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  • Varicella-zoster virus (shingles) often presents with a prodrome of dermatomal pain, pruritus, and dysesthesia prior to the onset of a rash, which is localized to a unilateral dermatome.

  • People with skin of color are less likely than fairer skinned individuals to develop shingles.

  • Genital herpes presents with chronic, recurrent episodes of painful vesicles and subsequent ulceration and requires diagnostic testing with viral culture, polymerase chain reaction analysis, or serology to establish the correct diagnosis.

  • Kaposi sarcoma, caused by human herpesvirus type 8, most commonly presents as violaceous lesions on the skin of the lower extremities, mucocutaneous surfaces, lymph nodes, or viscera.

  • Anogenital warts are caused by human papillomavirus types 6 and 11 in the majority of cases.

  • Common warts are most often observed in children, and they usually present with cauliflower-like papules on the dorsa of the hands or fingers.

  • Molluscum contagiosum infection causes pearly white or skin-colored papules with central umbilication.

Despite the U.S. population becoming increasingly multiracial and multi ethnic, there is limited evidence-based data regarding skin of color. It is crucial for our understanding of skin of color to improve so that we can advance treatment of diseases including viral infections. The goal of this chapter is to discuss important epidemiologic factors of common viral infections that have cutaneous manifestations. We will also highlight the pathogenesis, clinical manifestations, diagnosis, and treatment options of these viral infections.


Varicella-zoster virus (VZV) is a human neurotropic virus that causes varicella (chickenpox) and zoster (shingles). Primary infection causes varicella, a mild and self-limited disease of childhood. The virus subsequently establishes latency. VZV reactivates and causes herpes zoster when individuals have a decline in cell-mediated immunity. In a population-based cohort investigation, the effect of race on the risk of acquiring herpes zoster was examined in individuals older than 65 years of age.1 There were significantly fewer cases among darker skin of color subjects compared to fairer skinned subjects. In another study that included 3206 subjects older than 64 years of age, African Americans were one-fourth as likely as Caucasian patients to experience zoster infection.2


Up to 90% of nonimmune household contacts develop primary varicella infection after exposure to an infected individual.3 VZV is transmitted by respiratory secretions from the nasopharynx or by direct contact with infected skin lesions. Individuals are infectious from 2 days prior to the onset of the rash until all of the vesicles have crusted.

During primary varicella infection, the virus establishes latency in cranial nerve ganglia, dorsal root ganglia, and autonomic ganglia. A decline in T-cell proliferation in response to VZV antigens is thought to be involved in the process of reactivation. This reactivation occurs more commonly in the elderly, individuals infected with human immunodeficiency virus (HIV), organ transplantation recipients, and those treated with chemotherapy, radiotherapy, and long-term corticosteroids....

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