Gladiatorum herpes simplex virus in Child
The exact incidence of herpes gladiatorum is not known, but usually it afflicts young and active individuals engaged in contact sports. The disease typically presents with an incubation period of about 3-5 days, followed by the eruption of painful grouped vesicles on an erythematous base. HSVG usually presents on the torso, legs, shoulders, neck, or forearms. In one large outbreak occurring at a high school wrestling training camp, HSVG was identified in 60 of 175 wrestlers, and most lesions were present on the head (73%), the extremities (42%), and the trunk (28%). Autoinoculation may result in infection at multiple sites on the body.
Depending on the intensity of the host response, a primary herpes infection, including HSVG, may be accompanied by systemic manifestations including fever, sore throat, headache, and lymphadenopathy.
Like all other HSV infections, the condition resolves with dormancy in the dorsal ganglia. During future periods of reduced immune function, repeat eruptions will occur in the same anatomic area as the primary infection. Scarring may also result from the eruption, and lesions close to the eyes may lead to herpes keratitis, an ophthalmologic emergency.
B00.1 – Herpesviral vesicular dermatitis
240475000 – Cutaneous herpes simplex infection
Differential Diagnosis & Pitfalls
- Impetigo – A superficial infection with group A Streptococcus, impetigo results in erosion and intense crusting, but it is usually not as deep-seated, painful, or recurrent as herpes infections.
- Folliculitis – Bacterial or fungal folliculitis is follicularly centered and generally not as acutely painful as herpes. Although folliculitis is recurrent on occasion, the lesions are not confined to the same anatomic location as they are in recurrent herpes episodes.
- Tinea – Tinea corporis produces annular lesions with central clearing that are intensely pruritic rather than painful.
- Cellulitis – Expanding erythema, without a predominance of vesicles, is identified in most cases of cellulitis.
- Zoster (shingles) – Reactivation of varicella-zoster virus (VZV) infections (shingles) cannot be distinguished from HSV by light microscopy alone, but instead requires clinicopathological correlation. Zoster is chiefly a disease of older patients, and it is usually limited to a single dermatome; it is typically not as cyclical as HSV infections.