warts can grow and flourish and become easily irritated during pregnancy due to increased vascularity and altered immunity. However, in most cases, they may resolve on their own after childbirth without any treatment.

It is obvious for every woman to worry about the consequences that genital warts might have on their baby or the birth. Good news is that, HPV does not affect a woman’s fertility or ability to carry a pregnancy to term. This means that HPV in pregnancy doesn’t affect your risk of miscarriage, premature delivery or other pregnancy related complications. If a pregnant woman wants the warts to be removed, it is her choice, but genital warts do not require any special treatments during pregnancy. However it is very important to inform your doctor about your genital warts so your doctor can monitor them for any changes that could affect the birth process.

It is estimated that the risk of transmission of the virus to the baby is very low. Cesarean delivery is not always necessary in case of genital warts (only in few cases where warts grows abruptly and block the vaginal passage). In extreme rare cases of vaginal delivery a baby can develop warts in the throat called as respiratory papillomatosis which can be treated with laser surgery. Most babies coming in contact with HPV during pregnancy or birth are usually able to overcome the virus. Your baby may initially show the presence of HPV, but this often disappears within a year.

genital warts in pregnancy
genital warts in pregnancy

Today genital warts is very prevalent among all population and races. It is estimated that 75-80% of sexually active population may acquire HPV sometime during their life. Most of the people are unaware or will never know they have virus as these individuals do not show any signs and symptoms. It’s our immune system that keeps the virus under control or destroys it. HPV may only show-up when your body immune system is low. As in case of a pregnant woman, immune system is already somewhat compromised as her body needs to provide immune for another life in addition to hers.

Final notes, HPV often get worse during pregnancy as your immune system is suppressed in pregnancy. However there is no any documented research claiming HPV specific complications during pregnancy. Few complications that people talk about may usually be due to other associated diseases that go undiagnosed. Also, the risk of transmission from mother to child is very low. Just make sure you do a regular follow-up with your doctor and let him know any changes in your condition. As far as treatment is concern, some doctors recommends treating it during pregnancy, while others suggest waiting till delivery as in many cases they go away after child birth.

HIV Early Signs and Symptoms

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Skin rash can provide the first suspicion of early HIV infection in most individuals. When HIV early signs (mostly cutaneous) are correlated with systemic symptoms HIV infection can be suspected and diagnosed early. Although there is no cure for HIV, it can be managed effectively with antiretroviral (ARV) drugs and prevent complications and opportunists infection so one can live a normal life.

Signs and symptoms of HIV can occur as early as 5 days to 30 days following exposure to HIV, most commonly within 3-4 weeks. Early symptoms may be mild, asymptomatic or severe which might need hospitalization. It is estimated that around 60-70 percent of individuals recently infected with HIV may experience early symptoms and signs. These symptoms and signs can be divided into systemic and cutaneous which are discussed below.

Early Systemic Symptoms of HIV Infection

More than 80-90 percent of individuals may experience fever, lethargy and malaise. About 50-70 percent may experience muscular pain and joint pain; night sweat may be associated in around 50 percent of the patients, weight loss may be seen in about 25 percent of the patients, and other symptoms like headache, nausea vomiting, diarrhea etc, may be seen in around 30-60 percent of the patients. Few patients may also present with swollen lymph nodes. Below are the lists of early symptoms of HIV (Systemic).

Early Symptoms of HIV Infection

  • Swollen cervical, axillary and inguinal lymph nodes
  • Fever, Fatigue, muscular pain and joint pain
  • Vomiting, abdominal pain and diarrhea
  • Anorexia, weight loss and depression
  • Cough, pharyngitis and tonsillitis
  • Nausea, dizziness, headache
  • Sore eyes, photophobia
  • Oral candidosis
  • Night sweats
Mucocutaneous Signs and Symptoms of HIV Infection

Skin rash is seen in around 50-60 percent of the patients following HIV infection and usually appears 2-3 days after onset of fever. These infectious exanthema consists of pink macules and perifollicular papules that may erupt on face, palms and soles, but can occur on any parts of the body. These skin rashes may last a week and resolves. In few cases urticarial or vesicular lesions and alopecia may be present. Painful ulcers in mouth and ano-genital areas may be present.

Early Dermatological manifestations of HIV
  • Urticaria
  • Exanthema
  • Enanthema
  • Oral ulceration
  • Genital ulceration
  • Toxic erythema
  • Erythema multiforme
  • Oropharyngeal candidosis
  • Acute genitocrural intertrigo

The early symptoms and signs of patient infected with HIV may last from 1 week to 6 weeks or more. It is suggested that individual with early symptoms and signs that lasts more than 2 weeks may be associated with higher risk of developing AIDS within 3 years after initial symptoms than those with no early symptoms or that resolved within a week or two.

Herpetic Whitlow: Herpes on Hands

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People are aware about the herpes that commonly develops around mouth (herpes labialis) and genital areas (genital herpes). But the same virus can also affect fingers and toes. We call it herpetic whitlow; also called as finger herpes, hand herpes or digital herpes simplex. Herpetic whitlow is very painful viral infection of finger or toes caused by herpes simplex virus (HSV), the same virus that causes cold sores (herpes labialis) and genital herpes..

It is estimated that about 60 percent of the cases of hand herpes is caused by herpes simplex type 1, while the rest 40 percent is caused by herpes simplex type 2. One gets herpetic whitlow when he/she comes into direct contact with the herpes virus either from the same person having oral or genital herpes or through another person. Herpes virus enters the body through break in the skin (usually torn cuticle at the base of finger nails or any cuts).

Herpetic whitlow is commonly seen in children and dental health workers where they commonly come in oral contact (thumb sucking in children and oral or other contact for dentists and health workers). So, children and healthcare workers usually gets infected with herpes simplex type 1 (HSV-1) and in the rest HSV-2 may be quite common, possibly due to self-infection or during sexual foreplay or so.

Symptoms and Signs of Herpetic Whitlow

Symptoms may start to develop around 2 days to 3 weeks after exposure with the virus. Some patients may initially present with fever or malaise before the lesion appears. Initially there may be tingling, burning and pain before the blisters appear. Over next few days blisters (vesicles) start to appear commonly on thumb and index finger and may be associated with intense pain and swelling of finger. In case of recurrent herpes on hands similar lesion may appear on the same site.

Initially, one may notice clusters of clear grouped vesicles on bright red base. Although vesicles have usually clear fluid inside them, they may sometimes become cloudy and hemorrhagic and may ulcerate later. Few days’ later blisters start to crust and scab over and heal over a week or two. Swelling of axillary lymph node of the affected hand may be observed in some patients. Most of the patients may have pre-existing oral herpes or genital herpes lesion.

Other Condition to Consider

Pain and swelling of the finger doesn’t always mean herpes. There are several other common causes that can frequently cause painful swelling and infection of the fingers and nails that may sometimes be confused with herpetic whitlow. Most common condition are:

  • Cellulitis
  • Felon
  • Paronychia
How is Herpetic Whitlow diagnosed?

Your doctor will diagnose finger herpes clinically based on the characteristic lesion appearing the finger. Usually no other tests are required. In case of children, it is often associated with gingivostomatitis. Findings of oral or genital herpes in adults can confirm the case. If there is still confusion in diagnosis, your doctor may suggest few lab tests. Diagnostic test for herpes includes viral culture, Tzanck test, serum antibody titers, DNA hybridization or fluorescent antibody testing.

Treatment of Herpetic Whitlow

There is no cure for herpes virus but can be treated effectively and avoid recurrent and complications. Herpetic whitlow is self-limited disease so, treatments modalities are targeted to reduce the symptoms and to shorten the course of disease.

In case of primary infection, it has been suggested that topical 5% acyclovir can shorten the duration and course of the disease. Oral acyclovir, when given early can shorten the course of the disease. Other antivirals like famciclovir or valacyclovir has also been suggested to shorten the clinical manifestations of acute occurrence. If there is secondary bacterial infection oral or topical antibiotics may also be needed.

References:
Fitzpatrick’s Dermatology in General Medicine: 7th Edition
emedicine.medscape.com

Common Causes of Bumps on Penis

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There are several reasons one can develop papules or bumps on penis. It may be either due to non-infectious cause like pearly penile papules and Fordyce spots or may be due to sexually transmitted disease like genital warts. It is obvious to fear when someone gets bumps on penis or anywhere around genital areas but not every bumps are sexually transmitted, in fact most of the bumps around penis are harmless. Being said that, it is always wise to visit the doctor and confirm the case rather than trying to diagnose your-self just by looking picture on internet.

Molluscum Contagiosum

Molluscum contagiosum are small dome-shaped and painless pearly flesh-colored bumps with central depression. MC can occur in penis, scrotum, inner thigh or any other parts of the body. Early lesion may be confused with genital warts or herpes but unlike herpes they are painless and have distinguishing features like pearly bumps with central depression. Molluscum Contagiosum is harmless and is usually self-limited which gradually resolves over several months.

Pearly Penile Papules

Pearly penile papules, also called as hirsuties papillaris genitalis or hirsuties coronae glandis are small dome-shaped, skin-colored bumps seen on sulcus or corona of the glans penis. These papules are arranged in one or several rows around the base of the head of the penis. They are commonly seen in men with uncircumcised penis. They are usually asymptomatic and may persist throughout the life. No treatment is necessary for pearly penile papules except for cosmetic purpose.

Fordyce Spots

Fordyce spots are extremely common skin lesion occurring in around 80% to 95% of the total population. Fordyce spots can be commonly seen on glans penis, shaft of penis and scrotum and are usually multiple small, pinhead, painless, yellowish or whitish focally grouped macules or papules. Fordyce spots are non-infectious and totally harmless so, no treatment is required.

Genital warts or Condyloma Acuminata

Genital warts are pink to skin-colored bumps commonly seen on perianal areas, shaft of penis and scrotum. They are very common viral infection caused by human papillomavirus (HPV) which are acquired through sexual contact. Some people may never develop signs and symptoms but most develop lesion within 1-3 months of sexual contact with the partner. However, for some individuals it may take several months to years for warts to be clinically apparent. Genital warts initially starts with small, smooth or rough, flesh-colored bump and gradually increase in number and size which may be arrange in a groups resembling cauliflower appearance. Sometimes giant cauliflower like appearance may be seen on glans penis, foreskin and perianal areas which is termed as giant condyloma acuminata. Some papers suggest that they may represent a malignant transformation, verrucous carcinoma (VC).

Lichen Nitidus

Lichen Nitidus appear as small tiny clusters of red, brown violet or skin-colored shiny bumps with flat-topped. They are relatively uncommon and may appear on genitals. Although most of the lesions are asymptomatic, some may complain of mild itching. The cause of lichen Nitidus is unclear. Lichen Nitidus is harmless and no treatment is required.

Angiokeratomas

Angiokeratoma are harmless lesion commonly seen on scrotum, shaft of penis and glans penis in men. They appear as tiny black, blue, or dark red dome-shaped bumps with scaly surface. Although most of the cases are asymptomatic few may be associated with pain and itching. In young individuals the lesion tend to be smaller red and less scaly, while larger, dark blue or black with more scales in old individuals. Although angiokeratoma of the scrotum is often considered as harmless condition, it has the potential to cause considerable worry and distress to patients.

Bowenoid papulosis

Bowenoid papulosis usually occurs in young sexually active individuals. Bowenoid papulosis appear as single or multiple, small red, brown to flesh-colored bumps with flat or rough surface. Lesion occurs most commonly on shaft of penis, although it can occur anywhere around ano-genital areas. They are caused by human papillomavirus (the virus that causes genital warts) and are sexually transmitted and shares clinical similarities with genital warts. They are most commonly caused by HPV 16. Bowenoid papulosis is considered to be transitional state between genital warts and Bowen disease and has potential to be malignant.

Scrotal Calcinosis

Scrotal calcinosis is an uncommon harmless condition characterized by slowly growing multiple, painless, hard scrotal papules or nodules that occur in the presence of normal calcium and phosphate metabolism.

Penile syringoma

Syringoma that are localized on penis are thought to be rare dermatological condition. Only few cases of syringoma of the penis are documented in English literature. Clinically, syringoma on the penis appear as small asymptomatic yellow-brown or skin-colored bumps that may be localized on back or lateral surface of shaft of penis. Syringoma are harmless lesion and no treatment is required.

Penile Milia

Although not quite common, milia on penis can be occasional findings in men. These are again harmless and can be treated simply by unroofing the with a tip of a needle and extracting the contents. This is often quick and painless procedure.

There are several other disease and condition that can develop on scrotum or penis some of which are listed below. Please be warned that several other disease can also develop on genital areas that has not been discussed in this articles. To know more about skin colored, pigmented or red bumps on penis please refer to another article here

  • Seborrheic keratosis
  • Penile epidermoid cysts
  • Lichen planus
  • Lichen nitidus
  • Secondary syphilis
  • Epidermoid cyst
  • Neurofibroma
  • Leiomyoma
  • Mucinous syringometaplasia
  • Acrochordons (skin tags)
  • Melanocytic nevus
  • Scabies
  • Venous varicosities
  • Granuloma annulare
  • Nevus comedonicus
  • xanthogranuloma
  • Pseudo-Kaposi sarcoma
  • Carcinoma erysipeloids
  • Leprosy
  • Amyloidosis
  • Lipoid proteinosis
  • Tuberculide
  • Insect bite and tick bite
  • Primary lymphogranuloma venereum
  • Primary granuloma inguinale

Herpes Zoster Ophthalmicus: A Review

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Herpes zoster is caused by reactivation of varicella zoster virus. When primary infection by varicella during childhood (chickenpox) is resolved, the virus particles remain as a dormant in the dorsal root or other sensory ganglion for many decades. The virus then reactivates as a result of aging, excessive stress, immunosuppressive illness, or other medical treatment that suppress the immunity. This reactivation of latent varicella zoster causes herpes zoster.

Herpes zoster ophthalmicus (HZO) involves the ophthalmic branch, which is the first division of the trigeminal nerve. According to several studies ophthalmic division of the trigeminal nerve are involved in about 10-25% of reported cases of herpes zoster cases. Zoster ophthalmicus is estimated to occur approximately in 10% of zoster patients under the age of 10 years and about 30% of patients aged 80-year-old and older. Thus patients older than 50 years of age are frequently at increased risk of that HZO [1]. The rash of ophthalmic zoster may extend from the level of the eye to the vertex of the skull and does not cross the midline of the forehead.

Signs and Symptoms of Herpes zoster ophthalmicus

Influenza-like illness with malaise and low-grade fever are common at the start of HZO that lasts up to 5 days before the appearance of rash on the forehead, eyelids and periorbital region. Subsequently, erythematous macules appear along the involved dermatome, rapidly progressing to papules and vesicles containing clear serous fluid and pustules over several days. Then finally these lesions rupture and get crusted. The eye very rarely gets involved when the maxillary branch of nerve is involved. Involvement of the nasociliary branch of the ophthalmic nerve which is evidenced by a zosteric rash on the tip and side of the nose (Hutchinson’s sign) is seen in about one-third of patients HZO and is usually accompanied by ocular symptoms. Thus, when ophthalmic zoster affects the side and the tip of the nose, careful attention must be given to the condition of the eye and immediate ophthalmologic consultation is necessary in order to prevent complications of the eye and central nerve system Zoster Infection.

Herpes Zoster Ophthalmicus
Herpes Zoster Ophthalmicus

The reactivated VZV travels down the ophthalmic nerve ganglion resulting in HZO. It takes about 3-4 days for the virus to reach the nerve ending. Nasociliary branch innervates both the tip and the homolateral side of the nose as well as the cornea so most serious ocular involvement will develop if this branch is affected. Hutchinson’s sign is classical sign representing the involvement of ocular structures. VZV-DNA was detected in conjunctival swabs of some cases of acute ophthalmic zoster disease [2]. All the patients who develop herpes zoster adjacent to eye do not develop ocular involvement, but in those that do, there can be a wide variety of manifestations.

Acute Stage of Ocular Involvement

Besides pain and rash in the affected ophthalmic dermatome other acute stage ocular involvement includes swelling and reddening of eye, ptosis with some even developing blepharitis and vesicular lesions which mostly resolves with scarring. Conjunctivitis is also common finding usually presents with the appearance of rash and resolves within 1 week. Episcleritis and scleritis are also not uncommon and involvement of cornea occurs if the condition lasts more than 1 week. Keratitis is another common presentation which occurs in various forms e.g. nummular keratitis and disciform keratitis and is detected about 10–21 days after onset of rash. There is also a stromal haze surrounding the lesions. Anterior uveitis which is also quite frequently seen develops 2 weeks after the onset of rash, can result in iris atrophy due to sever inflammation of rash. Also endothelial dysfunction of the cornea may occur leading to edema with central vision loss [3].

Chronic Stage of Ocular Involvement

Chronic involvement of sclera and cornea is much more common than the acute clinical findings. Stromal keratitis which may develops after 3-4 months of initial onset of disease is characterized by infiltrates of differing degree and is usually localized in the center of cornea. Keratitis may finally result in neurotrophic keratopathy. Corneal thinning with bullous keratopathy and corneal perforation may also lead to vision loss.

Acute retinal necrosis syndrome (ARN) and progressive outer retinal necrosis syndrome (PORN) are almost very rare findings in young patients. ARN and PORN are characterized by pain and blurred vision in one or both eyes (30% bilateral involvement). Clinically the fundus of ARN shows whitening and peripheral patches with occlusive vasculitis and vitreous inflammation. In case of PORN, vitreous cells are absent as immunocompromised individuals are not able to produce an inflammatory response. In such cases even early course of antiviral therapy may not work and may lead retinal detachment in about 70% of the cases.

Recent study has reported several ocular manifestations of HZO. Pain was the most presenting symptoms in all individuals. Eyelid and ocular adnexal involvement is most commonly seen in patients with herpes zoster ophthalmicus followed by conjunctivitis, corneal complication, uveitis and PHN. As HZO may cause visual loss, regular ophthalmic examination is very important.

Treatment of Herpes Zoster Ophthalmicus

Beside, commonly used antivirals agents for herpes zoster like acyclovir, Famciclovir, valacyclovir, and brivudin, immediate use of a single intravitreal injection of foscarnet is usually recommended to further stop viral replication and progression to retinitis especially in case of ARN or PORN [4]. Systemic steroids are generally recommended for immunocompetent patients and those over 60 years of age but are strictly contraindicated in immunocompromised individuals at any age. Oral antiviral agents when given early have better prognosis and in management to PHN. Study shows that, Brivudin [5] had an 11% lower PHN rate than acyclovir and was as seen as effective as famciclovir to reduce zoster associated pain. In case of resistance to common antivirals agents, intravenous foscarnet, 40 mg/ kg body weight 3 times a day or 50 mg/ kg body weight twice a day is recommended. Treatment with cidofovir is recommended in case of resistance with intravenous foscarnet. These two antiviral agents should only be given in special cases when required as they have severe side effects like nephrotoxicity, ocular hypotony etc.

References:
[1] Hardening SP, Lipton JR, Wells JCD: Natural history of herpes zoster ophthalmicus: predictors of postherpetic neuralgia and ocular involvement. Br J Ophthalmol 1987:353–358.
[2] Zaal MJW, Völker-Dieben HJ, Wienesen M, DÀmaro J, Kijlstra A: Longitudinal analysis of aricella-zoster virus DNA on the ocular surface associated with herpes zoster ophthalmicus. Am J Ophthalmol 2001:25–29.
[3] Zaal MJW, Völker-Dieben HJ, DÁmaro J: Visual prognosis in immunocompetent patients with herpes zoster ophthalmicus. Acta Ophthalmol Scand 2003:216–220.
[4] Gümbel H, Ohrloff C: Opportunistic infections of the eye in immunocompromised patients. Ophthalmologica 1997:53–61.
[5] Vij O, Bornfeld N, Roggendorf M, Fiedler M, Schilling H: Brivudin as an alternative systemic therapy to acyclovir and ganciclovir in acute retinal necrosis syndrome due to varicella zoster virus. Klin Monatsbl Augenheilkd 200:710–715.

Herpes Zoster Oticus

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Herpes zoster oticus usually accounts for 1% of all the zoster infection and manifests as cutaneous vesicular eruption of the internal or external canal and pinna and is characterized by severe ear pain, a rash around the ear and usually associated with facial paralysis so called Ramsay Hunt Syndrome which was coined after the neurologist James Ramsay Hunt who had described the disease in 1907. He suggested that the disease resulted from a geniculate ganglionitis after reactivation of surviving viruses (VZV), a theory that recently proved true for many cases examined. Ramsay Hunt syndrome is considered as a rare complication of the varicella zoster virus and is characterized by peripheral facial palsy resulting from facial and auditory nerves injury during VZV infection. In addition, Ramsay Hunt syndrome may be also be associated with cranial nerves V, VI, IX, X and XII [1]

Facial palsy as a most important clinical symptom may be related to a necrotizing inflammation of the ganglion. However, sometimes it may occur without the involvement of ganglion or may be due to neuritis or perineuritis of nerve itself. Histological studies in temporal bones of decedents within the course of the disease revealed various perineural, perivascular or intraneural infiltration with different degrees of tissue destruction. Secondary effects like swelling by edema and/or hemorrhage may cause compression of the nerve within its bony canal. In those areas blood circulation may severely be impaired, leading to additional damage. Hearing loss, vertigo and tinnitus which are often seen is caused by inflammation of the inner ear structures.

Generally, herpes zoster oticus is considered as a disease of elderly and immunocompromised individuals. However, it may also be seen in young adults during stressful condition.[2] Even in children with acute peripheral facial paralysis, varicella zoster virus reactivation is considered an important factor [3]. Surgical manipulation is sometimes considered as a cause of outbreak of the disease. The disease is often unilateral and bilateral involvement is very rare but may be seen in immunocompromised individuals.

Although clinical course may vary from individual to individuals, general a prodromal period with fatigue and other sickness-like symptoms (approximately 7–14 days) is followed by a phase of erupting herpetiform lesions. Erythematous maculopapular lesions around or on the auricle (most often in the concha or the superficial part of the outer ear canal) soon vesiculate and sometimes turn to ulcers. Vesicles in the buccal mucosa of the corresponding sides or oropharynx can also be seen in rare cases. There may be slightly increase in body temperature and moderate to severe pain in the ear and surrounding which may persist even after the resolution of the lesions. Lesions usually turn dry and crust out after 1 week. Regional lymphadenopathy may be common findings. In about 8% to 10% of the patients zoster oticus may occur without the classical zoster rash also known as zoster sine herpete. [4]

Herpes zoster oticus accounts for about 10% all the facial palsy. Facial nerve involvement is seen in about 70% of the zoster oticus patients. Facial palsy is usually seen after the eruption of rash, proceeding from mild facial weakness to complete unilateral paralysis. If untreated the prognosis is very poor and chances of recovery is 70% in partial paralysis and only 10% in complete paralysis.[5]

References:
1. Sun WL, Yan JL, Chen LL: Ramsay Hunt syndrome with unilateral polyneuropathy involving cranial nerves V, VII, VIII, and XII in a diabetic patient. Quintessence Int. 2011 Nov-Dec;42(10):873-7.
2. Meister W, Neiss A, Gross D, Doerr HW, Höbel W, Malin JP, von Essen J, Reimann BY, Witke C, Wutzler P: Demography, symptomatology and course of disease in ambulatory zoster patients. Intervirology 1998;41:272–277.
3. Furuta Y, Ohtani F, Aizawa H, Kukuda S, Kawabata H, Bergstrom T: Varicella-zoster virus reactivation is an important cause of acute peripheral facial paralysis in children. Pediatr Inf Dis J 2005;24:97–101.
4. Rudra T: Zoster sine herpete. Br J Clin Pract 1990;44:284
5. 21 Devriese PP, Moesker WH: The natural history of facial paralysis in herpes zoster. Clin Otolaryngol 1988;13:289–298.

Fifth Disease in Children

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Fifth disease also known as Erythema infectiosum and slapped cheek is common in children especially during late winter or early spring. Fifth disease is usually not a serious condition and often requires no treatment.

What Causes Fifth Disease?

5th disease is a viral infection caused by human Parvovirus B19. The disease is spread by exposure to airborne droplets from the nose and throat of infected person. Once the person is infected he receives lifelong immunity so it won’t recur again.

Symptoms of Fifth disease

One or two weeks after your child has been exposed to the virus, some children will experience non-specific symptoms such as low grade fever, headache and tiredness. Approximately 2 days after the symptoms red rash appears on the cheeks which may look like slapped face. The rash may suddenly develop without any symptoms. Areas like nasal, perioral and periorbital are spared. This rash usually fades over 2-4 days.

After the facial rash fades over 2-4 days, pink, red rash start to appear on the trunk, neck and extensor surface of hands and legs. Sometimes, palms and soles may also be involved. These rashes have central fading giving lacy appearance. These rashes tend to fade and reappear in time. Rash may reappear due to exposure to sunlight, heat or temperature change, fever, exercise, bathing and emotional stress. Sometimes the rash may be itchy. In this stage children may have sign of illness or asymptomatic. It is estimated that around 10% of children with fifth disease will develop joint pain. Large joints are usually affected.

How is fifth disease diagnosed?

Your doctor will diagnose the fifth disease based on the clinical presentation alone; other investigations are usually not required.

Fifth Disease Treatment

There is no specific treatment for fifth disease. As fifth disease in self-limiting harmless condition, no treatment is generally required. Treatment approach is based on preventing the complications and symptomatic relief. Supportive therapy for pain and itching can be gained by using oral analgesics and antihistamines or topical anti-itch lotions.

Are there any complications in children?
Generally there are no complications in normal healthy children.

Prevention
Avoid your child from excessive sunlight exposure, heat and other external factors that might cause rash fare-ups.

Vaccine for fifth disease
Currently, there is no effective vaccine to prevent fifth disease. Clinical trial of a parvovirus B19 vaccine was terminated due to unexplained cutaneous events [1].

References:

1.Bernstein DI, El Sahly HM, Keitel WA, Wolff M, Simone G, Segawa C, Wong S, Shelly D, Young NS, Dempsey W. Vaccine. 2011 Oct 6;29(43):7357-63. Epub 2011 Jul 30

Distinguishing Cold Sores and Canker Sores

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Cold sores and canker sores share some physical characteristics so many of you might be confused resulting you to use inappropriate treatments or remedies which may reflect on its outcome. So it is necessary to differentiate between these two conditions. In this article we have tried to summarize some features of each so you can distinguish between these two conditions.

Distinguishing Cold Sores and Canker Sores

Location: Cold sores are primarily located outside the mouth (may also be seen inside mouth in immuno-compromised people), while canker sores are usually located inside the mouth, usually inner lining of the cheeks, tongue, lips and the base of the gums.

Frequency: Cold sores occur as multiple blisters, while canker sores may occur as a single or in small groups. Both have tendency to recur.

Appearance: Cold sores have fluid filled blisters surrounded by a red halo, while canker sore have large sallow round ulcer without blistering and surrounded by erythematosus halos.

Halitosis: Cold sores are associated with bad breath, while canker sores are not usually associated with bad breath (in case of canker sores due to bacterial or fungal infection, bad breath may be present).

Fever: Cold sores may be associated with fever, while canker sores are not generally associated with fever until it’s due to some systemic infection.

Association: Cold sores may be associated with swollen neck glands, while canker sores are generally not associated with swollen neck glands.

Note: The symptoms like fever and swollen glands are less likely to present in every individuals. However absence of these symptoms doesn’t exclude the disease.

Contagious: Cold sores are exclusively caused by herpes simplex virus type-1 and 2 and are highly contagious, while canker sore may be caused by either bacterial or may be due to the result of underlying hematological abnormalities or gastrointestinal disorders. Canker sores are not contagious.

Pain: In both of the cases of cold sores and canker sore, lesions may be painful.

Here are few home remedies for cold sores and canker sores

Home Remedies for Cold Sores


Home Remedies for Canker Sores

Home Remedies for Cold Sores

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Cold sores, also called as fever blisters are small painful fluid-filled blisters that appear most frequently on the lips mouth or inside the nose. In rare circumstances like in case of immuno-compromised patients they may also occur inside the mouth. Cold sores are not same as canker sores.

What causes cold sores?
Cold sores are caused by herpes simplex virus (HSV). Two types of herpes simplex virus causes cold sores namely HSV-1 and HSV-2. Although in most cases HSV-1 is responsible for cold sore and HSV-2 is responsible for genital herpes, they may both cause cold sore on the lips or mouth.

Once herpes simplex attacks you there is no cure, it stays in your body throughout your life. But the good thing is that after primary infection herpes simplex stays inactive without causing any symptoms or any serious complications and you may live a normal healthy life. It may later reactivate to certain triggering factors like excessive stress or other factors that decrease your immune system. If you are struggling with recurrent herpes and looking for some cold sore home remedies, here we go:

Some home remedies for cold sores

  • Do not pick, pinch, squeeze or bite the blisters.
  • Avoid licking the lips area.
  • Avoid acidic foods or other salty foods if they irritate your skin.
  • Rinse your mouth with available mouthwash or mix one teaspoonful of salt in 500 ml water and rinse, it will help soother cold sore and reduce irritation.
  • If you see yellow pus around the cold sore, it may be due to bacterial infection. Coat the lesion with some antibacterial ointment. If infection persists see your doctor.
  • Wash the lesion area gently with mild soap free liquid cleansers and pat dry with paper towel, but remember to keep the lesion moist afterwards to prevent further drying and fissuring.
  • Avoid sharing day to day applications like razors, toothbrush, and towels.
  • Clean your hands after touching the lesion. Try not to touch your eyes or genitals before washing the hands.
  • Don’t apply reusable applications like lip balms, lipsticks etc directly to the cold sore lesion. Apply with hands or cotton swabs and wash hands after application.
  • If you have pain you may take some analgesics to relive the pain. Do not take analgesics like aspirin or ibuprofen if you have peptic ulcers, gastritis. Aspirin is contraindicated in blood disorder and child below 12 years.
  • Over the counter topical medications like topical analgesics and skin protectants are available which will soothe the skin and relief pain. Apply the products directly to the lesion; do not spread to adjacent skin or non involved areas.
  • If you have difficulty in eating due to cold sores apply above mentioned products before eating. This will ease the pain and facilitate eating.
  • As cold sore are very contagious. Strictly avoid contact with other person during the blister formation periods. If you practice oral sex avoid it during this period.
  • Avoid excessive sunlight to your lips. Always apply broad spectrum sunscreen on your lips and over the area of your face where cold sore develops. Ultra violet radiation also is thought as one of the aggravating factor for cold sore.
  • Cold sore may persist for 10-14 days there is no cure for it, all available topical or medications will not help cure lesion but may shorten the duration of lesion if used early.
  • It is estimated that almost 80%-90% of the world population will have cold core at any time during their lifetime. Remember, herpes virus can be transmitted to another person even when a person is asymptomatic and no blisters are present.
  • If you have diabetes or recurrent herpes infection, above mentioned home remedies for cold sore treatment may not work for you all the time, you may need oral prescription drugs. Talk to your dermatologist for prescription products.
  • Avoid stress and other factors that you think has link to your recurrent cold sores.

References:
1.Paterson J, Kwong M: Recurrent herpes labialis. Assessment and non-prescription treatment. GlaxoSmithKline Continuing Education in Pharmacy CCCEP#268-0405 1-21, 2005