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AH3N2 Influenza: Dermatological manifestations and the role of topical natural remedies in treatment
Lorenzo Martini
1,2, Igor Feszak3, Piotr Brzeziński3
1University of Siena, Department of Pharmaceutical Biotechnologies, Via A. Moro 2, 53100 Siena, Italy, 2C.R.I.S.M.A. Inter University Centre for Researched Advanced Medical Systems, Via A. Moro 2, 53100 Siena, Italy, 3Institute of Health Sciences, Pomeranian University in Slupsk, Slupsk, Poland
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© Our Dermatology Online 2025. No commercial re-use. See rights and permissions. Published by Our Dermatology Online.
Sir,
Every year, tropical and subtropical regions, such as Italy, Macedonia, and Albania, experience two peak influenza seasons: one from January to March and another following the monsoon season in October-November. Seasonal changes in weather and climate bring a host of illnesses, with influenza being among the most prominent.
Influenza virus H3N2, a subtype of the Orthomyxoviridae family, has been increasingly observed in outbreaks due to its rapid atmospheric spread. Common symptoms such as cough, fever, sore throat, and body aches make it difficult to differentiate from other viral infections. While most individuals recover within a week, complications can arise if symptoms are ignored, including pneumonia, bronchitis, and in severe cases, fatal outcomes. Early diagnosis and prompt treatment remain crucial [1,2].
Influenza viruses are enveloped, single-stranded RNA viruses. They are classified into types A, B, and C based on variations in surface proteins. Among these, influenza A viruses, including the H3N2 subtype, are particularly associated with seasonal epidemics. Influenza B viruses, which include the Yamagata and Victoria lineages, also contribute to seasonal flu but are less common. Influenza C causes mild infections and is rarely included in diagnostic screenings.
The surface proteins hemagglutinin (H) and neuraminidase (N) define influenza A subtypes. The high mutation rate of these RNA viruses allows for frequent changes in these proteins, contributing to antigenic variability and complicating long-term immunity [2,3].
Role of Migratory Waterbirds in Transmission
Wild aquatic birds, particularly ducks and other waterfowl, are the natural reservoirs for influenza A viruses. These viruses are primarily transmitted via the faecal-oral route among birds, enabling migratory species to carry infections over long distances. This behavior increases the risk of interspecies transmission to animals and humans. Notably, pigs, horses, and humans also serve as hosts for influenza A viruses. In human populations, influenza typically co-circulates during winter months in temperate climates, whereas in tropical climates, transmission occurs over more extended periods without a distinct peak [4].
Clinical Features and Complications
Symptoms of AH3N2 infection range from mild to severe. Common signs include fever (≥38°C), cough, chills, headache, sore throat, fatigue, and muscle pain. In some cases, vomiting and diarrhea may also occur, particularly in children. Dermatological manifestations, such as macular or maculopapular rashes, have been reported in approximately 2% of cases, typically in pediatric patients [5,6].
Maculopapular rashes are characterized by discolored macules and raised papules, typically less than 1 cm in diameter. While these rashes can appear anywhere on the body, they often spread and may cause confusion in diagnosis due to their potential links with other diseases or medication reactions.
Transmission Dynamics
Influenza is primarily transmitted via respiratory droplets produced by infected individuals when talking, coughing, or sneezing. Although less common, aerosol transmission can occur in confined spaces or during specific medical procedures. The virus can also persist on hard surfaces for up to two days, facilitating indirect transmission.
The incubation period for influenza typically ranges from 1 to 7 days, with viral shedding peaking within the first two days after symptom onset. Children and immunocompromised individuals can shed the virus for extended periods, increasing the likelihood of further spread. Prompt antiviral therapy significantly reduces viral shedding and symptom duration [7,8].
The connection between AH3N2 and dermatological manifestations, particularly maculopapular rashes, remains poorly understood. The etiology may be multifactorial, involving immune responses, co-infections, or even medication reactions. While these rashes are not directly life-threatening, their occurrence may signal complications requiring medical intervention.
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The examination of the patient was conducted according to the principles of the Declaration of Helsinki.
Copyright by Lorenzo Martini, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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