Dermatology Rajeev Sharma, Sandipan Dhar, Ashok Kumar Bajaj
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Viral Infections of Skin1

 
COMMON WARTS (FIGS 1.1A AND B)
Caused by human papillomaviruses. Most commonly present over the extremities. Firm papules with a rough, warty surface, range in size from 1 mm to over a cm in diameter. Treatment modalities; cauterization with 50–100% trichloroacetic acid, phenol, podophyllin (15–20%), etc, electrodessiccation, cryotherapy or CO2 Laser.
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Fig. 1.1a: Verruca vulgaris (fingers)
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Fig. 1.1b: Verruca vulgaris (foot)
 
PLANE WARTS (FIG. 1.2)
The lesions present as flat irregular brown or skin colored papules 1–5 mm in size, commonly seen over the face in children. Other sites may also be affected. Treatment is same as for common warts, but aggressive treatment should be avoided.
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Fig. 1.2: Verruca plana
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FILIFORM (DIGITATE) WARTS (FIGS 1.3 AND 1.4)
These present as elongated excrescences over the head and neck, mostly in young adults. Shaving and combing may lead to frequent bleeding. Curettage and cautery (electro/chemical/cryo) is the therapeutic modality.
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Fig. 1.3: Verruca filiform
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Fig. 1.4: Filiform wart
 
PLANTAR WARTS (FIGS 1.5A AND 1.5B)
These are often seen on the pressure point of forefoot but any part of the sole can be affected.
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Fig. 1.5a: Verruca plantaris (close-up)
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Fig. 1.5b: Verrucae plantaris
The lesions are usually rough, hyperkeratotic papules surrounded by a smooth collar of thickened horn. Frequently there are several lesions on one foot and sometimes they are grouped. They are deep, dome-shaped and tender on lateral pressure. Salicylic acid ointment, trichloroacetic acid, cytotoxics, canthridin, tretinoin are topical modalities used for treating plantar warts. Excision should be avoided.
 
MOLLUSCUM CONTAGIOSUM (FIGS 1.6 AND 1.7)
This condition is caused by pox viridae and commonly affects small children. The individual lesion is a shiny, pearly, white hemispherical, umbilicated papule. The most common sites affected are the face and trunk, but it may also affect the limbs, scalp and genitalia in adults. Lesions are treated by chemical cautary by 50–100% trichloroacetic acid, potassium hydroxide (5%), phenol, canthridin or silver nitrate.
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Fig. 1.6: Molluscum contagiosum
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Fig. 1.7: Molluscum contagiosum in HIV +ve
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HERPES SIMPLEX INFECTION
This is one of the most common infections throughout the world. Primary infection may be subclinical but when clinical lesions develop, the severity is generally greater than that in recurrences.
 
Herpes Labialis (Cold Sores) (Figs 1.8 and 1.9)
Grouped vesicles on erythematous base are the primary lesions which tend to recur with bouts of fever, physical exertion, stress, excessive sun exposure and menstruation. Only symptomatic treatment is usually sufficient. In severe cases acyclovir in adequate doses is to be given for 5–7 days depending upon the severity and extent of the disease.
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Fig. 1.8: Herpes labialis (primary episode)
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Fig. 1.9: Herpes labialis (recurrent)
 
Herpetic Gingivostomatitis (Fig. 1.10)
This is mostly seen in children as primary herpes infection. This presents as stomatitis gingivitis, with fever, malaise, restless-ness and excessive dribbling.
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Fig. 1.10: Herpes simplex stomatitis
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The gums are swollen, painful and bleed easily. For primary infection the dose of acyclovir is 200–400 mg 3 times/day for 10 days.
 
Keratoconjunctivitis (Fig. 1.11)
Primary herpes infection of the eye causes a severe and often purulent conjunctivitis with opacity and superficial ulceration of the cornea. It should be treated by an ophthalmologist. Eye drops of idoxuridine, trifluridine are useful for this disease.
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Fig. 1.11: Herpes simplex keratitis
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HERPES ZOSTER (FIGS 1.12 TO 1.16)
Herpes zoster is caused by varicella-zoster virus. The typical lesions are grouped vesicles on an erythematous base along dermatomes on one side of the body. Multidermatomal involvement specially in young adults should arouse suspicion of underlying HIV infections. Thorax is the common site of involvement and adults are commonly affected. Variable degree of pain is associated and in some cases it may be intolerable. In milder cases topical calamine lotion and NSAIDs suffice. In severe and symptomatic cases, oral acyclovir, 400–800 mg 5 times/day or famciclovir 250–500 mg 3 times a day for 7–10 days is advised along with pain killers and sedatives.
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Fig. 1.12: Herpes zoster
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Fig. 1.13: Herpes zoster(close up)
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Fig. 1.14: Herpes zoster ophthalmicus
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Fig. 1.15: Herpes zoster (mandibular)
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Fig. 1.16: Herpes zoster multidermatomal
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Fig. 1.17: Chicken pox trunk
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Fig. 1.18: Chicken pox
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VARICELLA (CHICKENPOX) (FIGS 1.17 AND 1.18)
It is a highly contagious disease of childhood and at times adulthood caused by varicella-zoster virus. Transmission is by droplet infection. The incubation period of the disease is 15–20 days and the disease usually begins with fever, malaise and development of an exanthem on the first day. The eruption usually starts on the trunk and has a centripetal distribution and the involvement of mucous membrane is characteristic. The vesicles are polymorphic in nature, i.e. present in the form of macules, papules and vesicles, all in different stages of evolution at the same time. Patients are believed to be contagious for 1–2 days before and for approximately 5 days after the onset of rash. Acyclovir orally at a dose of 20 mg/kg/dose 5 times a day for children, if started within 24–48 hours, gives good results. This is also useful in immunocompromised children. Symptomatic treat-ment with oral antihistaminics, topical calamine may help relieving the local discomfort.