Influenza (flu) and the skin (For professionals)

• Influenza (flu) is an ubiquitous infection caused by a RNA virus. Symptoms of the disease include sore throat, fever, cough, chills, myalgia, headache, asthenia (fatigue), general discomfort. Influenza can evolve into pneumonia, which can cause death.
• There is a infinite variety of different genotypes. Two proteins on the viral surface called Haemagglutinin (H) and Neuraminidase (N) enable together to serologically identify an influenza virus strain.
• Treatment is often supportive but vaccination (immunization) and neuraminidase inhibitors/M2 protein inhibitors are used in respectively fragile patients and when the virulence is considered high.

• Skin associations are rare and include:

1. Persistent erythema multiforme
2. Pityriasis Rosea (due to a H1N1 virus)

• More associations with dermatological conditions have been described following vaccination (immunization):

1. Bullous Pemphigoid
2. Erythema Multiforme
3. Fixed Drug Eruption
4. Leukocytoclastic Vasculitis
5. Lichen Planus
6. Linear IgA Bullous dermatosis
7. Neutrophilic dermatosis of the hands
8. Pemphigus (exacerbation)

Bibliography

A Case of Pityriasis Rosea Concurrent with the Novel Influenza A (H1N1) Infection. Mubki TF, Bin Dayel SA, Kadry R. Pediatr Dermatol. 2010 Apr 9.

A novel influenza a (H1N1) virus as a possible cause of pityriasis rosea? Kwon N, Kim J, Cho B, Park H. J Eur Acad Dermatol Venereol. 2010 Jun 17.

Bullous pemphigoid triggered by influenza vaccination? Ecological study in Galicia, Spain. García-Doval I, Mayo E, Nogueira Fariña J, Cruces MJ. Br J Dermatol. 2006 Oct;155(4):820-3.

Childhood bullous pemphigoid developed after the first vaccination. Baykal C, Okan G, Sarica R. J Am Acad Dermatol. 2001 Feb;44(2 Suppl):348-50.

Erythema multiforme following vaccination in an infant. Kaur S, Handa S. Indian J Dermatol Venereol Leprol. 2008 May-Jun;74(3):251-3.

Exacerbation of pemphigus after influenza vaccination. De Simone C, Caldarola G, D’agostino M, Zampetti A, Amerio P, Feliciani C. Clin Exp Dermatol. 2008 Nov;33(6):718-20.

Fixed drug eruption due to influenza vaccine. Al-Mutairi N, Al-Fouzan A, Nour-Eldin O. J Cutan Med Surg. 2004 Jan-Feb;8(1):16-8. Epub 2004 Jan 23.

Leucocytoclastic vasculitis and influenza vaccination. Tavadia S, Drummond A, Evans CD, Wainwright NJ. Clin Exp Dermatol. 2003 Mar;28(2):154-6.

Linear IgA bullous dermatosis following influenza vaccination. Alberta-Wszolek L, Mousette AM, Mahalingam M, Levin NA. Dermatol Online J. 2009 Nov 15;15(11):3.

Neutrophilic dermatosis of the hands after influenza vaccination. Wolf R, Barzilai A, Davidovici B. Int J Dermatol. 2009 Jan;48(1):66-8.

Persistent erythema multiforme and CMV infection. Wanner M, Pol-Rodriguez M, Hinds G, Hutt C, Husain S, Grossman ME. J Drugs Dermatol. 2007 Mar;6(3):333-6.

The first reported case of lichen planus following inactivated influenza vaccination. Akay BN, Arslan A, Cekirge S, Erkin G, Anadolu-Brasie R. J Drugs Dermatol. 2007 May;6(5):536-8.

Wikipedia