Viral Infections - Skin Uoa

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viral warts define

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are tumours or growths of the skin caused by infection with Human Papilloma Virus (HPV)

esp common in childhood

spread by direct contact or auto-inocculation

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whats this

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exophytic wart and periungual warts

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whats this

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common wart

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whats this

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filiform wart

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whats this

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Condyloma acuminata (genital warts)

often transmitted sexually

Types 6 & 8 are the most common to cause symptoms but types 16 & 18 predispose to cervical, penile and vulval cancer

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Koebnerised plane wart (arising in the line of minor trauma)

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Mosaic warts (clustered in a mosaic-like plaque)

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whats this

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Myrmecia (domed with central depression, like an ant hill)

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whats this

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Plane (flat) warts

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In children, even without treatment, 50% of warts disappear within 6 months; 90% are gone in 2 years. They are more persistent in adults but in most they clear up eventually. true/false

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true

Many people don't bother to treat them because treatment can be more uncomfortable and troublesome than the warts - they are hardly ever a serious problem.

Wart removal may stimulate an immune response, if not, recurrence is likely.

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The most popular wart treatments include

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Occlusion with duct tape

Daily application of paints containing keratolytics such as 15- 60% salicylic acid

Cryotherapy sufficient to cause blistering repeated every 2-4 weeks on 4-6 occasions

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other wart tx

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wart pain - up to 70% will resolve with this tx

other measures include:

Podophyllin, a cytotoxic agent, contraindicated during pregnancy.

Soaks using cotton balls with 3% formalin solution applied for 10 minutes daily

Electrosurgery (curettage & cautery) is used for particularly large and annoying warts.

Under local anaesthetic, the growth is pared away and the base burned by diathermy or cautery. The wound heals in about two weeks; even then 20% of warts can be expected to recur within a few months.

Bleomycin injections

Laser vaporisation

Immune modulators (imiquimod).

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whats this

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Molluscum contagiosum

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whats this

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Localised eczema due to molluscum contagiosum

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whats this

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Scarring from recently resolved molluscum contagiosum

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Molluscum contagiosum is a common cutaneous infection mainly presenting in childhood as multiple soft umbilicated papules in the flexures.

Molluscum often provokes localised eczema.

As the lesions resolve they may become inflamed or necrotic and may leave punctate scars.

The cause is a pox virus.

The papules resolve after a few months and rarely persist for longer than a year.

Thick white material (molluscum bodies) can be expressed from the papules, which hastens their resolution.

tx?

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Emollients and mild topical steroids to reduce itching and eczema

No other treatment is necessary or advisable in the majority of young children

In older children the lesions can be removed individually. Methods include expressing lesion contents using forceps or curettage, simply poking with a sharp stick, and cryotherapy.

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whats this

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Herpetic gingivostomatitis caused by herpes virus

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whats this

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Recurrent herpes labialis (cold sores) caused by herpes virus

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whats this

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Recurrent facial herpes

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whats this

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Eczema herpeticum (severe herpes simplex infection in an individual with atopic dermatitis)

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whats this

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genital herpes

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whats this

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Child with primary herpes (mother had concurrent cold sore)

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herpes complications may include

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Postinflammatory hypo- or hyperpigmentation or scarring

Localised neuralgia and/or paresis

Keratoconjunctivitis

Eczema herpeticum.

Throat infections

Meningoencephalitis

Disseminated infection

Neonatal herpes infection.

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Recurrent herpes infections can be triggered by:

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Localised trauma: dental procedure, injection, cosmetic treatment

Upper respiratory tract infections

Exposure to ultraviolet radiation

Premenstrual tension

Emotional stress and unknown factors.

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herpes simplex virus The diagnosis may be confirmed by one of the following methods:

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Viral culture of swab from vesicle (reported in about 5 days)

Immunofluorescence of basal cells collected from fresh vesicles onto slides for rapid identification (24 hours).

5ml plain tube blood or 500 µl serum for serology

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tx for herpes simplex virus

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may include aciclovir for acute severe infections and prophylaxis.

This may be required short term to cover facial surgical or cosmetic procedures or parturition, or long term in those with frequent recurrences.

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whats this

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herpes zoster inxn = zoster vesicles

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whats this

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Ophthalmic zoster caused by h. zoster

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whats this

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T2 zoster

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whats this

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Mandibular zoster, affecting tongue

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whats this

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T5 zoster

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whats this

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Ophthalmic zoster

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Treatment of active herpes zoster may include:

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Rest and analgesicsPovidone iodine or calamine lotion applied to blistersOral aciclovir 800mg 5 times daily for 7 daysFor severe infections, systemic steroids may be recommended.Oral antibiotics may be needed for secondary infection.

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herpes zoster can affect

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muscle nerves and sensory nerves

facial nerve palsy is the most common result

50% chance of complete recover + overtime i/t in nearly all pxs

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herpes zoster causes

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shingles

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Post-herpetic neuralgia is defined as

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persistence or recurrence of pain more than a month after the onset of shingles

esp if GT 40 and facial infxn

painful, burning, rarely itchy, numb/tender

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Post-herpetic neuralgia may be difficult to treat successfully. It may be tx with

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tricyclic antidepressant medications such as amitriptyline or

anti-epileptic medication such as carbamazepine or sodium valproate.

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the virus that causes each dermatological eruption

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HPV e.g. warts

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Molluscum contagiosum is due to infection with

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molluscum contagiosum pox virus, the largest virus known.

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Cold sores are the secondary eruption of

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herpes simplex

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a wart can be described as a

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Hyperkeratotic papule

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Molluscum contagiosum

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umbilicated papule

Characteristically, molluscum contagiosum presents as umbilicated papules. A soft white core can be expressed from the central umbilication

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cold sores can be described as

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Umbilicated vesicles

Characteristically, cold sores present as umbilicated vesicles, although the umbilication is not always obvious and late lesions are crusted erosions.

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Shingles

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Dermatomal umbilicated vesicles

Characteristically, shingles presents as umbilicated vesicles in a unilateral dermatomal distribution. There may be painful erythematous plaques instead or as well.

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Which of the following statements are true about a viral wart?

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It may induce mucocutaneous malignancy

Viral warts may induce malignancy, particularly genital warts oncogenic types 16 and 18, which cause cervical, vulvar and penile cancer.

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Which of the following statements are true about molluscum contagiosum?

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It often provokes localised eczema

Molluscum contagiosum may present as localised eczema in warm moist flexural areas; the viral papule(s) are sometimes unnoticed.

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Which of the following statements are true about herpes simplex?

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The most common site is a mucosal surface

Herpes simplex frequently affects oral and genital mucosae, but it can also affect cutaneous areas.

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Which of the following statements are true about herpes zoster?

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It may be accompanied by persistent dermatomal pain

Secondary herpes zoster infection is characteristically painful, and may result in disabling postherpetic neuralgia for weeks or months after the skin eruption has resolved.