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| Viruses | Skin Manifestations | Treatment |
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| Herpes simplex | It has been found that the rate of infection due to herpes simplex is high as 35 %, and reactivation occurs usually within 3 weeks after liver transplantation. Dermatological manifestations associated with herpes simplex are generally atypical and present with necrosis, torpid ulceration, and pseudotumoral mass. | Antiviral medications including acyclovir, famciclovir, and valacyclovir for up to a year, with reassessment at the end of therapy. |
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| Cytomegalovirus | Less common, but one of the most important infectious complications after liver transplantation. It usually occurs in the setup of strong immunosuppression. Skin manifestations include polymorph vesicles, ulceration, necrotic lesions in oral cavity, and genitalia. | Antiviral medications such as ganciclovir (GCV), valganciclovir (VGCV), foscarnet (FOS), and cidofovir (CDV) for 3-6 months. |
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| Herpes zoster | Herpes zoster virus infection that presented as necrotic or hemorrhagic pustules, is generalized in distribution, and is limited to dermatome. It affects less than 5% of liver graft recipients. | The nucleoside analogues acyclovir, valacyclovir, or famciclovir can be used for 7 days. |
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| Epstein-Barr virus | Responsible for lingual infection. | Acyclovir, desciclovir, ganciclovir, interferon-alfa, interferon-gamma, adenine arabinoside, and phosphonoacetic acid. |
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| Parvovirus B19 | It presents with erythema infectiosum and vasculitis. | Intravenous immunoglobulin (IVIG) |
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| Papillomavirus | Clinical manifestations like verrucae vulgaris, condyloma, and plantar warts. | Antiviral medications such as podophyllotoxin, trichloroacetic acid (TCA), bichloroacetic acid (BCA), and interferons. Sometimes cryoablation, surgical excision, and laser ablation are also used. |
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| Human Herpes virus 6 and 7 | Reactivation usually occurs in the setup of strong immunosuppression within 2 to 8 weeks of liver transplantation and presents with cutaneous maculopapular rashes. | HHV-6 infections in immunocompetent patients are generally not treated, since most cases are self-limited and antiviral therapy has not been studied in such patients. In severe cases of HHV-6 ganciclovir can be used.
No treatment is available for HHV-7 infection at present. In vitro, foscarnet, cidofovir, and tenofovir inhibit HHV-7 replication by achievable concentrations. The virus is relatively resistant to acyclovir, penciclovir, and ganciclovir. |
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