Viral Warts and Their Types
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Questions and Answers

What virus is responsible for causing Viral Warts?

  • Herpes simplex virus
  • HIV
  • Human papillomavirus (correct)
  • Cytomegalovirus

    • Which HPV types are most commonly associated with genital warts?

  • HPV 6, 11, 16 and 18 (correct)
  • HPV 1 and 4
  • HPV 2 and 16
  • HPV 3 and 10

    • What characteristic is specific to common warts?

  • They may present with black dots when scraped. (correct)
  • They are typically painful.
  • They have a smooth surface.
  • They are flat and elevated.

    • What is a typical feature of plantar warts?

    <p>They may appear as painful, deeply embedded papules.</p> Signup and view all the answers

    Which of the following generally occurs from direct skin-skin contact?

    <p>Common warts</p> Signup and view all the answers

    Which HPV genotypes are primarily associated with cervical and anal cancers?

    <p>HPV 16 and 18</p> Signup and view all the answers

    How long can the majority of warts take to regress spontaneously?

    <p>1-2 years</p> Signup and view all the answers

    What type of wart is characterized as slightly elevated, flat, and smooth?

    <p>Plane or flat wart</p> Signup and view all the answers

    What is the primary mode of transmission for HSV-1?

    <p>Direct contact with contaminated saliva or lesions</p> Signup and view all the answers

    Which symptom typically precedes the onset of mucocutaneous lesions in primary HSV-1 infection?

    <p>Tender lymphadenopathy</p> Signup and view all the answers

    Which of the following is NOT commonly associated with recurrent infections of HSV?

    <p>Pregnancy</p> Signup and view all the answers

    What characteristic feature distinguishes primary herpes infection from recurrent disease?

    <p>Presence of regional lymphadenopathy and fever</p> Signup and view all the answers

    What type of presentation can occur in patients with eczema who develop HSV infection?

    <p>Eczema herpeticum</p> Signup and view all the answers

    What type of lesions are characteristically formed during primary HSV-2 infection?

    <p>Painful grouped vesicles</p> Signup and view all the answers

    What treatment is recommended for eczema herpeticum in young infants?

    <p>Acyclovir 5-10 mg/kg IV</p> Signup and view all the answers

    How long does a typical primary HSV-1 infection take to show symptoms after exposure?

    <p>3 to 7 days</p> Signup and view all the answers

    Which areas are most commonly affected by warts?

    <p>Face and dorsum of the hands</p> Signup and view all the answers

    What is Koebner’s phenomena associated with?

    <p>Occurrence of new lesions at trauma sites</p> Signup and view all the answers

    Which HPV types are most commonly associated with genital warts?

    <p>Types 6 and 11</p> Signup and view all the answers

    What is the most standard method for wart treatment?

    <p>Cryotherapy by liquid nitrogen</p> Signup and view all the answers

    What is the primary cause of oral warts?

    <p>Low-risk genital HPV types</p> Signup and view all the answers

    What is a common characteristic of mucosal warts?

    <p>They often appear macerated and pale</p> Signup and view all the answers

    Which virus is associated with chickenpox and herpes zoster?

    <p>HHV-3</p> Signup and view all the answers

    Which method is NOT a routine treatment for warts?

    <p>Immediate surgical removal of all warts</p> Signup and view all the answers

    What is the primary mode of transmission for Orf (Ecthyma Contagiosum)?

    <p>Contact with infected livestock</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the lesions caused by Orf infection?

    <p>Contains pus and drains fluid</p> Signup and view all the answers

    Which complication is most commonly associated with Orf infection?

    <p>Secondary bacterial infection</p> Signup and view all the answers

    What is the recommended management for a healthy individual infected with Orf?

    <p>Use of topical antibiotics to prevent infection</p> Signup and view all the answers

    Which group of individuals may require more intensive treatment for Orf infection?

    <p>Immunocompromised patients</p> Signup and view all the answers

    What is the appearance of the initial varicella lesion?

    <p>2-4 mm red papule with irregular outline and clear vesicle</p> Signup and view all the answers

    What is a known complication of varicella?

    <p>Reye's syndrome</p> Signup and view all the answers

    Which treatment is contraindicated during varicella due to the risk of Reye's syndrome?

    <p>Aspirin</p> Signup and view all the answers

    In herpes zoster, pain often localizes to which area before the skin eruption?

    <p>The affected dermatome</p> Signup and view all the answers

    What triggers the reactivation of varicella-zoster virus leading to shingles?

    <p>Emotional upset and immunosuppression</p> Signup and view all the answers

    How is herpes zoster characterized in terms of its eruption?

    <p>Grouped vesicles on erythematous bases along a sensory nerve</p> Signup and view all the answers

    What dosage of oral acyclovir is recommended for adults with chickenpox?

    <p>800 mg five times daily for 7 days</p> Signup and view all the answers

    Which of the following statements about herpes zoster is true?

    <p>It can occur multiple times in a lifetime</p> Signup and view all the answers

    What type of wart is primarily associated with painful, deeply embedded papules on the sole of the foot?

    <p>Plantar wart</p> Signup and view all the answers

    HPV types 16 and 18 are linked to cervical and anal cancers.

    <p>True</p> Signup and view all the answers

    Name one HPV type that is associated with common and plantar warts.

    <p>HPV 1, 2, or 4</p> Signup and view all the answers

    Mosaic warts consist of a plaque of closely grouped ______.

    <p>warts</p> Signup and view all the answers

    Match the type of wart with a characteristic feature:

    <p>Common wart = Firm, papules with hyperkeratotic surfaces Filiform wart = Thread-like projections on the face Plane wart = Slightly elevated, smooth papules Mosaic wart = Closely grouped plaques of warts</p> Signup and view all the answers

    How does genital wart transmission primarily occur?

    <p>Intimate contact</p> Signup and view all the answers

    Most warts will not regress on their own within 1–2 years.

    <p>False</p> Signup and view all the answers

    What are the names of the HPV types that are commonly found in genital warts?

    <p>HPV 6 and 11</p> Signup and view all the answers

    What is the primary characteristic of anogenital warts?

    <p>They appear as well-defined papules.</p> Signup and view all the answers

    Koebner's phenomena is not observed in warts.

    <p>False</p> Signup and view all the answers

    What is the primary mode of transmission for Orf (Ecthyma Contagiosum)?

    <p>Direct contact with infected animals</p> Signup and view all the answers

    Name one treatment option for flat warts.

    <p>Retinoids</p> Signup and view all the answers

    Warts caused by low-risk genital HPV types ______ and ______ are typically responsible for anogenital warts.

    <p>6, 11</p> Signup and view all the answers

    Orf lesions typically clear within 3 to 6 weeks without active treatment.

    <p>True</p> Signup and view all the answers

    Name one comorbidity that can lead to more severe manifestations of Orf infection.

    <p>Immunocompromised status</p> Signup and view all the answers

    Match the herpes viruses with their associated diseases:

    <p>HSV-1 = Herpes Labialis HSV-2 = Herpes Genitalis VZV = Chickenpox and Herpes Zoster EBV = Infectious Mononucleosis</p> Signup and view all the answers

    What percentage of warts typically resolves on their own within two years?

    <p>More than two-thirds</p> Signup and view all the answers

    The lesion progresses through six stages, including maculopapular, targetoid, _____, regenerative, papillomatosis, and regression.

    <p>weeping nodule</p> Signup and view all the answers

    Match the following stages of Orf lesion progression with their descriptions:

    <p>maculopapular = Initial rash stage weeping nodule = Fluid-filled lesion papillomatosis = Growth of wart-like lesions regression = Healing phase where lesions diminish</p> Signup and view all the answers

    Surgical excision is an unnecessary treatment for all types of warts.

    <p>False</p> Signup and view all the answers

    What is a standard method used for wart treatment?

    <p>Cryotherapy</p> Signup and view all the answers

    Which route is primarily responsible for the transmission of HSV-2?

    <p>Sexual contact</p> Signup and view all the answers

    Primary HSV-1 infection always presents with noticeable symptoms.

    <p>False</p> Signup and view all the answers

    What medical treatment is recommended for eczema herpeticum in young infants?

    <p>Acyclovir 5-10mg/kg IV</p> Signup and view all the answers

    Symptoms of primary HSV-1 infection typically occur within _____ days after exposure.

    <p>3 to 7</p> Signup and view all the answers

    Match the clinical features with the appropriate type of HSV infection:

    <p>Primary HSV-1 = Painful, grouped vesicles on an erythematous base Primary HSV-2 = Extremely painful erosive balanitis Recurrent HSV-1 = Lesions occur in the same location each time Eczema herpeticum = Rapid, widespread discrete erosions</p> Signup and view all the answers

    Which of the following are common triggers of recurrent HSV infections? (Select all that apply)

    <p>Menstruation</p> Signup and view all the answers

    In addition to painful lesions, primary HSV-2 infection can also present with constitutional symptoms.

    <p>True</p> Signup and view all the answers

    What is a distinguishing feature of lesions during recurrent infections of HSV?

    <p>Lesions usually occur on the same place each time.</p> Signup and view all the answers

    What complication is associated with recurrent herpes simplex infections?

    <p>Erythema multiforme</p> Signup and view all the answers

    An attack of chickenpox usually confers lifelong immunity.

    <p>True</p> Signup and view all the answers

    Which topical antiviral cream is commonly used to manage mild recurrent herpes simplex attacks?

    <p>Acyclovir</p> Signup and view all the answers

    The lesions of chickenpox are usually present at different stages, including papules, vesicles, pustules, and __________.

    <p>crusts</p> Signup and view all the answers

    Match the following terms related to herpes simplex and varicella infection with their descriptions:

    <p>Eczema herpeticum = Herpes infection occurring in individuals with atopic dermatitis Herpetic whitlow = Painful vesicular infection of the finger Varicella-zoster virus = Causes chickenpox and shingles Acyclovir = Antiviral medication used to treat herpes infections</p> Signup and view all the answers

    What is the incubation period range for varicella (chickenpox)?

    <p>9 to 21 days</p> Signup and view all the answers

    Herpetic whitlow primarily affects adults and is rarely seen in children.

    <p>False</p> Signup and view all the answers

    What is the first sign of recurrence for which acyclovir cream should be applied?

    <p>Pain or itching</p> Signup and view all the answers

    What type of HPV is primarily associated with cervical and other anogenital cancers?

    <p>HPV 16</p> Signup and view all the answers

    HSV-2 is primarily associated with oral herpes.

    <p>False</p> Signup and view all the answers

    Name one common treatment option for managing common warts.

    <p>Salicylic acid</p> Signup and view all the answers

    Herpes Simplex Genitalis is characterized by painful __________.

    <p>genital sores</p> Signup and view all the answers

    Match the clinical manifestations with their corresponding virus:

    <p>HPV = Plantar warts HSV-1 = Cold sores HSV-2 = Genital sores</p> Signup and view all the answers

    What is a characteristic feature of flat warts?

    <p>Usually found on the face or shins</p> Signup and view all the answers

    Direct skin-to-skin contact is the only method for transmitting HPV.

    <p>False</p> Signup and view all the answers

    What antiviral medication is commonly used to reduce the symptoms of herpes simplex virus infections?

    <p>Acyclovir</p> Signup and view all the answers

    Which virus is primarily responsible for causing shingles?

    <p>Varicella-Zoster Virus</p> Signup and view all the answers

    What is a potential complication of untreated herpes simplex virus infections?

    <p>Painful vesicular lesions</p> Signup and view all the answers

    Which of the following symptoms is most commonly associated with varicella?

    <p>Pruritic vesicular rash</p> Signup and view all the answers

    What is the main mode of transmission for Human Papillomavirus (HPV) associated with genital warts?

    <p>Skin-to-skin contact</p> Signup and view all the answers

    What is the characteristic appearance of lesions caused by Orf (Ecthyma contagiosum)?

    <p>Painful nodular lesions</p> Signup and view all the answers

    Which type of herpes simplex virus is primarily associated with oral lesions?

    <p>HSV-1</p> Signup and view all the answers

    Which high-risk HPV types are associated with an increased risk of certain cancers?

    <p>HPV 16 and 18</p> Signup and view all the answers

    Which treatment is often used for molluscum contagiosum lesions?

    <p>Cryotherapy</p> Signup and view all the answers

    Study Notes

    Viral Warts

    • Caused by the Human Papillomavirus (HPV)
    • More than 150 HPV genotypes
    • Genital Warts are spread via intimate contact
    • Non-Genital Warts are spread via skin-to-skin contact, contaminated surfaces, objects (e.g. swimming pool, gym), or autoinoculation
    • Most warts resolve within 1-2 years
    • Persistent infection with sexually transmitted high-risk mucosal types, mostly HPV 16 and 18, can cause cervical, anal, vaginal, vulvar, penile, oropharyngeal cancers

    Common Wart (Verruca Vulgaris)

    • Firm, papules with hyperkeratotic surfaces
    • Occur singly or in groups
    • Commonly on fingers and hands
    • Filiform warts, a variant of Common Warts, show thread-like keratinous projections and occur mostly on the face and scalp

    Plantar Wart (Verruca Plantaris)

    • Painful, deeply embedded papules on the sole of the foot, esp. on pressure points
    • May be single or multiple
    • Covered with a rough hyperkeratotic surface, when removed, black dots (thrombosed capillaries) become apparent
    • Mosaic wart is a plaque of closely grouped warts
    • DDx: Corn, Callus

    Plane or Flat Wart (Verruca Plana)

    • Slightly elevated, flat, smooth papules
    • Usually skin-colored or pigmented
    • Commonly on face and dorsum of hands
    • Occur in numbers ranging from few to hundreds
    • Koebner’s phenomena (i.e.occurrence of new lesions at trauma sites) is positive, like in the common wart
    • DDx: Lichen Planus, Acne

    Anogenital Wart (Condylomata Acuminata)

    • Affect vulva, vagina, cervix, penis, scrotum, perianal skin, and anal canal
    • Lesions are well-defined papules
    • On mucosal surfaces, they are macerated and appear pale, on dry skin, they can become hyperkeratotic
    • May be small or coalesce into cauliflower-like masses

    Oral Warts

    • Warts on the lips, in the oral cavity, and upper respiratory tract
    • Usually regarded as STD
    • Low-risk genital HPV (6,11) types cause oral warts, less commonly other HPV subtypes

    Treatment Considerations

    • Routine treatment of every wart is unnecessary
    • Self-resolution may occur (more than 2/3 resolve within 2 years)

    Topical Applications

    • Common and plantar warts: keratolytics (salicylic acid and lactic acid) and Trichloroacetic acid (TCA)
    • Flat warts: Retinoids
    • Anogenital warts: Podophyllin and Imiquimod cream

    Surgical Methods

    • Standard: Cryotherapy by liquid nitrogen
    • Filiform warts and exophytic lesions: Curettage
    • Electrosurgery and Cautery
    • Recalcitrant warts: Surgical excision and Laser Surgery

    Herpes Simplex Viruses (HSV-1 & HSV-2)

    • Herpes Labialis, Cold Sore, Fever Blister, Herpes Genitalis
    • Produce primary and recurrent vesicular eruptions, favoring the orolabial and genital regions
    • HSV-1: cause extra-genital infection, HSV-2: cause genital disease.
    • Transmission can occur during asymptomatic periods of viral shedding.

    HSV-1 Transmission

    • Spread primarily through direct contact with contaminated saliva or lesions secretions.

    HSV-2 Transmission

    • Spread primarily by sexual contact.

    Clinical Features

    • HSV replicates at the site of infection and then travels by retrograde axonal flow to the nerve ganglia, where it establishes latency until reactivation
    • Asymptomatic infection is common
    • Symptoms typically occur within 3 to 7 days after exposure.
    • Prodrome of tender lymphadenopathy, malaise, anorexia, and fever often occurs before the onset of mucocutaneous lesions
    • Mucocutaneous lesions may be preceded by localized pain, tenderness, burning, and tingling
    • Painful, grouped vesicles appear on an erythematous base, followed by erosions or ulcerations with a scalloped border
    • Primary HSV-2 infection is frequently asymptomatic but can present as extremely painful erosive balanitis, vulvitis or vaginitis.

    Primary HSV-2 Infection

    • Presents with constitutional symptoms and painful grouped vesicles in genitalia
    • Progresses to pustules, crusting, and tender ulcers
    • May have painful lymphadenopathy, cervicitis, urethritis, and proctitis
    • More extensive local involvement, regional lymphadenopathy, and fever distinguish primary herpes infection from recurrent disease

    Recurrent HSV-1 and HSV-2 Infection

    • Lesions usually occur in the same place each time
    • Precipitated by:
      • Fever
      • Respiratory tract infection
      • Exposure to sun
      • Menstruation
      • Stress
      • Trauma

    Cutaneous Herpes Simplex

    • Occurs in patients with atopic dermatitis and other skin diseases with impaired skin barrier

    Eczema Herpeticum

    • Rapid, widespread, monomorphic, discrete, 2–3 mm punched-out erosions with hemorrhagic crusts
    • Mostly occur in areas of active or recently healed atopic dermatitis, particularly the face
    • The disease in most cases is a primary HSV-1 infection
    • Severity of infection ranges from mild to fatal
    • Eczema herpeticum of the young infant is a medical emergency, treated with acyclovir 5-10mg/kg 8 hourly IV
    • In adults, acyclovir 800mg 3 times daily for 10 days.

    Oral Lesions (enanthem) and Scalp Lesions

    • Highly suspicious for HSV-1 infection

    Varicella (Chickenpox)

    • The lesion starts as a 2-4 mm red papule that develops an irregular outline (rose petal) and a thin-walled clear vesicle appears on the surface (dewdrop)
    • This lesion, "dewdrop on a rose petal," is highly characteristic of varicella

    Complications of Varicella

    • Secondary bacterial infection
    • Encephalitis
    • Reye’s syndrome
    • Pneumonia
    • Scarring (if lesions are secondarily infected or excoriated)

    Treatment of Varicella

    • In healthy children, varicella is generally benign and self-limited
    • Cool compresses, calamine lotion locally, and oral antihistamines may relieve itching
    • Antipyretic like Paracetamol (excluding aspirinà Reye’s syndrome)
    • Oral antibiotic against Strep.and Staph. like cephalexin is indicated for secondarily infected lesions
    • Adult chickenpox, in addition to the above, should be treated with oral acyclovir (800mg 5 times daily for 7 days)
    • Shingles: Same dose as adult chickenpox (800mg 5 times daily for 7 days)
    • Children: 20 mg/kg/dose

    Herpes Zoster (HZ) (Shingles)

    • Varicella and shingles are both produced by the same virus.
    • Varicella results from contact of a non-immune person with the virus, whereas shingles occurs in persons who have had previous varicella, either clinically or subclinically
    • Reactivation of a latent infection in either a spinal or a cranial sensory ganglion causes HZ.
    • Precipitating factors for reactivation:
      • Age
      • Immunosuppression (drug, disease)
      • Emotional upset
      • Radiation
    • Occurs largely in adults, particularly in old age, but it can occur in children with a mild course
    • Localized pain, tenderness, paresthesia precedes the eruption by 4-5 days, accompanied by fever, headache, and malaise
    • Regional lymphadenopathy may be present
    • Pain may simulate pleurisy, MI, renal pain, abdominal disease, or migraine headache
    • Transmission of the virus is possible and can cause chicken pox in non-affected individuals
    • Eruption consists of grouped vesicles on an erythematous and edematous inflammatory base, arranged along the course of a sensory nerve in an interrupted or continuous band
    • HZ is characteristically unilateral, dermatomal
    • Thoracic region affected in 2/3 of cases
    • Possible, though very unusual, to have two or three episodes in a lifetime

    Molluscum Contagiosum

    • Benign poxvirus infection
    • Lesions are small, waxy, pearly, flesh-colored papules with a central umbilication
    • Typically occur on the face, trunk, extremities, and genitals
    • Cause: human molluscum contagiosum virus (MCV)
    • Spread: direct contact, fomites (especially contaminated towels), autoinoculation
    • Usually self-limiting, resolving within 6 to 18 months without treatment
    • Treatment:
      • Cryotherapy (liquid nitrogen)
      • Curettage (squeezing out the lesions with forceps, piercing them with a needle, and curettage)
      • Wart paints and topical imiquimod
    • Young children generally don't require treatment as Mollusca are self-limiting and usually clear in 6–9 months.

    Orf (Ecthyma Contagiosum)

    • Zoonotic infection caused by orf virus
    • Contracted from sheep and goats
    • Most commonly seen on the hands and fingers of shepherds, their wives who bottle-feed lambs, butchers, vets, and meat porters
    • Lesion develops 3–7 days after contact with an infected animal or animal carcass
    • Progresses through six stages:
      • maculopapular
      • targetoid
      • weeping nodule
      • regenerative
      • papillomatosis
      • regression
    • May be accompanied by lymphangitis, lymphadenopathy, malaise, fever
    • DDx: Milker’s nodule, Pyogenic granuloma, and Herpetic whitlow

    Orf Complications:

    • Secondary bacterial infection
    • Erythema multiforme is a well‐recognized sequel of orf infection
    • Giant orf or widespread lesions can occur in persons with impaired immunity
    • Bullous-pemphigoid‐like eruptions may rarely develop

    Orf Management

    • No active treatment is required, the lesions heal after 3–6 weeks
    • Topical antibiotic can be used to prevent secondary bacterial infection
    • Immunocompromised patients may require debridement, antiviral cidofovir cream, or imiquimod topical immunomodulatory therapy

    Viral Warts

    • Caused by Human papillomavirus (HPV), a DNA virus that infects the skin and mucous membranes
    • HPV affects people of all ages and races, but it is most common in children and young adults.
    • More than 150 genotypes of HPV exist, each with varying specificity for different anatomical sites, causing different skin lesions.
    • HPV types 1, 2, and 4 are found in common and plantar warts.
    • HPV types 3 and 10 are found in plane warts.
    • HPV types 6, 11, 16, and 18 are most common in genital warts and oral warts.
    • Genital warts are mostly transmitted by intimate contact, while non-genital warts can be spread through direct skin-to-skin contact or contaminated surfaces (e.g., swimming pools, gyms).
    • Autoinoculation (spreading the virus from one part of your body to another) is also possible.
    • The majority of warts resolve spontaneously within 1-2 years.
    • Reinfection with the same HPV type after clearance is uncommon.
    • Persistent infection with high-risk mucosal HPV types, particularly HPV 16 and 18, can cause cervical and most anal cancers, along with other cancers, including vaginal, vulvar, penile, and oropharyngeal cancers.
    • Persistent infection with these high-risk HPV types is rarely linked to cancers of the digits.

    Common Wart (Verruca Vulgaris)

    • Characterized by circumscribed, firm papules with "verrucous" hyperkeratotic surfaces.
    • Occur singly or in groups.
    • Usually associated with minimal tenderness.
    • Most commonly found on the dorsal aspects of fingers and hands.
    • Filiform warts, a variant of common warts, show thread-like keratinous projections, mostly occurring on the face and scalp.

    Plantar Wart (Verruca Plantaris)

    • Typically present as deeply embedded, painful papules on the sole of the foot, specifically on pressure points.
    • Can be singular or multiple.
    • Covered with a rough hyperkeratotic surface. Black dots (thrombosed capillaries) may become visible when the surface is removed with a scalpel.
    • A plaque of closely grouped warts is known as a mosaic wart.

    Plane or Flat Wart (Verruca Plana)

    • Slightly elevated, flat, smooth papules.
    • Usually skin-colored, but may be pigmented.
    • Most commonly affect the face and the dorsum of the hands.
    • Numbers can range from a few to hundreds.
    • Positive Koebner phenomenon (new lesions develop at trauma sites) is present, similar to common warts.

    Anogenital Wart (Condylomata Acuminata)

    • Found on the vulva, vagina, cervix, penis, scrotum, perianal skin, and anal canal.
    • Appear as well-defined papules.
    • On mucosal surfaces, they are often macerated and appear pale.
    • On dry skin, they can become more visibly hyperkeratotic.
    • May be small or coalesce into cauliflower-like masses.

    Oral Warts

    • Warts can develop on the lips, in the oral cavity, and in the upper respiratory tract.
    • Usually considered sexually transmitted.
    • The low-risk genital HPV types (6, 11) are the most common cause, with other types causing the condition less frequently.

    Treatment of Warts

    • Routine treatment is not necessary for every wart as self-resolution may occur.
    • More than two-thirds of warts resolve within 2 years.
    • Topical applications:
      • Keratolytics (salicylic acid and lactic acid) for common and plantar warts.
      • Trichloroacetic acid (TCA) is also used for common and plantar warts.
      • Retinoids might be effective for flat warts.
      • Podophyllin is used for anogenital warts.
      • Imiquimod cream is effective for various types of warts.
    • Surgical methods:
      • Cryotherapy (liquid nitrogen) is a standard treatment for warts.
      • Curettage (especially for filiform warts and exophytic lesions).
      • Electrosurgery.
      • Cautery.
      • Surgical excision.
      • Laser surgery (especially for recalcitrant warts).

    Herpes Simplex Viruses (HSV-1 & HSV-2)

    • Also known as Herpes Labialis, Cold Sore, Fever Blister, Herpes Genitalis.
    • Cause primary and recurrent vesicular eruptions that favor the orolabial and genital regions.
    • HSV-1: causes extra-genital infections.
    • HSV-2: causes genital infections.
    • Both viruses can affect any area of skin or mucous membrane.
    • Transmission:
      • HSV-1 is spread through direct contact with contaminated saliva or lesion secretions.
      • HSV-2 is spread primarily through sexual contact.
    • Pathogenesis:
      • Virus replicates at the site of infection.
      • Travels by retrograde axonal flow to the nerve ganglia where it remains latent until reactivation.

    Clinical Features of HSV Infection

    • Primary HSV-1 Infection:
      • Asymptomatic infection is common.
      • Symptoms usually appear within 3-7 days of exposure, often preceded by localized pain, tenderness, burning, and tingling.
      • Prodrome (symptoms before the rash) may include tender lymphadenopathy (swollen lymph nodes), malaise, anorexia, and fever.
      • Painful, grouped vesicles (small, fluid-filled blisters) on an erythematous (reddened) base appear.
      • Lesions progress to erosions or ulcerations with a characteristic scalloped border.
    • Primary HSV-2 Infection:
      • Frequently asymptomatic but can be extremely painful.
      • Often presents as erosive balanitis (inflammation of the head of the penis), vulvitis (inflammation of the vulva), or vaginitis (inflammation of the vagina).
      • May involve constitutional symptoms (fever, chills, muscle aches, etc.).
      • Characterized by painful, grouped vesicles in the genitalia that progress to pustules, crusting, and tender ulcers.
      • Can also cause painful lymphadenopathy, cervicitis (inflammation of the cervix), urethritis (inflammation of the urethra), and proctitis (inflammation of the rectum).
      • More extensive local involvement, regional lymphadenopathy, and fever help distinguish primary herpes infection from recurrent disease.
    • Recurrent Infection of Both HSV-1 & HSV-2:
      • Lesions usually occur in the same location each time.
      • Recurrent outbreaks can be triggered by:
        • Fever.
        • Respiratory tract infections.
        • Sun exposure.
        • Menstruation.
        • Stress.
        • Trauma.

    Cutaneous Herpes Simplex

    • Other clinical presentations of HSV infection include:
      • Eczema Herpeticum:
        • Occurs in patients with conditions that impair the skin barrier, such as atopic dermatitis.
        • Rapid, widespread monomorphic (uniform), discrete (separate), 2-3 mm punched-out erosions with hemorrhagic crusts.
        • Usually appears in areas of active or recently healed atopic dermatitis, particularly the face.
        • Usually a primary HSV-1 infection.
        • Severity ranges from mild to fatal.
        • Treatment:
          • Eczema herpeticum in young infants is a medical emergency and requires intravenous acyclovir at a dosage of 5-10 mg/kg every 8 hours.
          • In adults, acyclovir is typically prescribed at a dose of 800 mg three times daily for 10 days.
      • Herpetic Whitlow:
        • Cutaneous herpetic infection presenting with pain, swelling, and clustered vesicles on a finger.
        • Often affects young children, usually due to HSV-1.
        • Can also affect dental and medical professionals who did not wear gloves.
        • Caused by direct virus inoculation through abraded skin.

    Investigations for HSV Infection

    • Typically not necessary, but may be considered in doubtful cases.
    • Possible investigations include:
      • Tzank smears (examination of a sample of skin for multinucleated giant cells, characteristic of HSV infection).
      • Viral culture.
      • Polymerase chain reaction (PCR) testing.
      • Skin biopsy.

    Complications of HSV Infection

    • Secondary Bacterial Infection: Common complication.
    • Erythema Multiforme: Can follow recurrent herpes simplex infections.
    • Recurrent Dendritic Ulcers: Can lead to corneal scarring.
    • Disseminated Herpes Simplex: Can cause severe illness, especially in newborns or immunosuppressed patients.
    • Herpes Encephalitis and Meningitis: Can occur without accompanying skin or mucous membrane manifestations.

    Management of HSV Infection

    • The disease is generally self-limited and no significant intervention is often required.
    • For mild recurrent attacks, a cool water compress or surgical spirit dabbing and topical antibacterial cream may suffice.
    • More severe and frequent outbreaks may require the application of acyclovir cream (5 times daily for 5 days) at the first sign of recurrence.
    • Oral acyclovir (200 mg five times daily for 5 days) is more effective and can be used for widespread or systemic involvement.
    • Famciclovir and valacyclovir are alternative antiviral treatments.

    Varicella (Chickenpox)

    • Highly contagious viral infection caused by varicella-zoster virus (VZV).
    • Transmission occurs through droplets or vesicular fluid.
    • Contagious period: 2 days before onset of the rash until all lesions have crusted.
    • Chickenpox usually confers lifelong immunity.
    • After causing chickenpox, VZV remains latent in the dorsal root ganglia.
    • Incubation period: 14 days on average, ranging from 9 to 21 days.
    • Prodromal symptoms in children are often absent or mild, consisting of low fever, headache, and malaise. Symptoms are more severe in adults.
    • Skin lesions of different stages (papules, vesicles, pustules, and crusts) are present simultaneously in any given body area.
    • New lesion formation ceases by day 4 and most crusting occurs by day 6.
    • The rash begins on the face and trunk and spreads to other parts of the body.

    Molluscum Contagiosum

    • Caused by Molluscum contagiosum virus (MCV) - a poxvirus.
    • Common, highly contagious, and self-limiting.
    • Transmission occurs through direct contact, fomites (inanimate objects), or autoinoculation.
    • The incubation period is 2-7 weeks.
    • Lesions are small, pearly, umbilicated papules (dome-shaped, with a central depression).
    • They are usually asymptomatic or mildly pruritic (itchy).
    • Commonly found on the face, trunk, arms, and legs.
    • Can occur in children, adults, and immunocompromised individuals.
    • Can be triggered by trauma to the skin.

    Treatment of Molluscum Contagiosum

    • Routine treatment is not usually necessary as most cases resolve spontaneously within six months to two years.
    • Treatment is more often pursued in cases of extensive or symptomatic lesions, or in immunocompromised individuals.
    • Treatment options include:
      • Cryotherapy (liquid nitrogen):
        • Effective in destroying lesions.
        • May be painful and leave a light scar.
    • Curettage (scraping off the lesions): - Effective but can be painful and may cause bleeding.
    • Electrocautery (burning off the lesions): - Effective but can be painful and leave a scar.
    • Topical treatments: - Cimetidine cream: - May be used for treating lesions on the face.
    • Other treatment options: - Laser ablation:
      - Can be effective but may result in scarring.
      - Imiquimod cream: - Stimulates the immune system to fight the virus. - May cause redness, irritation, and itching.

    Orf (Ecthyma Contagiosum)

    • Zoonotic infection caused by orf virus (a parapoxvirus).
    • Acquired through contact with infected sheep or goats.
    • Commonly seen on the hands and fingers of individuals who work with sheep, goats, or their carcasses (e.g., shepherds, butchers, veterinarians).
    • Lesion development occurs 3-7 days after contact with an infected animal, progressing through six stages:
      • Maculopapular (flat, red, raised).
      • Targetoid (resembling a bull's eye).
      • Weeping nodule.
      • Regenerative.
      • Papillomatosis (formation of wart-like growths).
      • Regression (healing).
    • Might be accompanied by lymphangitis (inflammation of lymph vessels), lymphadenopathy, malaise, and fever.

    Differential Diagnosis of Orf

    • Milker's nodule (another zoonotic infection).
    • Pyogenic granuloma (non-infectious, benign growth).
    • Herpetic whitlow (viral infection of the fingers).

    Complications of Orf

    • Secondary bacterial infection.
    • Erythema multiforme.
    • Giant orf or widespread lesions in immunocompromised individuals.
    • Bullous-pemphigoid-like eruptions.

    Management of Orf

    • No active treatment usually required, as lesions heal spontaneously after 3-6 weeks.
    • Topical antibiotics can be used to prevent secondary bacterial infection.
    • Immunocompromised patients might require debridement, antiviral cidofovir cream, or imiquimod topical immunomodulatory therapy.

    Human Papillomavirus (HPV)

    • Over 200 types of HPV exist, with over 40 types capable of infecting the genital area, mouth, and throat.
    • HPV is primarily spread through direct skin-to-skin contact, including sexual and non-sexual routes.
    • Common Warts are caused by HPV types 1, 2, and 4, appearing on hands and feet.
    • Plantar Warts, painful warts located on the soles of the feet, are also caused by HPV.
    • Flat Warts, usually found on the face or shins, are caused by HPV types 3 and 10.
    • Genital Warts, appearing as small, flesh-colored bumps in the genital area, are caused by HPV types 6 and 11.
    • High-risk HPV types such as 16 and 18 are linked to cervical and anogenital cancers.
    • Diagnosis involves clinical appearance, patient history, and in certain cases, biopsy or HPV typing for high-risk types.
    • Treatment options include topical treatments like salicylic acid and cryotherapy, as well as surgical options like excision and laser therapy for persistent cases.
    • The HPV vaccine (Gardasil and Cervarix) is effective against most high-risk HPV types.

    Herpes Simplex Virus (HSV)

    • HSV is classified into two main types: HSV-1 (primarily oral herpes) and HSV-2 (primarily genital herpes).
    • Transmission occurs through direct contact with infected areas or bodily fluids, even when lesions are not present.
    • Herpes Simplex Labialis (cold sores/fever blisters) appears around the lips.
    • Herpes Simplex Genitalis presents as painful genital sores.
    • Herpetic Whitlow, an infection on fingers, is common in healthcare workers.
    • Eczema Herpeticum is an acute infection in patients with atopic dermatitis.
    • Diagnosis is based on clinical history, examination, viral culture or PCR for active lesions, and serological testing for antibodies.
    • Management includes antiviral medications like acyclovir, valacyclovir, and famciclovir, which reduce symptoms and outbreak frequency.
    • Symptomatic relief can be achieved with analgesics and topical treatments.
    • Preventative strategies include condom use and suppressive therapy for recurrent cases.
    • Potential complications include neurological complications like herpes simplex encephalitis and the risk of neonatal herpes for pregnant women during delivery.

    Herpes Simplex Virus (HSV)

    • Causes skin infections, commonly known as cold sores and genital herpes.
    • Two types: HSV-1 primarily affects the mouth, while HSV-2 primarily affects genitals.
    • Symptoms include painful blisters, itching, and burning.
    • Spreads through direct contact with infected lesions or mucous membranes.
    • Diagnosed through clinical examination, viral culture, PCR, or serology.
    • Treated with antiviral medications like acyclovir and valacyclovir, and pain management.

    Human Papillomavirus (HPV)

    • Causes warts and is linked to certain skin cancers, including squamous cell carcinoma.
    • Over 200 types, with the most common ones: HPV 6 and 11 causing genital warts, and HPV 16 and 18 being high-risk types linked to cervical and anal cancers.
    • Symptoms include raised, flat, or cauliflower-like skin lesions.
    • Transmission occurs through skin-to-skin contact and sexual contact for genital warts.
    • Diagnosed via clinical assessment and biopsy when necessary.
    • Treatment involves topical therapies like salicylic acid and cryotherapy, and surgical options like excision and laser therapy.

    Varicella-Zoster Virus (VZV)

    • Causes chickenpox and shingles.
    • Chickenpox is highly contagious, characterized by an itchy, vesicular rash and systemic symptoms like fever and malaise.
    • Shingles is a reactivation of the latent virus, manifesting as a painful, dermatomal vesicular rash.
    • Spreads through respiratory droplets and direct contact with lesions.
    • Diagnosed through clinical presentation, and VZV PCR or serology for atypical cases.
    • Treatment includes antiviral medications like acyclovir for shingles and supportive care with antihistamines and analgesics.

    Molluscum Contagiosum

    • Caused by a poxvirus, commonly affecting children.
    • Characterized by dome-shaped, flesh-colored papules with a central depression.
    • Spreads through skin-to-skin contact, sharing personal items like towels and toys.
    • Often asymptomatic, but can cause itching or irritation.
    • Diagnosed through clinical examination and biopsy when unsure.
    • Often self-resolving, but lesions can be removed through cryotherapy, curettage, or topical agents.

    ORF (Ecthyma Contagiosum)

    • Caused by the Orf virus, a zoonotic parapoxvirus primarily affecting sheep and goats.
    • Characterized by a painful, nodular lesion that progresses to a vesicular stage and can ulcerate.
    • Transmission occurs through direct contact with infected animals or contaminated materials.
    • Symptoms include a localized red papule that becomes crusted.
    • Diagnosed through clinical presentation and confirmed with PCR when needed.
    • Usually self-limiting, but wound care and symptomatic treatment can be provided.

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