Common Skin Infections

Other viral causes of vescicular rashes

• Coxsackie viruses can cause herpangina and hand, foot and mouth disease.

Herpangina is characterised by a painful eruption of vesicles in the mouth and throat, including the soft palate (unlike herpes simplex), fever and abdominal symptoms. It is commonest in children aged 2-10 years and is self limiting.

Hand, foot and mouth disease consists of an ulcerative exanthem of the buccal mucosa, mild fever followed by painful vesicular lesions on the hands or feet. It may spread within families and is also self limiting. Sometimes the lesions look more like a little paper cut on a base of erythema.

Vesicles on sole in Hand foot and mouth disease

• Parapoxviruses: can cause orf, a contagious pustular dermatitis contracted from sheep and goats, and paravaccinia (pseudocowpox, ring sores) which is contracted from cattle. Infection is localised and occurs via cuts and abrasions. Lesions start as erythematous papules and progress to a ‘target’ lesion 1-2 weeks after infection, appearing as a red centre surrounded by a white halo and an outer erythematous halo. The lesion then becomes nodular and then papillomatous, often with a weeping surface, and resolves over a period of weeks with crusting. Occasionally lesions become large and granulomatous, needing surgical removal. Vesicles are occasionally visible to the naked eye, but the lesion generally does not look classically vesicular. Most patients have a single lesion only, which is mildly painful. The patient is normally systemically well although lymphadenopathy and malaise may occur. Diagnosis is clinical, but samples of the lesion may be sent to the virology lab for detection of the virus using electron microscopy. Infection may spread between human contacts, so patients should be advised to avoid spreading the infection by contact with broken skin.

 Maculopapular rashes may arise following infection with any of the following:

•  Rubella
•  Parvovirus
•  Entero/Echovirus
•  Measles
•  EBV
•  CMV
•  Dengue