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Herpes Simple

Posted by WEBMASTER on November 16, 2012 at 7:45 AM

Herpes Virus

 



Los virus son causa frecuente de enfermedades. La palabra latina virus, quiere decir veneno, y se discute si en realidad son seres vivos o inanimados ya que están formados solo por moléculas de DNA o RNA cubiertos por una capsula protectora llamada capsidia.

En dermatología las enfermedades que con más frecuencia se tratan son las causadas por herpes virus.

Dentro de este grupo quedan: el herpes simple, varicela - zoster, el Epstein Barr virus.

La palabra herpes, quiere decir vesícula. Tenemos 2 tipos del virus del herpes simple, tipo 1 que afecta de la cintura hacia arriba, y el tipo 2 de la cintura para abajo, aunque no es excepcional encontrar el tipo 2 arriba y el tipo 1 abajo.

Es una enfermedad muy frecuente, verdaderamente problemática, pues no deja inmunidad por lo que las redivivas son muy frecuentes.

La primoinfección se realiza en edades tempranas y no es raro que el niño al nacer obtenga el virus al pasar por el canal vaginal de madres que padecen esta enfermedad.


El periodo de incubación es de 2 a 20 días, generalmente esta primoinfección pasa inadvertida en el 95% de los casos, apenas unos cuantos pacientes presentan síntomas en piel y mucosas que suelen ser intensos y aparatosos con síndrome febril, queilitis, gingivoestomatitis, queratoconjuntivitis, eczema herpético [ vesículas diseminadas] y el panadizo herpético [ lesiones vesículocostrosas en la punta de los dedos].

Cuando se trata del tipo 2 las lesiones aparecen en pene, escroto, vulva y vagina, perine o regiones glúteas, estas lesiones tienen tendencia a la curación en 10 a 15 días.

 

Los nuevos brotes aparecerán en relación con las condiciones inmunológicas del huésped y la reinfección. El virus permanecerá indefinidamente en los ganglios radiculares regionales y de ahí se activara cuando bajen las condiciones inmunológicas del huésped. Los factores que determinan la aparición de nuevos brotes son: estados febriles, infecciones, exposición al sol, medicamentos inmunosupresores, enfermedades como las leucemias, VIH-SIDA que deterioran la inmunidad, por cambios en la temperatura y hasta por problemas emocionales. La transmisión sexual es posible sobre todo en el virus tipo 2.

El cuadro clínico es muy conocido. La gente llama fuegos a las lesiones cuando aparecen en los labios. Se tratan de racimos de vesículas sobre un fondo eritematoso que se presenta bruscamente con ardor marcado. Estas lesiones se erosionan muy pronto, por lo que a veces solo observamos exulceraciones cubiertas por costras melicericas. Su topografía habitual es en los labios, comisuras labiales, mucosa labial, lengua, es decir en zonas cutáneomucosas y alrededor de ellas.

En el caso de del herpes tipo 2, las lesiones aparecen en prepucio, glande, piel del pene, escroto, labios mayores o menores, paredes vaginales, perine y glúteos.

Estas lesiones involucionan espontáneamente en alrededor de 7 días sin dejar cicatrices. Solo en casos inmunodeprimidos, las lesiones se extienden, se ulceran y persisten hasta un mes o más.

 

En un buen número de pacientes se presentan recidivas: herpes recidivante, que altera mucho la vida del paciente sobre todo cuando es genital. Estos brotes pueden presentarse cada mes, cada 3 o 6 meses, pero hay casos en que se presentan cada 10 o 15 días.

La complicación mas frecuente es la impetiginizacion por el manipuleo de las lesiones y, en tales casos, se añaden pústulas y más costras melicericas. Son raras las complicaciones viscerales, como la queratoconjuntivitis que puede causar perforación corneal o la encefalitis.

El diagnostico se basa mas que nada en el cuadro clínico y las recidivas; aunque puede realizarse por medio de biopsia de ser requerido.

El tratamiento del herpes simple es sencillo, pero solo de los brotes que aun sin tratamiento involucionan espontáneamente. Hasta la fecha no existe ningún tratamiento que asegure a todos los pacientes que no tendrán ya recidivas. Las lesiones suelen secarse con fomentos de suero fisiológico o de agua de manzanilla y después deben aplicarse polvos secantes que llevan talco y oxido de zinc. Es perjudicial la aplicación de merthiolate o violeta de genciana, ya que solo manchan la piel; deben contraindicarse los corticosteroides que pueden diseminar el cuadro y producir complicaciones.

No existen medicamentos antivirales efectivos en el herpes simple, cuando se usan tanto local como por vía sistémica, en los dos primeros días, lo único que se logra es acortar la evolución del herpes, pero ninguno de los medicamentos actualmente en uso [aciclovir, Valaciclovir] pueden evitar las recidivas. Estos medicamentos, deben usarse solo en casos de herpes muy extensos, o en personas con esta patología que además presenten alguna condición de inmunodepresión.


Los medicamentos antivirales pueden actuar de varias maneras, unos impiden la penetración del virus en las células; otros impiden la replicación viral inhibiéndose la síntesis de DNA.

En conclusión, a pesar de ser un cuadro dermatológico aparatoso en muchas ocasiones, es importante evitar la automedicación, y visitar su medico con regularidad para poder estar en control de esta patología y resolver sus dudas al respecto.

 

 

Dr. Ricardo Ruano

 

Categories: Enfermedades de la piel

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