Journal of Clinical and Aesthetic Dermatology

JAN 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

Issue link: http://jcadonline.epubxp.com/i/775221

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JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY January 2017 • Volume 10 • Number 1 E 5 Introduction The herpes family of viruses includes herpes simplex virus 1 and 2 (HSV-1 and HSV-2), herpes zoster virus (HZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human herpes virus 6, 7, and 8. 2 Following initial infection, the virus lies dormant in the dorsal root nerve ganglion and reactivation can occur at a later date. It is thought that reactivation can be provoked by direct damage to the nerve axon by a needle during an aesthetic procedure. Tissue manipulation and an inflammatory reaction may also play a role in this process, however in the case of dermal filler injections, hyaluronic acid has been demonstrated to act as a protective agent and prevent viral replication. 2 Incidence HSV-1 is ubiquitous with an estimated 50 percent of high socioeconomic status patients becoming seropositive by age 30. 3 The risk of herpes reactivation following dermal filler injection is rare with an incidence of HSV-1 reactivation estimated to be less than 1.45 percent and herpes zoster is even more rare. 4 Signs and Symptoms Signs and symptoms often appear 24 to 48 hours after treatment 2 and initially appear as neuralgic pain or a tingling sensation. There may be some pruritus and dysesthesia. HZV will appear as vesicles or blisters in a unilateral dermatomal distribution, whereas HSV may be bilateral and may appear in several distinct areas. Herpetic lesions appear initially as thin walled intra-epidermal vesicles that subsequently burst, crust, and then heal. They are typically circular ulcerations covered by a yellowish film with surrounding erythema. There is often some weeping from the ulcerations. Prophylaxis and Treatment of Herpetic Infections Martyn King, MD Definition "Any of several viral infections marked by the eruption of small vesicles on the skin or mucous membranes, especially herpes simplex." (From Greek, herpein, to creep) 1 JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY Aesthetic complications Guidelines

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