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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_141_библиотеки_им_акад_М_И_Перельмана
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15 Herpes Simplex: Buttock Herpes and Buttock Herpes Simplex
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Figs. 15.7 and 15.8 Herpes simplex observed in the buttock area
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Figs. 15.9 and 15.10 Buttock herpes simplex
Fig. 15.11 Herpes simplex that occurred in the buttock area
Fig. 15.12 Herpes simplex that occurred in the thigh area
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15 Herpes Simplex: Buttock Herpes and Buttock Herpes Simplex
clovir, and famciclovir can be prescribed for more than a
year for the purpose of suppressing recurrence in cases where
recurrence occurs more than ve times a year. When administering antiviral drugs, the dosage and administration period
should be adjusted according to the patient’s immune status.
It was explained to Ms. P that unlike shingles, which usually
occurs once in a lifetime, herpes simplex recurs whenever
the condition is bad, and she left the clinic with a worried
face.
Exanthem Subitum, Roseola
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16
Our grandson had a fever of unknown cause for 3–4
days, and when the fever suddenly dropped, he had a lot
of red rashes on his body. Is it okay?
Mrs. M, a 60-year-old woman receiving laser treatment,
brought her 13-month-old grandson who had a high fever for
3–4 days and then suddenly had a rash on his body when the
fever dropped sharply. I told her, “It’s worrying if he keeps
having a fever and a rash, but if the fever drops and owers
bloom, it seems like you can relax!” and explained in detail
about this disease called exanthem subitum (roseola)
(Figs.16.1 and 16.2).
Exanthem subitum (also known as roseola infantum) is a
rash-causing disease in children caused by infection with
human herpesvirus 6 (HHV-6). It was rst described as a distinct disease in 1910 and named “exanthem subitum” in
1921. The virus is known to be transmitted through saliva.
The pathological mechanism of the skin rash is unclear. The
incubation period is about 5–15 days, and it is mainly seen in
spring and autumn. It rarely occurs in infants under 3 months
old and children over 4 years old, but it occurs frequently in
infants aged 6–15 months. The disease often starts suddenly
with a fever without cause, which can rise to 37.9–40 °C and
cause febrile convulsion. Diagnosis can be delayed because
no specic ndings can be found on examination. The throat
mucosa may be slightly reddened or there may be a runny
nose, but there are no specic symptoms. The lymph nodes
in the neck, back of the head, and behind the ears are often
enlarged. The child does not appear to be sick in proportion
to the degree of fever, and there are no physical ndings to
explain the severe fever. The high fever continues for 3–4
days, showing signs of relief in the morning, then suddenly
drops, and at the same time, a skin rash begins to appear. The
rash is rose-red, macular or maculopapular, similar to rubella
rash. It mainly appears on the trunk, neck, and behind the
ears and is less on the face and legs. The rash usually fades
quickly within 24 h, and it is rare for it to last more than 48
h. There is no skin discoloration or desquamation. Infections
Fig. 16.1 Exanthem subitum (roseola) rash observed on the torso
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_16
Fig. 16.2 Exanthem subitum is characterized by a rash that occurs
when a fever of unknown cause lasts for 3–4 days and then the fever
drops sharply
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Fig. 16.3 Exanthem subitum
16 Exanthem Subitum, Roseola
with HHV-7 occur in slightly older children, with less fever
and a shorter course, but it is difcult to distinguish clinically. Generally, the prognosis of roseola is very good, and
the rash usually disappears within 2–3 days. However, complications can occur in 10% of cases, with convulsion due to
high fever, and rarely encephalitis, meningitis, hemiplegia,
Guillain-Barré syndrome, anemia, granulopenia, thrombocytopenia, and liver dysfunction, which can lead to a poor
prognosis. Diagnosis is mostly based on clinical ndings, but
there is still no special method to easily diagnose roseola in
its early stages. The diagnosis can be made by combining the
appearance of a rash as the fever subsides, other symptoms
caused by this disease, the course of the disease, and proving
HHV-6 in mononuclear cells. It should be differentiated
from rubella, measles, scarlet fever, erythema infectiosum,
other viral infections with rash, and drug eruption (Figs.16.3,
16.4, 16.5, 16.6, 16.7, 16.8, 16.9, 16.10, and 16.11).
Figs. 16.4 and 16.5 Exanthem subitum
Figs. 16.6 and 16.7 Roseola lesions on the trunk
16 Exanthem Subitum, Roseola
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Figs. 16.8 and 16.9 Exanthem subitum
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Exanthem subitum heals naturally after about 6–7 days,
and there is no need for isolation. There is no way to shorten
the clinical course or prevent it, and there is no special treatment other than symptomatic treatment. Inform parents that
it is a viral disease and there is no need to take antibiotics. If
the baby has a fever and is irritable, administer a safe antipyretic to lower the fever and stabilize the baby. HHV-6
infection is generally in good condition despite the high
fever, but it can cause convulsions due to the high fever.
Therefore, sedatives can be administered to infants who are
prone to febrile convulsion when the fever starts to rise rapidly to prevent febrile convulsion. HHV-6 and HHV-7 do not
respond to acyclovir, and it has been mentioned that ganciclovir, foscarnet, cidofovir, brincidofovir, etc. can be considered to prevent fatal outcomes in case of complications or in
immunosuppressed patients. I reassured Mrs. M that in most
cases, the prognosis is good for the exanthem subitum where
the fever drops and owers bloom, so don’t worry. After
informing her of the precautions, she left the clinic with a
bright face.
Figs. 16.10 and 16.11 Exanthem subitum on the torso and legs
Nummular Eczema, Discoid Eczema
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17
I have round, coin-shaped eczema on my arms, legs,
hands, and feet. If I don’t get treatment, it gets worse,
and even if it gets better with treatment, it often recurs.
An 18-year-old male, K, has been suffering from round,
coin-shaped dermatitis on his arms, legs, hands, and feet for
some time. Even though it gets better with treatment, it often
recurs, and if he doesn’t get treatment, it persists for a long
time and gets worse, seriously affecting his quality of life.
This is one of the diseases that really distresses me as a doctor, considering the pain of the patients suffering from this
dermatitis (Figs.17.1 and 17.2).
Nummular eczema is a type of eczematous disease characterized by relatively clear round-shaped plaque lesions
accompanied by itching. Clinically, there are scattered papules and vesicles on the lesion site, and a small amount of
exudate and crust can be observed. It was rst named in 1857
and is also known as discoid eczema. The incidence is generally similar in men and women, or it is reported to be more
common in men than in women. The age of onset peaks
between the ages of 55 and 65, when the oil content in the
skin decreases and the skin becomes more sensitive to dryness. Additionally, the second peak occurs between the ages
of 15 and 25, when emotional changes occur rapidly and
physiological or external stress occurs due to hormonal
changes. The cause of this disease is not yet certain, but it is
known to be triggered by various factors acting alone or in
combination. It is suggested to be related to skin dryness as
it often occurs in winter, and it can be triggered or worsened
by infection or allergic reactions to infectious strains, physical or chemical stimuli, genetics, soap, long baths, emotional
tension, drinking, drugs, aloe, mercury, gold, etc. Lesions
show an increase in various neuropeptides. Because the skin
lesions of coin-shaped dermatitis show a similar pattern to
atopic dermatitis in children, it is possible to suspect a relationship between the two diseases, but the age of onset and
the distribution of lesions are different, and there is a difference in the concentration of total immunoglobulin E in the
serum. Lesions mainly occur on the back of the hands, feet,
limbs, trunk, etc., especially often on the legs. The diameter
of the lesion is about 1–3 cm, but it can rarely grow to over
10cm, and the color is pink or dark red. It can be divided into
acute phase with erythema, papules, vesicles, exudates, and
Fig. 17.1 Nummular eczema observed on the back of the hand
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_17
Fig. 17.2 Nummular eczema observed on the foot and ankle
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Fig. 17.3 Nummular eczema
17 Nummular Eczema, Discoid Eczema
crusts, subacute phase with scales and ne cracks, and
chronic phase with lichenication and prominent skin lines.
It usually shows a chronic course, and most of the lesions are
relieved and then recur or persist for a long time. Nummular
eczema is a relatively common skin disease, but it is a major
disease with a decrease in quality of life and socioeconomic
loss due to severe itching and frequent recurrence. According
to a study of 211 patients with nummular eczema in Korea,
the repeat rate of recurrence was 51.7%, more than half of
the patients, and the shorter the duration of the disease, the
higher the cure rate and the possibility of repeated recurrence
decreased (Figs. 17.3, 17.4, 17.5, 17.6, 17.7, 17.8, 17.9,
17.10, and 17.11).
Nummular eczema can be diagnosed by visual examina-
tion due to the characteristic lesions that form a circular or
elliptical plaques of coin shape with relatively clear boundaries, where papules and vesicles are scattered on the lesion
Figs. 17.4 and 17.5 Nummular eczema
Figs. 17.6 and 17.7. Nummular eczema observed on the arm
17 Nummular Eczema, Discoid Eczema
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Figs. 17.8 and 17.9 Nummular eczema on the ankle and foot
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Figs. 17.10 and 17.11 Nummular eczema on the ankle and leg
site or exfoliated impetigo-like lesions are appeared by
scratching. Diagnosis is easy, especially if there are multiple
coin-shaped eczematous lesions on the legs. However, when
it occurs on the back of a housewife’s hand or ngers, it is
not easy to diagnose because there is a possibility of allergic
contact dermatitis and atopic dermatitis. If it shows a persistent and recurrent course, the possibility of allergic contact
dermatitis as the underlying cause should be considered, and
a patch test including metal antigens must be considered. If
the central skin appears normal as the lesion progresses, it
should be distinguished from tinea corporis by a fungal test.
In particular, tinea corporis, which is transmitted from cats,
occurs in multiple lesions and is relatively uniform in size,
occurring in the size of a 100 won coin or smaller. It is necessary to distinguish it from impetigo, psoriasis, xed drug
eruption, and stasis dermatitis. Serum IgE is known to show
almost normal levels unlike atopic dermatitis, but according
to Korean studies, the serum IgE level was increased in 1/3
or 43.9% of all patients. It was reported that the total
immunoglobulin E concentration in the serum in nummular
eczema showed a lower level than atopic dermatitis, but it is
thought to be higher than normal people. In a study on the
relationship between nummular eczema and contact allergy,
32.5% of 1022 nummular eczema patients who underwent a
patch test showed positive, and the substances with high
reaction rates were nickel sulfate, potassium dichromate, and
cobalt chloride. Histological examination reveals typical
ndings of subacute spongiotic dermatitis (Figs. 17.12,
17.13, 17.14, 17.15, 17.16, 17.17, 17.18, 17.19, 17.20, 17.21,
17.22, 17.23, 17.24, 17.25, and 17.26).
Nummular eczema generally shows a chronic course, and
it has been reported that the longer the duration of the disease, the lower the cure rate and the higher the possibility of
recurrence. In particular, it is known to recur when basic
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measures for dry skin are neglected, so it is important to
manage the skin so that it does not dry out for successful
treatment. Avoid long and hot water baths, avoid using strong
soaps, apply skin softeners to the whole body after bathing in
lukewarm water for a short time, and avoid skin irritation
from wool and low humidity environments. Moisturizing the
skin, wet dressing, and applying a medium or higher potency
topical steroid once or twice a day are basic primary treatments, and combined use of H1 antihistamines helps relieve
itching. Occasionally, topical calcineurin inhibitors such as
tacrolimus and pimecrolimus or tar preparations are known
to be effective. If these treatments do not respond, intralesional or systemic administration of steroids may be necessary. Ultraviolet therapy can be helpful in cases with
extensive lesions, and there have been reports that metho-
17 Nummular Eczema, Discoid Eczema
Fig. 17.12 Nummular eczema on the arm and wrist
Figs. 17.15 and 17.16 Nummular eczema on the leg
Figs. 17.13 and 17.14 Nummular eczema on the hand
17 Nummular Eczema, Discoid Eczema
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Figs. 17.17 and 17.18 Nummular eczema on the arm and leg
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Figs. 17.19 and 17.20 Nummular eczema on the shoulder and back
trexate was effective in moderate to severe pediatric lesions
that failed previous treatments. Appropriate antibiotics are
used when secondary bacterial infection is present.
Signicant improvement or complete disappearance can
occur within 3–4 weeks of starting treatment, but recurrence
is common. I sincerely hope that Mr. K will also be cured
without recurrence.
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