VZV, HSV, HPV — Oh My!

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.

 

 

May is Skin Cancer Awareness Month

We are in the month of May so there’s still time for a plug for Skin Cancer Awareness Month.

Skin cancer is common.

How 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:

How to do a self skin exam

The basics on skin cancer and the ABCDEs of melanoma