12 - Viral Infections Flashcards
What are warts?
Benign epidermal neoplasms caused by HPV (small DNA viruses)
Causes/pathophys of warts
HPV (>100 types)
HPV infects keratinocytes and induces hyperplasia and hyperkeratosis
Infection can be
- latent
- subclinical
- clinical
Which warts are associated w SCC?
38
41
48
How are warts spread?
Touch
- adjacent toes
Moist surfaces (pools)
Sites of trauma
Course that warts follow?
May resolve spontaneously in
- weeks - months
- Years - lifetime
Regression involves a multifactorial immune response
Wart removal?
May take several sessions
Minimal scarring
If normal skin lines return, removal was successful
Morphology of warts?
Verrucous papule 1-5mm in size
Cylindrical projections
Thromboseses vessels become trapped in projections and seen as black dots on surface of warts
Diagnostic sign
Warts may become fused and produce mosaic pattern on surface
Comon warts are aka?
Verruca vulgaris
Describe a verruca vulgaris
Dome shaped Gray-brown Hyperkeratotic Papule Black dots on surface
Tx or verruca vulgaris?
Liquid nitrogen Q 2-4 weeks Light electrocautery Salicylic acid (topical) Imiquimod (topical) Blunt dissection
Describe filiform warts
Finger like
Flesh-colored projections
Very superficial
- easiest to treat
MC site of filiform warts?
MC on face
Tx for filiform warts?
Curettage Apply bilat traction Use 1 firm stroke Light electrocautery Light cryosurgery
Flat warts are aka?
Verruca plana
Describe verruca plana
Flat (lol)
Flat-topped papules Grouped Pink, light brown, yellow Sites - Forehead - around mouth - back of hands - shaved areas (beard, legs)
Tx for veruca plana
Imiquimod 5% cream (aldara)
Cryosurgery/electrosurgery
5-fluorouracel cream (efudex)
Tretinoin cream (retin-a)
Where are plantar warts found?
Soles of feet
points of max pressure
- metarasal heads or heels
How to differentiate plantar warts from corns?
Shave and look for black dots and lack of skin lines
- corns have skin lines
Plantar wart treatment?
Not required if painless
- will regress over time
But if youre feeling froggy:
Debride (pare) and warm water soak prior to tx - salicyclic acid w occlusion - 40% salicylic acid plaster - imiquimod (aldara) w occlusion - cantharidin w occlusion Blunt dissection
Alternate plantar wart tx?
Laser
E D and C
Chemotherapy (bichloracetic acid)
Intralesional bleomycin sulfate ($$)
When treating plantar warts you should avoid?
Cryo
- blister on sole can be painful
What are subungual and periungual warts?
Wart next to nail
- maybe the tip of the iceburg
- painful
May be spread by cuticle biting
Subungual and periungual wart tx?
Resistant to chemical and surgical methods
Cryosurgery Cantharidin (paint wait for blister, repaint, occlude x 48hrs) Salicyclic acid Duct tape Blunt dissection
Genital warts are aka?
Condyloma acuminata or veneral warts
Condyloma acuminata or veneral warts are associated w?
HPV 6, 11, 16, 18
MC viral STD
Describe genital warts
Pale pink w numerous discrete narrow-to-wide projections on a broad base
Surface is smooth, velvety, moist and lacks hyperkeratosis of warts found elsewhere
May coalesce to form large, cauliflower-like mass
Self inoculation of genital warts?
Spread rapidly over moist areas
Kissing lesions on labia or rectum