Viral infections and the skin

Common childhood viral infections can cause widespread exanthems (rashes):

• Measles (morbilli)
• German measles (rubella)
• Chickenpox (varicella)
• Erythema infectiosum and papular purpuric gloves and socks syndrome (parvovirus)
• Roseola (erythema subitum, due to herpesvirus 6 and 7)
• Infectious mononucleosis (glandular fever) (due to Epstein-Barr virus)
• Enterovirus infections.

Other viral syndromes with mucocutaneous features include:

• Pityriasis rosea, herpesviruses 6 and 7
• Hand foot and mouth disease (enteroviral vesicular stomatitis), due to coxsackie infection. More widespread vesicular eruptions can also be due to enterovirus
• Papular acrodermatitis of childhood (Gianotti-Crosti syndrome) most often caused by Epstein-Barr Virus or hepatitis B
• Laterothoracic exanthem (asymmetric periflexural exanthem of childhood or APEC), cause uncertain but many viruses implicated in case reports
• COVID-19 (SARS-CoV-2)
• Haemorrhagic fevers caused by togavirus, bunyavirus, and arenavirus are potentially fatal, with bleeding into the skin
• Smallpox, a deadly disease hopefully now eradicated by widespread vaccination
• Cowpox
• Monkeypox, a newly emerged pox virus present in the Congo
• Chikungunya fever, dengue, dengue haemorrhagic fever, and zika fever (due to arboviruses).
• Other haemorrhagic fevers include Crimean-Congo haemorrhagic fever (nairovirus), Lassa fever (arenavirus), Ebola haemorrhagic fever, and Marburg haemorrhagic fever (filovirus).
• Epidermodysplasia verruciformis is a genetic disorder with a predisposition to unique cutaneous human papillomavirus types and skin cancer.
• Various skin complaints are more common with Human Immunodeficiency Virus (HIV) infections (AIDS) including acute human immunodeficiency virus infection syndrome and Kaposi sarcoma (which is due to infection with herpesvirus 8)
• Rickettsial diseases are due to organisms classified between bacteria and viruses
• Yellow fever is a serious flavivirus infection characterised by yellow skin and eyes due to jaundice.

Viral infections can also cause cancer. Examples include:

• Human papillomavirus-associated penile, vulval, and oral intraepithelial neoplasia, vulval and oral cancer, epidermodysplasia verruciformis 
• Epstein–Barr virus-associated lymphoproliferative disorders.

Localised skin and mucosal conditions caused by viral infections include:

• Herpes simplex (cold sores and genital herpes), eczema herpeticum
• Herpes zoster (shingles), including Ramsay Hunt syndrome
• Herpangina / vesicular stomatitis (oral ulcers)
• Molluscum contagiosum
• Viral warts (verrucas, anogenital warts or condylomas and squamous cell papillomas)
• Orf
• Milker's nodules
• Oral hairy leukoplakia.

In the future, we expect to classify more skin conditions as viral in origin as more sophisticated tests for viral particles become available.

Viral infections including viral hepatitis sometimes give rise to:

• Erythema multiforme
• Erythema nodosum
• Kawasaki disease.