Those patients with herpes simplex infection should be advised that reactivation of the virus may occur in between 15% and 50% within to 12 months Prompt antiviral treatment for any reactivation should be advised through their primary care clinician or dermatologist to avoid a recurrence of more widespread viral secondary infection Papular-Purpuric Gloves-and-Socks Eruption Papular-purpuric gloves-and-socks eruption (PPGS) presents as an often painful petechial eruption concentrated on the palms and soles, but often extending proximally to involve the skin of the wrists, forearms, ankles, and lower legs in a so-called “gloves-and-socks” distribution ( Fig 70.16 ) The condition is triggered most commonly by infection with parvovirus B19, although other organisms have been linked to this condition, including cytomegalovirus, HHV 6,7, coxsackie B6, Epstein–Barr virus (EBV), hepatitis B virus, measles virus, Arcanobacterium hemolyticum , and Mycoplasma pneumoniae FIGURE 70.16 Papular-purpuric gloves-and-socks eruption caused by parvovirus B19 Note the multiple petechial papules on the ankles and feet which were also present on palms and forearms