Medical Dermatology

Herpes Simplex

HSV Treatment | Shingles Treatment | Acne Rosacea Treatment Kentfield CA | San Francisco CA

Herpes Simiplex I (Cold Sore)

Herpes simplex virus (HSV) infections are also known as a “cold sores” or “fever blisters.”   They occur most often around mucous membranes, such as the lips or genitals, but they can occur anywhere on the body.  Herpes simplex is transmitted by touch, including kissing or sexual contact as well as by contact with infected material (such as a shared glass, silverware, or toilet seats).

Herpes simplex infections appear as red, grouped, watery blisters which crust up and are often painful or itchy.  An outbreak usually persists for 1-2 weeks and always recurs at the same site.   During the initial episode patients frequently feel ill and may have a fever.  Initial episodes usually take three weeks to heal.   Subsequent attacks are preceded by stinging or soreness at the site prior to the eruption. With the passage of time, the duration between outbreaks lengthens and the infection usually becomes milder.

Oral Herpes (HSV-I) is contagious up to a day before it appears and until the lesion has visibly resolved.  Genital Herpes (HSV-II) is contagious even if there are no signs or symptoms.  Therefore, it is possible to transmit the virus to a sexual partner without any sign of an outbreak.  It is estimated that 80% of Americans have been exposed to and carry the herpes simplex virus.

Treatments include oral and/or topical antiviral prescription medications. Topical antiviral medication is less effective and is now extremely expensive.  Oral antivirals taken at the onset of symptoms, before a visible lesion appears, lessen its intensity or may even avert a breakout.  Maintenance dosing is used when attacks are frequent to prevent and avoid spreading both oral and genital herpes.

Herpes Zoster

Herpes zoster, or shingles, is caused by the zoster/varicella virus.  The first exposure to the herpes zoster virus results in chickenpox, an itchy rash characterized by small blisters with surrounding redness beginning on the torso before spreading over the rest of the body. After the chickenpox rash resolves, the virus travels to the dorsal root ganglions (collections of nerve tissue at the base of the spine), where it remains until reactivation.

Later in life, typically when under stress, the virus may become reactivated.  It travels along a specific nerve and appears as a rash along a nerve root on one side of the body.   Shingles normally presents as a visible rash of red, grouped blisters that follow the course of a specific nerve.  It does not cross the midline.  It can be preceded or accompanied by pain.  The pain (resulting from injury to the nerve) can last months or longer, is often very severe, and is referred to as “post-herpetic neuralgia.”   Post-herpetic neuralgia is more prevalent in older patients. Chicken pox is disappearing in the younger population due to immunization early in life.

Prevention can be achieved with the Zostavax immunization, though it is not 100%.  However, if an immunized patient subsequently does get shingles, it is usually very mild.

Treatment of acute infections usually includes an oral anti-viral prescription medication with or without cortisone, topical medications, and pain treatment when necessary.  Injections of very low dose triamcinolone under the eruption speed healing and can diminish the severity of or resolve post-herpetic neuralgia.

Acne Rosacea

Acne rosacea is a common, chronic skin condition that affects both men and women. It usually presents in fair skinned adults after the age of 30. Typically, a person may have had parents or grandparents with the same symptoms. Rosacea often begins with intermittent flushing of the medial cheeks, nose, or chin. One or any combination of these areas may be involved.  Over time the initial intermittent flushing becomes a persistent redness with many small permanently dilated blood vessels known as telangiectasia. It can also progress to include full-blown acne with papules (small, red, solid bumps), pustules (white heads), and cysts.  More severe or advanced cases of acne rosacea can also cause thickening of the skin on the chin (gnatophyma) and/or nose (rhinophyma). Examples of individuals with rhinophyma are W.C. Fields and Jimmy Durante. The eyes may also be affected in up to one third of patients manifested by redness on the eyelids and white part of the eyes.

Since acne rosacea is a chronic skin condition, the symptoms may come and go and can vary in severity. The best treatment includes early diagnosis and maintenance of treatment in order to halt progression of the disease.

There are many options to treat and control acne rosacea. Rosacea can be treated with several topical medications. Some oral antibiotics such as doxycycline are also anti-inflammatory and decrease inflammation, reduce severity of the acne, minimize redness and may halt disease progression.  Isotretinoin can cure acne rosacea and even halt the progression of rhinophyma.  Mirvaso (brimonidine tartrate gel) applied every morning will markedly decrease redness. Lasers such as the VariLite™, V-beam™, and the Intense Pulse Light™, will reduce redness and dilated blood vessels. If the acne rosacea has progressed to thickened skin on the nose and chin, laser resurfacing can restore the skin’s appearance to normal.

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