Life-threatening cutaneous viral diseases

Most viral infections present with a cutaneous eruption that in the greater majority of cases is self-healing. Only in rare instances is the eruption accompanied by constitutional symptoms, and even more rarely, irreversible damage may occur or death may ensue. As with other infectious diseases, prognosis depends on the status of immunologic surveillance. Immunodepressed patients are, therefore, at the greatest risk. It has become more evident, however, that even in immunocompetent patients, eruption that were considered not long ago as benign diseases may in fact result in complications and even death. The introduction of polymerase chain reaction assays has allowed us to attribute conditions to a specific viral infection, which in the past was not possible. Therefore, dermatologists may come across, directly or during consultation, patients presenting with skin lesions that may be related to a viral disease and may lead to possible severe systemic complications. Dermatologists, however, may not be prepared for such developments, and thus the goal of this article is to suggest some of the possibilities. Discussing all the viral diseases that may present with cutaneous manifestations would be cumbersome; thus this article will be limited to the diseases that may endanger the life of a patient who is seeking dermatologic advice and who does not seem to have, at first sight, severe systemic involvement.