VZV, HSV, HPV — Oh My Indeed!
A point of confusion for many patients (because it is legitimately confusing) is the difference between VZV, HSV, and HPV viruses. First, let’s clarify these acronyms.
VZV = Varicella Zoster Virus
HSV = Herpes Simplex Virus
HPV = Human Papillomavirus
So the reason it is confusing is because A) the acronyms sound somewhat similar, B) VZV and HSV are both part of the Herpes family of viruses (Herpesviridae), and C) VZV can cause a diagnosis called herpes zoster which has the word herpes in it. Herpes zoster is not caused by the Herpes Simplex Virus.
So let’s do a quick synopsis of each one.
VZV = Varicella Zoster Virus
Conditions it causes: Chickenpox, Herpes zoster – aka Shingles
Chickenpox is something most of us are familiar with (at least those of us old enough to remember having had it). These days, most kids are immunized to it in the US when they are young. It is characterized by little blisters with some surrounding redness, along with fever and feeling tired. For those who want a descriptive analogy of what the rash looks like, check out “dew drops on a rose petal.”
Herpes zoster, aka Shingles, is something that occurs most frequently in adulthood. Classically, it occurs on one side of the body, with the same little blisters which can be grouped together. It can be burning, stinging, painful or itchy. There is a vaccine that is recommended for most people over 60 years of age since the risk of getting this rash is more frequent with increased age. Shingles occurs because the varicella zoster virus reactivates. After initial exposure, the virus lays dormant in the nerves and with some trigger or waning immunity, it can reactivate and case shingles.
HSV = Herpes Simplex Virus
Conditions it causes: Cold sores/oral herpes/herpes labials/fever blisters, Genital herpes/Anogenital herpes, herpes simplex
There are two types of the herpes simplex virus – HSV1 and HSV2. Generally, HSV1 favors the oral area and HSV2 favors the genital area. That being said, either could be found in either place. Herpes can also infect skin besides the oral area or the genital area.
Like the Varicella Zoster Virus, the herpes virus can reside in the nerves after initial infection. Then, it can reactivate (e.g. during times of trauma, stress, decreased immunity or otherwise), and show up. Like shingles, it also shows up with little blisters. These tend to be small clustered blisters. More on herpes in a future post to follow.
HPV = Human Papillomavirus
Conditions it causes: Warts including warts on the skin and genitalia, can also cause cancer like cervical cancer, penile cancer, and other cancers
Most commonly, the HPV virus causes common warts. These could be on the hands, fingers, soles of feet, or skin otherwise. However, they can also cause cancers in various areas including the anal canal and the cervix, vulva and vagina in women and the penis in men (thus the need for Pap smears, and the development and recommendation of the HPV vaccine). There are many different strains of HPV, with some considered relatively benign strains (e.g. those commonly causing warts) and some considered higher risk strains (e.g. those responsible for HPV induced cancers). Check out this link from the CDC for more info and more on HPV in a future post to follow.
We are in the month of May so there’s still time for a plug for Skin Cancer Awareness Month.
Skin cancer is common.
More than 5 million cases of skin cancer are diagnosed in the U.S. every year.
As a dermatologist, I diagnose many of these skin cancers in my clinic every week. Today, I’m going to highlight a few statements that I have heard from various patients who were ultimately diagnosed with melanoma.
“This mole was changing but I wasn’t too worried because it wasn’t painful or causing any symptoms.”
A changing mole is a reason to see your dermatologist. About 50% of melanomas (a potentially deadly form of skin cancer) arise de novo — meaning not from an existing growth. That leaves the other ~50% of melanomas having arisen from pre-existing moles. If a mole is changing, please please bring it to the attention of your dermatologist. When you call the office, be clear that you have a changing mole. If you can’t get into see your dermatologist, see your primary care physician. These days, many insurance plans may require you to see your primary care physician first in order to get a referral (hopefully expedited) to your dermatologist. Melanoma is most often neither itchy nor painful. I often counsel my patients that it’s not your job to play doctor; let us evaluate your growth for you.
“I have a flaky spot on my face. I pick off or scrub off the flake and my skin seems to go back to normal but the flaking keeps coming back.”
This is often the history I get for a potentially pre-cancerous spot called an actinic keratosis. Left alone, it can progress to a type of skin cancer called a squamous cell carcinoma. If you have these spots, see your dermatologist! It’s a good marker of prior sun exposure that you’ve had. You are also more at risk for developing skin cancer. Actinic keratoses are easy for your dermatologist to treat.
“I had this growth I was concerned about for some time but I really don’t want a scar from any procedures so I didn’t come in until now. My [family member, spouse] finally made me come in.”
Yes, taking a skin biopsy can leave a scar. Yes, taking out a skin cancer can leave a scar. And yes, taking a skin cancer out can also save your life. Especially if you get it out early.
Find a dermatologist who you can communicate with so you can have a discussion about what your growth might be and what the steps for diagnosing and treating the growth are. We are not looking to biopsy and cut things out willy-nilly.
For more resources about skin cancer:
Yes, it’s real. Being on a progestin only contraceptive like the Mirena IUD can trigger hormonal acne. Yes, the type of acne that can hound you even though you’re in your 20s, 30s or 40s etc and even though you thought you had said goodbye to acne forever. Yes, the type of acne that shows up as pesky red uncomfortable bumps of your chin and jawline. Yes, the type of acne that can leave a little blemish – maybe a pink or dark spot – even when it goes away. Yes, the type of acne where maybe you have one bump that just keeps coming back — like a bad teen movie sequel – Parts I, II, III and more.
So what should you do?
You could have your physician remove your IUD and that could help your hormonal acne. However, that’s not a practical option for everyone. After all, there’s a reason you chose to have it placed in the first place. There are practical benefits to having an IUD after all.
You could also see your dermatologist. Most of the time, we are able to “treat through” the hormonal effects of the Mirena IUD. We can tailor your acne treatments to your acne. This may involve a medication called spironolactone which helps address hormonal acne. We may use other meds in combination with spironolactone or even choose a different med all together.
So in short, don’t despair! If your Mirena comes along with a tag-along called acne, it may be time to see your dermatologist (or get your Mirena removed)!
Differin (adapalene) gel is now available over the counter. This is great news since it means you no longer need a prescription for it. Also, the prices over the counter (e.g. at your local Walgreens or CVS) have been quite reasonable. Or you can purchase online also.
So what is Differin (adapalene) used for?
Differin is marketed for acne. It can be used in combination with other products or on its own depending on the type of acne you have and the severity of your acne. It is also particularly good for comedonal acne (eg whiteheads or blackheads) which other types of medications might not address.
Differin is also a topical retinoid and as such it may be helpful for reducing appearance of wrinkles, and helping with skin texture and pigmentation issues. (You may have heard of using retinols for anti-aging.) There are a lot of topical retinoids out there though so definitely consult with your dermatologist if you’re wondering whether Differin is right for you.
Are there side effects to using Differin?
Any medication has potential side effects. Most commonly, people will report dryness, redness, or flaking. This is actually to be expected to a degree. We recommend spacing out use to every other night or mixing with some moisturizer if you need to. Your skin tends to get used to the medication after a month or so. You may also need to take it easy on other products you are using (eg benzoyl peroxide or salicylic acid which can also be drying and irritating)
Also, if you are pregnant or trying to get pregnant, you should discuss with your obstetrician before using this medication (it is still a medication after all!) Many/ ?most will recommend that you stop your topical retinoid.
Spironolactone is an oral medication that is used to treat hormonal acne. Although it is often thought of as a blood pressure medication, it is also effective for hormonal acne. Hormonal acne manifests in women as acne that has a predilection for the jawline and chin. Additionally, the acne often flares before periods. Patients with polycystic ovarian syndrome (PCOS) often have hormonal acne as well. Do you have hormonal acne? If so, talk to your medical provider. There are side effects and contraindications to this medication so it’s important to discuss whether this medication is appropriate for you. Additionally, don’t be surprised if the effect of the medication does not kick in immediately. It may take a few months or further dosage adjustments to see an effect!
Whether it’s a need to do chores involving water, due to one’s occupation, or just a habit, frequent handwashing can lead to irritated skin of the hands. The hands become dry and stripped of their natural protective oils. Irritant dermatitis is the name of the rash which often ensues from frequent handwashing — it is a type of rash that occurs as a result of direct physical, mechanical or chemical trauma from an outside culprit. The most frequent culprit is handwashing. Between the soap and the water, the damage is done. Skin becomes dry and rough, and can become variable degrees of pink/red.
So how can you prevent irritated hands from frequent handwashing?
– First, if it’s not necessary, then don’t wash your hands. This is not to mean that you should not wash your hands when they are dirty or soiled. You should! Handwashing is important in preventing spread of germs. However, if you find yourself excessively handwashing, figure out if you can cut back.
– Although hot water helps cleanse the hands more readily of microbes, they can also strip the skin’s oils more readily. Depending on how germy your hands are, you may considering using lukewarm or cold water to wash as opposed to hot water.
– Limit the amount of time you are washing. Do not wash for an excessively long time.
– Pat dry instead of rubbing dry.
– Follow up with a moisturizer.
– If all else fails, see a medical professional such as a dermatologist for help. If your rash is particularly bad, prescription medicated creams or ointments may be helpful.
We’ve previously discussed the use of skin protectants and ointments for irritated skin such as eczema skin. One of my favorites is Vaniply ointment. One frequent complaint I hear from patients about ointment is that it leaves the skin and clothing sticky and goopy, and that it’s difficult to apply. Vaniply is somehow much smoother and much easier to spread. It also doesn’t leave that really sticky feel behind.
Vaniply is made by the same company that makes Vanicream. All of their products are meant to be hypoallergenic. Specifically, Vaniply is free of fragrance, preservatives, lanolin, parabens, formaldehyde, formaldehyde releasers, sulfates, gluten, and chemical irritants. Patients with eczema are more likely to develop contact dermatitis so it’s good that Vaniply has taken out all the above offenders.
So what does Vaniply contain? 1% dimethicone, C30-45 alkyl methicone, C30-45 olefin, hydrogenated polydecene, microcrystalline wax, polyethylene, silica dimethyl silylate
What are the uses of Vaniply?
It can function as a skin protectant — serving as an extra barrier between the skin and the outside world. As such, you can use it over chapped lips, hands, feet, and elsewhere. You can also use it in areas that develop a rash from constant moisture (think babies’ bottoms or skin folds). It helps “seal” in the water content of the skin, so you could use it as part of the “soak and smear” method if you’re trying to hydrate the skin and then trap the moisture in (e.g. for those with eczema). It can also be used as part of the wet wrapping procedure (again, often used in eczema patients).
Vaniply is “kid friendly” and has also received the National Eczema Association Seal of Acceptance.
The Bamboo Bubby Bag is a sleep sack made of bamboo and cotton designed for babies with eczema. The material is stretchy and is relatively lightweight, so dress your child accordingly inside the sack depending on the weather. The Bamboo Bubby Bag features covered sleeves which can fold over to shorten the length of the sleeves. Because of the adjustable sleeves, they can accomodate small babies of about 6 months old up to 6 year old toddlers.
Here are some things I like about the Bamboo Bubby Bag:
– The stretchiness of the material makes for easy on and off. This is important as when an eczema child is tired and needs to rest, the scratching often starts. You don’t want to spend all day trying to get on your mittens, gloves, scratch sleeves and then your sleep sack, etc.
– The sack accommodates a wide age range. Eczema clothing and accessories can be expensive and this can last you a long time. Just be sure to take care of your sack in order to preserve its longevity.
– The double zipper means easy diaper changes.
– There’s a hole in the back to accommodate placing your baby in the stroller or car seat. If you’re taking a long car ride and can’t constantly monitor your child’s hands, this is a nice benefit.
The cost is currently $79.95 and you can buy it through the company’s website. You can also get it with the ScratchMeNot Flip Mitten Sleeves for a total of $89.95. I recommend you line dry the sack as noted in the care instructions, so you may want to invest in two sacks.
One of the most frequent growths that brings patients into the office are seborrheic keratoses. Frequently mistaken for moles, they are most commonly brown “stuck-on” growths that can occur essentially anywhere on the body. They tend to arise in adulthood and have a likely genetic inheritance. Most of my patients refer to them as barnacles, nuisance growths, age spots, or “moles.”
So now the important question… how do you get rid of them?
Seborrheic keratoses can be frozen off by a process called cryotherapy, scraped (curetted) off, cut out (not usually optimal), or burned off with an electric needle if small. If they are pretty flat, lasers can be used to remove them as well. Be careful how you get them removed though. I have seen patients left with bad darkening or lightening of the skin as well as scarring after removal. As with most cosmetic procedures, it’s best not to be tan in general during the procedure as that could increase risk of pigmentary change of the skin. If you are concerned about a particular growth or interested in removal, schedule an appointment with a dermatologist who can evaluate the growth to 1) make sure it is indeed a benign growth, and 2) counsel you on the best way to remove the growth.
The AD RescueWear RescueSuit is a body suit made of soft stretchy Tencel (R) that covers your baby or child neck down. Conceived by eczema mom Beth Scott, it is designed as an aid for wet wrapping for eczema, and can also be used for dry wrapping. It features fold over mitts to cover the hands when needed as well as fully enclosed feet. The neck down full coverage is important in providing a protective layer from scratching.
The Tencel (R) fabric is excellent for gently hugging your child’s skin. Traditionally, parents have used tight fitting cotton pajamas for wet wrapping. However, I have yet to find cotton pajamas which are able to fit a child’s body as well as this RescueSuit. Additionally, the wet cotton pajamas end up heavy, bulky and bunchy when used for wet wrapping. This RescueSuit molds to the body so that the damp fabric is right next to the skin and really is superior for wet wrapping. Another benefit I have found of the body molding RescueSuit is that bulky diapers do not rub against thighs as much — this sort of rubbing can incite eczema and itch.
This suit can also be used for dry wrapping and worn day to day. It is an added protective layer to protect the skin from scratching and because of the body molding fit, can easily fit under outer garments.
The AD RescueWear RescueSuit is very helpful for those of you whose children benefit from wet wrapping. Watch the YouTube demo on how to wet wrap with the RescueSuit. You may have to practice a couple of times to become as adept at putting the suit on as the mom in the video.
The AD RescueWear RescueSuit retails at $105. You may want to have a couple on hand as they are delicate and should be air dried flat, so that would cost a couple hundred dollars. The suit costs significantly more than cotton pajamas, but at the same time, they are actually designed for wet and dry wrapping. Check out the AD RescueWear website as well as The Eczema Company’s website to look for sales and promotions.
All in all, as a dermatologist and eczema mom, I found the AD RescueWear Rescue Suit to be a helpful item to have and would recommend it to other parents of children with eczema.
For the month of March, use the code DERM10 to receive 10% off from The Eczema Company.