Cutaneous Manifestations of Zika in Peru

Abstract

This article aims to describe the cutaneous manifestations observed in the Zika epidemic in Peru during 2016 and 2017, as well as discuss the potential differential diagnoses. During the outbreak, the main reason for seeking medical advice was the development of a pruriginous maculopapular rash with a marked papular component, which started on the chest and later generalized to the rest of the body. Similar manifestations were noted in adults, children, and pregnant women. Other manifestations such as conjunctivitis, edema, or petechiae on the palate were rare. We suggest that in areas that are endemic for arboviral infections, in the differential diagnosis of a rash one must consider infections such as dengue, Zika, or chikungunya viruses. In nonendemic areas, the diagnosis is more difficult, as the rash may result from other viral infections not transmitted by arthropods and/or reactive or inflammatory diseases (urticaria, atopic dermatitis, systemic lupus erythematosus). We recommend that primary care health personnel are trained in the recognition of the mucocutaneous lesions caused by Zika virus infection, which could contribute to the identification of suspicious cases, particularly pregnant women.

Cutaneous Manifestations of Zika

“…We read the publication on "Cutaneous Manifestations of Zika in Peru" with a great interest. 1 Ramos et al noted that "During the outbreak, the main reason for seeking medical advice was the development of a pruriginous maculopapular rash with a marked papular component, which started on the chest and later generalized to the rest of the body." 1 As noted by Ramos et al, there might be several dermatological presentations in Zika virus infection.…”

Clinicopathologic features among different viral epidemic outbreaks involving the skin

“…Skin manifestations are considered a valuable hallmark of the disease, because although the rash is by itself aspecific, characteristically occurs 24-48 hours after the onset of the general flu-like symptoms. 123 , 124 , 125 , 126 This very short time lapse is the clue to differentiate Zika from other exanthematous diseases frequent in the same geographical areas, including dengue, and Chikungunya, whose rash manifests 4-5 days after the symptoms’ onset. Morphology is variable, mainly maculopapular, but also arranged in linear net-shaped pattern, or even wheals, bleaching on palpation.…”

“… 126 Oral aphthous ulcerations are common. Another distinctive feature is intense itching, scratching emphasizing the papular components of the rash, and representing main reason for seeking medical advice, 125 accompanied by symmetric painful joints edema, most commonly on wrists and ankles. During the course of the disease other lesions might occur as consequence of viral immune-induced thrombocythemia, such as petechiae, ecchymosis, subcutaneous hematomas, jaundice.…”

Response to Letter to the Editor Regarding: “Cutaneous Manifestations of Zika”

“…We appreciate the feedback sent by Joob and Wiwanitkit, which enriches the discussion of our results. 1 In their communication, they mention that according to their experience, it is rare to observe patients with cutaneous manifestations produced by Zika. Similarly, various studies based on epidemiological and clinical data showed that the main pattern of infection is asymptomatic, occurring in 80% of individuals infected with the Zika virus.…”