2 results
Chap. 12 - LIFE-THREATENING CUTANEOUS VIRAL DISEASES
-
- By Aron J. Gewirtzman, Albert Einstein College of Medicine, Brandon Christianson, University of Texas Southwestern Medical Center, Anne Marie Tremaine, University of California–Irvine School of Medicine, Brenda L. Pellicane, Wayne State University School of Medicine, Stephen Tyring, University of Texas Health Science Center
- Edited by Ronni Wolf, Batya B. Davidovici, Jennifer L. Parish, Lawrence Charles Parish
-
- Book:
- Emergency Dermatology
- Published online:
- 07 September 2011
- Print publication:
- 17 January 2011, pp 115-125
-
- Chapter
- Export citation
-
Summary
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.
Chap. 2 - CLEAN AND ASEPTIC TECHNIQUE AT THE BEDSIDE
-
- By Sapna Amin, Baylor College of Medicine, Aron J. Gewirtzman, Albert Einstein College of Medicine, Stephen Tyring, University of Texas Health Science Center
- Edited by Ronni Wolf, Batya B. Davidovici, Jennifer L. Parish, Lawrence Charles Parish
-
- Book:
- Emergency Dermatology
- Published online:
- 07 September 2011
- Print publication:
- 17 January 2011, pp 12-17
-
- Chapter
- Export citation
-
Summary
CUTANEOUS SURGICAL INTERVENTIONS are becoming more and more popular as this area of dermatology continues to rapidly expand. Dermatologists are performing progressively more surgical procedures in their private offices. A survey performed by the American Society of Dermatologic Surgery (ASDS) in 2003 revealed that 3.9 million procedures were performed that year by participating ASDS members. These outpatient procedures allow the dermatologist to provide more comprehensive care to the patient and present the patient with a more affordable option, because outpatient procedures under local anesthesia are less expensive than in the hospital setting.
With the upsurge in the number of cutaneous surgeries, an important goal remains to keep patients free of nosocomial and surgical site infections (SSIs). Traditionally, dermatologic procedures and surgeries have benefited from relatively low infection rates, despite varying infection-control practices. Strict adherence to aseptic technique is required to maintain this low rate of infectious complications. In addition to the principles of asepsis, the surgeon must also minimize patient and environmental risk factors, achieve adequate preoperative preparation, decide if antibiotic prophylaxis is necessary, as well as maintain proper surgical suite protocol and surgical technique.
SURGICAL SITE INFECTIONS
Postoperative infections after dermatologic procedures are rare. These surgeries are largely considered either “clean” or “clean-contaminated,” with infection rates of less than 5% and 5%–10%, respectively. Studies examining the rate of infectious complications following dermatologic procedures have indicated an even lower incidence in this field.