Aron Gewirtzman

Epidermodysplasia verruciformis and human papilloma virus.

Purpose of reviewDespite its rarity, epidermodysplasia verruciformis was addressed in depth in recent literature. Patients are afflicted by persistent human papillomavirus infections and develop cutaneous malignancies more frequently and younger than in the general population. The disease is therefore considered a model for a viral role in cutaneous oncogenesis, although implication is controversial. We focus on recent findings in genetics, highlight multiple viewpoints regarding the role of epidermodysplasia verruciformis-human papillomavirus in nonmelanoma skin cancer and other diseases, and discuss treatment strategies. Recent findingsSusceptibility loci for epidermodysplasia verruciformis were mapped and encoded protein functions are becoming better understood, but a unified genetic theory for epidermodysplasia verruciformis is lacking. Epidermodysplasia verruciformis-human papillomavirus, originally thought present only in epidermodysplasia verruciformis, is now considered ubiquitous, its role still being elucidated. Numerous therapies for epidermodysplasia verruciformis lesions were proposed, although there is no consensual first-line treatment strategy. SummaryDiscoveries of novel mutations and further study of epidermodysplasia verruciformis-human papillomavirus in lesional and nonlesional skin of epidermodysplasia verruciformis patients and the general population may generate a cohesive theory regarding a viral role in cutaneous oncogenesis. Future understanding of the disease may yield an optimal approach to treating epidermodysplasia verruciformis patients.

Mucocutaneous Manifestations of Epstein-Barr Virus Infection

This review focuses on Epstein-Barr virus (EBV) infection, diagnosis, and current treatment, with emphasis on EBV-associated mucocutaneous manifestations in primary infections, acute EBV-associated syndromes, chronic infections, lymphoproliferative disorders, and lymphomas. In primary infection, EBV infects B cells and can cause mucocutaneous manifestations in infectious mononucleosis or acute EBV-associated syndromes such as Gianotti-Crosti syndrome and hemophagocytic syndrome. EBV then persists in the majority of humans generally without causing disease. In some cases, however, latent EBV infection may result in diseases such as hydroa vacciniforme, hypersensitivity to mosquito bites, and lymphoproliferative disorders such as plasmablas- tic lymphoma, oral hairy leukoplakia, and post-transplant lymphoproliferative disorders, particularly in immunocompromised patients. Latent EBV infection has also been implicated in a variety of malignant conditions such as Burkitt lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma, and Kikuchi histocytic necrotizing lymphadenitis. Since the immune system is critical in preventing the progression of EBV disease, the immunologic status of the patient plays a crucial role in the subsequent development of pathologies.

Epidemiology of Sexually Transmitted Infections

Sexually transmitted infections (STIs) are commonplace worldwide and may be caused by bacteria, fungi, protozoa, parasites, or viruses. Epidemiology involves the study of incidence and prevalence of disease in large populations as well as detection of the source and cause of epidemics of infectious disease. Acute diseases tend to have high incidence and low prevalence; chronic diseases may have high prevalence even if incidence is low.

Single-day treatment for orolabial and genital herpes: a brief review of pathogenesis and pharmacology

Herpes simplex virus (HSV) infection is a highly prevalent condition responsible for significant morbidity and occasional mortality each year. Approximately half of all patients infected by HSV will experience at least one recurrence in their lifetime. For these recurrences, traditional therapy has included both suppressive and episodic treatment with nucleoside analogs. In regards to episodic treatment, 2- to 5-day oral regimens are best studied and most commonly reported. As with any medical condition having a well-understood mechanism of action and targeted treatment, therapeutic intervention is only as effective as allowed by patient compliance. Based on these concerns, recent studies have focused on shorter, less complicated, and more affordable options. This review delineates the evidence for single-day treatments of orolabial and genital herpes. Randomized, double-blind studies of both valacyclovir and famciclovir as single-day episodic therapy for HSV have been reported in the literature. Although no head-to-head studies between the drugs have been performed, both regimens produced significant improvement in healing time and symptom resolution over placebo. Single-day therapy for HSV infection is appealing for multiple reasons. First, it simplifies the regimen, increasing likelihood of patient compliance. Additionally, it allows complete delivery of the medication at the onset of symptoms, when viral replication is highest and intervention has greatest effect. Lastly, the reduced number of pills necessary for single versus multiple day therapy decreases the overall cost of treatment per episode, an important factor in modern-day healthcare.

A rare case of disseminated shingles in an immunocompetent patient following a 7-day treatment with oral valacyclovir

Varicella-zoster virus (VZV) is the causative agent of both chickenpox and herpes zoster (shingles). More than 90% of the adult population in theUnited States is seropositive for VZV. VZV remains latent in the dorsal root and cranial nerve ganglia after chickenpox and reactivates to give rise to herpes zoster.1 Herpes zoster affects over 1 million Americans each year, and 60% of cases occur in individuals over the age of 50.2 Dissemination of herpes zoster, although extremely rare in immunocompetent patients, may be as high as 10–40% in immunocompromised hosts.3 We report a case of disseminated herpes zoster in a young, immunocompetent man following a 7-day treatment with valacyclovir.

Physical Barrier Methods and Microbicides

STIs represent a significant source of morbidity and mortality and cause significant financial strain worldwide.

Immunodermatology and Viral Skin Infection

The skin is the largest organ in the human body, acts as our fist line of defense, and has a sophisticated array of cells and signaling molecules to help protect the body from infection. Yet even with this sophisticated defense, viruses cause a range of cutaneous diseases in humans, many of which are widespread in the population and cause significant morbidity and mortality, along with psychological and financial repercussions. Each virus has unique mechanisms by which it evades the immune system, replicates, and spreads. Some viruses infect the skin directly while others gain access systemically first. Infections can be acute or subclinical and then resolve, while others are persistent or can remain latent for years. This spectrum of presentations is mirrored by an equally wide array of evasion tactics that the viruses use to manipulate and escape both the adaptive and innate immune responses. In addition to highlighting viral responses, particular attention is also paid to the local immune response generated in the skin. Five viruses will be discussed in detail: herpes simplex virus, varicella zoster virus, human immunodeficiency virus, molluscum contagiosum virus, and human papilloma virus; along with the latest information on the development and advancement of both therapeutic and prophylactic vaccines.