Viral Skin Infections: Verrucae Valgarus
Viral Skin Infections: Verrucae Valgarus
Viral skin diseases are classified by clinical features into three types:
Viral warts
subtypes of DNA human papilloma virus have been identified. The virus
most commonly infects children and young adult by direct inoculation and
is transmitted by touch, sexual contact or at the swimming baths. They
commonly appear at sites of trauma. A line of warts may appear as a result
of scratching (Koebner phenomenon).
Clinical presentation
Certain clinical patterns are well recognized:
verrucae valgarus
1. Common warts. These present as dome-shaped papules or nodules with
a rough keratotic surface. They are usually multiple, and are commonest
on the hands or feet in children but also affect the face and genitalia. Their
surface interrupts skin lines. Thrombosed capillaries appear as black dots
on the surface of warts, an important diagnostic sign.
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4. Plantar warts. These are seen in children and adolescents on the soles
of the feet; pressure causes them to grow into the dermis. They are painful The only
type
and covered by callus, which, when pared, reveals dark punctate spots because
(thrombosed capillaries). A cluster of fused planter warts is referred to as itinward
grows
They occur next to the nails, at the tips of fingers and toes.
6. Genital warts. In males these affect the penis, and in homosexuals, the
perianal area. In females, the vulva, perineum and vagina may be involved.
The warts may be small, or may coalesce into large cauliflower-like
'condylomata acuminata'. Genital warts may be associated with an
increased risk of cervical and anal carcinoma.
7. Epidermodysplasia verruciformis:
Management
In children, 30-50% of common warts disappear spontaneously within 6
months. Otherwise treatment will depend on the type of wart. Generally
any destructive non scarring method could be used, such as:
- Electrocautery.
- CO2 laser.
- Cryotherapy.
- Curettage.
- Contact immunotherapy by using dinitrochlorobenzene "D.N.C.B."
- Topical tretinoin or 5- fluorouracil "5FU" for plane warts.
- Podophyllum resin especially for genital warts.
- Intralesional Bleomycin sulphate.
- Intralesional interferon alpha- 2b recombinant.
- Oral zinc sulphate, levamisole or cimitedine for widespread warts.
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Molluscum contagiosum
ORF:
Diagnosis:
Geimsa stain
1. Tzanck smear: a cytological smear from the base of viral vesicles,
stained to show the multinucleated giant cells, characteristic of herpes
infections.
2. Serological tests: seroconversion or a rise in Ab – titer can be detected
by complement fixation test (C.F.T.), especially in the primary infections,
or by ELISA test.
3. Culturing the virus from vesicular fluid.
Management
Mild herpetic lesions may not require any medication. The treatment of
choice for recurrent mild facial or genital herpes simplex is acyclovir
(Zovirax) cream (applied 5 times a day for 5 days), in severe primary or
extensive recurrent cases, antiviral drugs should be tried:
"Acyclovir": inhibits viral DNA polymerase. It is active against HSV
and HZV.
"Famcyclovir": similar action to acyclovir with longer half life.
"Valcyclovir": it is an acyclovir pro – drug, with better oral
bioavailability.
1 Varicella (chickenpox)
Cause
The herpes virus varicella-zoster is a highly contagious viral infection,
commonly afffects children, transmitted by airborne droplets or vesicular
fluid. The severity of the disease and the complications are greater in
adults.
Presentation and course papules > vesicles > pustules > crusts > healed
The incubation period ranges from 9 – 21 days, averages 14 days,
Example of
polymorphi followed by the prodromal symptoms of slight malaise, fever or headache
c rash 1
followed by the development of papules, which
3
turn rapidly into clear
2
vesicles, the contents
4
of which soon become pustular. Over the next few
5
days the lesions crust and then clear, Lesions of different stages are present
at the same time in any body area, giving the characteristic "polymorphic
rash". Lesions appear in crops, are often itchy, and are most profuse on the
trunk and least profuse on the periphery of the limbs (centripetal). Patients
are contagious from 2 days before onset of the rash until all lesions have
crusted. An attack of chicken pox usually confers lifelong immunity.
Complications
• Pneumonitis, with pulmonary opacities on X-ray.
• Secondary infection of skin lesions.
• Haemorrhagic or lethal chickenpox in the immunocompromised.
Acute cerebellar ataxia and Reye's syndrome (if the patient had took
salicylates during the infection).
Systemic involvement (myocarditis, hepatitis, arthritis…).
Treatment
2
HERPES ZOSTER (SHINGLES):
Clinical presentation
Complications
Management