Most cases of oral herpes (cold sores) are caused by HSV-1.

There is no cure for HSV infection.

HSV is generally transmitted by direct contact of lips or genitals when the sores are present, or just before they appear (known as shedding).

Symptoms

1. Prodromal symptoms
2. Skin appears irritated
3. Sore or cluster of fluid-filled blisters appear
4. Lesion begins to heal, usually without scarring

It is estimated that 50% of adults in the UK are carriers of the Herpes Simplex Virus, many of which will never exibit any symptoms of infection. It is also possible for the virus to be transmitted across the skin in the absence of a coldsore. Oral herpes lesions typically occur on the lips, but can occur almost anywhere on the face. They can also occur on the fixed mucosa inside the mouth, including the hard palate (roof of the mouth), and gingiva (gums). Oral herpes and cold sores can sometimes be confused with canker sores. Only a medical physician can provide adequate diagnosis.

Outbreak Triggers

Physical or psychological stress can trigger an outbreak. Local injury to the face, lips, eyes or mouth, as through trauma, surgery, or sunburns are well established triggers of recurrent orolabial herpes due to herpes simplex virus type 1 (HSV-1). Similarly, intercurrent infections, such as upper respiratory viral infections or other febrile diseases, can cause outbreaks, hence the historic terms “cold sore” and “fever blister”. Generalized psychological stress and anxiety are also triggers.

Symptoms

Herpes infections, whether initial or recurring, are usually first felt as a tingling and/or itching sensation in the affected location. These initial feelings are usually followed, depending on how severe the infection is, by the emergence of a raised or swollen area on the skin. This swollen area then becomes painful in general, but acutely sore when touched, stretched or moved. Eventually the sore area will abscess, and emit a virus laden clear fluid for several days before scabbing over. Once scabbed over the lesion will usually heal completely within a period of a week to ten days. In immuno-compromised individuals this cycle can be significantly protracted.

From the onset of infection/outbreak, many patients experience headaches, fatigue (sometimes extreme), and peculiar twitching sensations in the nerves that lead to the area of the outbreak. The fatigue associated with herpes infections can concatenate with depression brought on by the cosmetic or sexually compromising nature of the infection, to yield a deeply gloomy overall mental state that some believe can contribute to increasing the length and severity of an infection.

Transmission

Herpes is contracted through direct skin contact (not necessarily in the genital area) with an infected person, and less frequently by indirect contact (for instance, by sharing lip balm or a virus infested shared towel). The virus travels through tiny breaks in the skin (or mucous membranes in the mouth and genital areas), so, healthy skin and mucous membranes are normally an effective barrier to infection. However, in the case of mucous membranes, even microscopic abrasions are sufficient to expose the nerve endings into which the virus splices itself. This is why most herpes transmission happens in mucous membranes, or in areas of the body where mucous membranes and normal skin merge (e.g., the corners of the mouth).

Treatment

Currently, there is no cure for herpes. There is no treatment that can eradicate herpes virus from the body at reactivations of the virus. Non-prescription analgesics can reduce pain and fever during initial outbreaks.

Anti-viral medication: There are several prescription antiviral medications for controlling herpes outbreaks, including aciclovir (Zovirax), valaciclovir (Valtrex), famciclovir (Famvir), and penciclovir.

Source: http://www.medic8.com/healthguide/articles/coldsores.html

The term “cellulitis” is commonly used to indicate a nonnecrotizing inflammation of the dermis and hypodermis related to acute infection that does not involve the fascia or muscles, and that is characterized by localized pain, swelling, tenderness, erythema, and warmth.

Pathophysiology

Cellulitis usually follows a break in the skin, such as a fissure, cut, laceration, insect bite, or puncture wound. Facial cellulitis of odontogenic origin may also occur. Patients with toe web intertrigo and/or tinea pedis and those with lymphatic obstruction, venous insufficiency, pressure ulcers, and obesity are particularly vulnerable to recurrent episodes of cellulitis. Organisms on the skin and its appendages gain entrance to the dermis and multiply to cause cellulitis.

The vast majority of cases are caused by Streptococcus pyogenes or Staphylococcus aureus. Occasionally, cellulitis may be caused by the emergence of subjacent osteomyelitis. Cellulitis may rarely result from the metastatic seeding of an organism from a distant focus of infection, especially in immunocompromised individuals. This is particularly common in cellulitis due to Streptococcus pneumoniae and. Neisseria meningitidis, Pseudomonas aeruginosa, Brucella species, and Legionella species have also been reported as rare causes of cellulitis resulting from hematogenous spread.

Frequency

United States

Because cellulitis is not a reportable disease, the exact prevalence is uncertain; however, it is a relatively common infection. A 2006 study found an incidence rate of 24.6 cases per 1000 person-years. In a large epidemiological hospital-based study on skin, soft tissue, bone, and joint infections, 37.3% patients were identified as having cellulitis.

International

Cellulitis has been found to account for approximately 3% of emergency medical consultations at one United Kingdom district general hospital.

Mortality/Morbidity

Cellulitis generally is a localized infection. Most patients treated appropriately recover completely. Mortality is rare (5%) but may occur in neglected cases or when cellulitis is due to highly virulent organisms (eg, P aeruginosa). Factors associated with an increased risk of death are the presence of concurrent illness (eg, congestive heart failure, morbid obesity, hypoalbuminemia, renal insufficiency) or complications (eg, shock).

Race

No racial predilection has been noted.

Sex

No predilection for either sex is usually reported, although a higher incidence among males has been reported in some studies.

Age

No age predilection is usually described; however, studies found a higher incidence of cellulitis in general among individuals older than 45 years. Moreover, cellulitis at certain anatomic sites may show a predilection for persons in certain age groups.

• Facial cellulitis is more common in children younger than 3 years.
• Perianal cellulitis is predominantly a disease of children.

Clinical

History

The incubation period is somewhat organism dependent. Postoperative cellulitis at the surgical site due to group A beta-hemolytic streptococci may develop rather rapidly. On the other hand, cellulitis due to staphylococci usually is delayed in onset.

• Patients report local pain and swelling at the site of cellulitis.
• The patient may report a history of trauma to the site. Severe bacterial cellulitis may occur as a postsurgical complication, such as following hip replacement or liposuction, or secondary to lymphatic occlusion following either radical mastectomy or conservative breast surgery; impaired lymphatic drainage and edema are also considered predisposing factors to leg cellulitis following saphenous vein resection for coronary artery bypass. However, cellulitis may follow a trivial injury to the skin (eg, scratch, abrasion, animal bite, intravenous or subcutaneous drug injection, body piercing). Cellulitis has also rarely been reported as a possible postprocedural complication of radiation therapy.
• Fever is common, and chills may be noted, particularly if suppuration has occurred.
• Malaise may be present.

Physical

• Involved sites are red, hot, swollen, and tender.
• Unlike erysipelas, the borders are not elevated or sharply demarcated.
• Lymphangitis, regional lymphadenopathy, or both may be present.
• Malaise, chills, fever, and toxicity may occur.
• In severe cases, patients may develop hypotension.
• Local suppuration may follow if therapy is delayed.
• Overlying skin may develop areas of necrosis.
• The most commonly involved site is the leg.
• Perianal cellulitis due to group A streptococci is usually observed among children with perianal fissures. It is characterized by perianal erythema and pruritus, purulent secretions, painful defecation, and bleeding in the stools.
• Pneumococcal facial cellulitis occurs primarily in young children who are at risk for pneumococcal bacteremia. It may manifest as 2 distinctive clinical syndromes, as follow:
• Extremity involvement in individuals with diabetes mellitus or substance abuse
• Head, neck, and upper torso involvement in individuals with systemic lupus erythematosus, nephrotic syndrome, or hematologic disorders

Causes

• In immunocompetent adults, cellulitis is usually due to S pyogenes and, occasionally, S aureus. Isolation of methicillin-resistant S aureus (MRSA) is steadily increasing, especially among intravenous drug users, HIV infected patients, prisoners, athletes, military trainees, and male homosexuals. Bacterial strains may also show multiple resistance to other standard antibiotic treatments, including erythromycin.
• In children, the most common cause of cellulitis is S aureus. Other causes include S pyogenes (perianal cellulitis), Haemophilus influenzae, and S pneumoniae.
• Recurrent staphylococcal cellulitis may occur in patients with nasal carriage of staphylococci and those with Job Syndrome. S aureus is also the leading cause of soft tissue infections in persons who abuse injection drugs.
• Recurrent cellulitis due to streptococci may be observed in patients with chronic lymphedema (eg, from lymph node dissection, irradiation, Milroy disease, elephantiasis). Streptococcal infections are also common in injection drug users.
• Non–group A streptococci (ie, groups B, C, and G) are commonly implicated in cellulitis in patients with lymphatic obstruction or venectomy for coronary artery bypass graft.
• S pneumoniae is an uncommon cause of cellulitis in adults. Pneumococcal cellulitis may occur from bacteremia. In a review of pneumococcal skin infection in adults, all such patients had an underlying chronic illness or were immunocompromised by drug or alcohol abuse. Pneumococcal facial cellulitis occurs primarily in young children at risk for pneumococcal bacteremia.
• Patients who are immunocompromised with granulocytopenia, such as renal transplant recipients, may develop cellulitis due to infection with other organisms, including gram-negative bacilli (eg, Pseudomonas, Proteus, Serratia, Enterobacter, Citrobacter), anaerobes, other opportunistic pathogens (eg, Helicobacter cinaedi, Fusarium species), mycobacteria, and fungi (eg, Cryptococcus). Preseptal cellulitis caused by dermatophytes is rarely observed, mostly in the pediatric age group. Persistent cellulitis due to Cryptococcus neoformans infection has also been reported in a patient receiving renal dialysis.
• Escherichia coli may be responsible for cellulitis in patients with nephrotic syndrome.
• Cellulitis from unusual bacterial species, including Enterococcus faecalis, Enterobacteriaceae, and Bacteroides and Clostridium species, may be observed following subcutaneous injections of illegal drugs. If Clostridium species or other anaerobes (Bacteroides, Peptostreptococcus, Peptococcus, Prevotella) cause the infection, crepitant cellulitis is often observed clinically.
• Other uncommon causes of cellulitis include Neisseria meningitidis; Mycobacterium avium-intracellulare; Pasteurella multocida, following animal bites; Aeromonas hydrophilia, following contact with fresh water; Streptococcus iniae, a fish pathogen causing infections in aquaculture farms; and Chromobacterium violaceum and Vibrio vulnificus, following contact with seawater. Cellulitis from marine vibrios in hepatopathic patients may also follow ingestion of contaminated raw oysters. Acinetobacter baumannii is an emerging multidrug-resistant pathogen that causes hospital-acquired soft tissue infections, including cellulitis, following gunshot wounds or use of invasive devices. H influenzae has become a rare cause of buccal cellulitis in children after the introduction of the H influenzae type B vaccine

Source: http://emedicine.medscape.com/article/1053686-overview

Harlequin Ichthyosis is a very rare, incurable, genetic skin condition. In it, the skin grows far faster than normal. This condition is seen in individuals only when both parents carry the same defective gene. The chances of this are one in a million. However, the chance of these parents producing a harlequin child are 1 in 4.

In sufferers of Harlequin Ichthyosis, the whole body becomes completely encased in a very thickened, scaly suit of skin armor. The skin becomes very tight causing restriction of movement of the arms and legs and, particularly, the fingers and toes. The face is deformed, the eyelids are inverted, the ears are bound down, and the mouth is very tight. Restricted movement of the chest can lead to breathing difficulties and respiratory failure.

The skin normally forms a protective barrier between the body and its surrounding environment. The skin abnormalities associated with harlequin ichthyosis disrupt this barrier, making it more difficult for affected infants to control water loss, regulate their body temperature, and fight infections. Infants with harlequin ichthyosis often experience an excessive loss of fluids (dehydration) and develop life-threatening infections in the first few weeks of life. It used to be very rare for affected infants to survive the newborn period. However, with intensive medical support and improved treatment, people with this disorder now have a better chance of living into childhood and adolescence.

Treatment

Unfortunately, there no known cure for Harlequin Ichthyosis and treatment is largely supportive. This involves optimizing fluid, electrolyte, and nutritional repletion, aggressive use of emollients, and environmental measures to decrease transepidermal water loss. Treatment of harlequin babies can be done with a battery of medication ranging from oral retinoids to antiseptics and topical paraffin ointments to soften the skin. In general, harlequin fetuses do not survive for long. There have been improvements in care, most notably the drug Isotrex.

Sources:

http://ghr.nlm.nih.gov/condition=harlequinichthyosis

http://www.mymultiplesclerosis.co.uk/misc/harlequin.html

Dermatitis Herpetiformis is a rare and chronic skin disorder characterized by extremely itchy and almost intolerable rashes made of bumps and blisters that normally occur on the elbows, knees, shoulders, back, and buttocks. It is believed to be related to coeliac disease, a disorder of the small intestine. Dermatitis Herpetiformis is also referred to as Durhing’s disease.

The predominant symptoms of Dermatitis Herpetiformis include intense burning, stinging, and itching sensations in affected areas. Diagnosis is mainly through physical evidence and analysis of skin biopsies. The ailment most commonly affects young adults, particularly males, aged 20 and higher. Estimates suggest that the disease currently affects about 11.2 out of every 100,000 people in the United States and about 10 out of every 100,000 people internationally. The disease is more common in young males of European descent (particularly from Scandinavian countries) than those of other ethnic backgrounds.

The exact cause of Dermatitis Herpetiformis is unknown but it is believed to be related to an allergy to gluten, a protein found in wheat and other grains. When gluten combines with IgA (an antibody produced by the intestines), the combination enters the blood stream and begins circulating. This combination then causes small blood vessels in the skin to get clogged up, attracts while blood cells, and secretes chemicals which then cause rashes to form.

Treatment

The most effective means of treating Dermatitis Herpetiformis is with a drug called Dapsone. Dapsone can alleviate symptoms within days but it does have side effects like haemolytic anaemia, a blood disorder. Therefore, its usage should be monitored closely and it should only be taken under the supervision of a qualified physician. For those intolerant or allergic to Dapsone, topical and systemic steroids and Sulfapyridine are also available options. A gluten free diet is also highly recommended and this reduces dependence on Dapsone and the risk of developing other conditions.

This condition is characterized by itchy spots on the wrists, legs, genitals, mouth and lips. The spots are shiny red on the skin and grayish-white in the mouth. They may also develop around toenails or fingernails and may cause hair loss
if found on the scalp.

The cause of this recurrent skin condition is unknown but it is common in adults over 40 especially women. A virus is believed to be responsible for the disease and flare-ups may be triggered by stress or the use of certain drugs. As the itchy bumps disappear, they may leave dark spots on the skin.

“Most commonly lichen planus appears in mid-life. The initial attack may persist for weeks or months, and recurrences can continue over many years. Oral symptoms, consisting of a dryness and metallic taste or burning in the mouth, may appear first and be the only evidence of the disease,” according to Dr. David E. Larson, editor-in-chief of the Mayo Clinic Family Health Book.