VIRAL DISEASES frequently have cutaneous manifestations, most of which are self-limited and of little consequence; however, there are occasions when a viral cutaneous disease may be accompanied by systemic manifesttions that can be life threatening. In general, healthy children and adults are at little risk for these severe complications. Persons at highest risk for systemic involvement include patients who are immunosuppressed, as well as neonates, extremely elderly persons, and the undernourished population. Because many viruses have some form of cutaneous exanthem, almost any virus known to have systemic involvement can be considered a dermatological emergency. This chapter focuses mainly on those viruses in which the cutaneous findings would be likely to prompt dermatological investigation in an emergency situation.

HERPES SIMPLEX VIRUS

Presentation and Clinical Features

Herpes simplex virus (HSV) is not typically associated with life-threatening or emergency situations; rather, HSV is better known as an acute, self-limited infection that may recur in certain individuals. In rare instances, fatal and highly morbid complications can arise. Neonates and immunocompromised persons generally make up the vast majority of patients with these poor outcomes, but in extremely rare cases some immunocompetent patients suffer severe complications.

HSV can be divided into two subgroups (HSV-1 and HSV-2) based on molecular and immunologic characteristics. HSV-1 typically causes lesions in the oral mucosa and produces gingivostomatitis and pharyngitis in primary infections. Primary infections of HSV-2 most commonly cause genital lesions and produce acute vulvovaginitis and progenitalis.