Lecture 4: Infections Part 2 Flashcards
What is condyloma acuminatum?
Genital warts
What is the cause of condyloma acuminatum and the transmission?
- Cause: HPV, mainly 6 & 11
- 16, 18, 31, 33 are most dangerous
- Transmission via microabrasion, does not require active lesions
MC in sexually active young adults
What are the RFs for condyloma acuminatum?
- Number of partners
- Frequency of sex
- Partner with HPV
- Other STIs
Lots of sex with lots of people
Is conyloma acuminatum transmissible to a baby?
Yes, an infected mother can transmit it.
How does low risk and high risk condyloma acuminatum appear?
- Both appear with warts.
- However, if immunosuppressed, there is a higher risk for warts if infected.
Clinical manifestations of condyloma acuminatum?
Warts
- Asymptomatic is the MC presentation
- Anxiety
- Obstruction if large mucocutaneous lesions
What are the 4 types of mucocutaneous lesions seen in condyloma acuminatum?
- Small papular
- Cauliflower-floret
- Keratotic warts
- Flat topped papules/plaques (MC on cervix)
What is a red flag on condyloma acuminatum presentation that may suggest an immunocompromised state?
Large and multiple lesions
Where are the MC sites for lesions on a male with condyloma acuminatum? Female?
- Male: Frenulum, corona, glans penis, prepuce, shaft, and scrotum
- Female: labia, clitoris, periurethral, perineum, vagina, and cervix
- Both: perineal, perianal, anal canal, rectal, urethral meatus, urethra, and bladder
Features of laryngeal papillomas
- Uncommon with HPV 6 & 11
- MC on the vocal cords
- age: < 5 or > 20 = risk of SCCis and invasive SCC
What tests help diagnose condyloma acuminatum?
- Pap smear
- Dermatopathology
- Typically clinical diagnosis
- Dermoscopy showing papillomatosis = hallmark
- Shave biopsy if wart was refractive to tx
Finger like knob projections.
Tx for condyloma acuminatum
- Patient: imiquimod, podofilox, trichloroacetic acid
- Provider: Cryotherapy, electrosurgery, surgical removal, laser
Also can be self-resolving
Follow-up for condyloma
- Monthly until lesions are gone, then Q3months
- Routine PAP in females
- Prevention via Gardasil (6, 11, 16, 18)
Highest chance of recurrence is within 3 months
When is condyloma MC to recur within?
3 months
Hence why you still check within 3 months if lesions gone
Gardasil vaccine schedule
Starting at age 9 or 15
Summary of condyloma tx specifics
Non pharmaceuticals
Surgical is best for > 1 cm
MOA of imiquimod
Condyloma
Induction of immune system to recognize and destroy lesions
Anti-tumor topical; ImIquImod Induces Immune
How to use imiquimod?
- Small amount at bedtime 3x/wk.
- Wash off upon awakening
- Don’t have sex
- continue tx until complete clearance
- may need holidays due to strong SEs.
MOA of podofilox
Prevention of cell division and causes tissue necrosis
must know antimitotic
How do you apply podofilox?
Schedule and pt education
- Cotton tipped applicaiton
- Q12h x 3 days on, 4 days off
- You want to also put it on normal skin around lesion
- Wash med off after 1-4 hrs
- Tx area must be <= 10cm2 and total volume < 0.5ml/d
I guess it is very potent
MC SEs of podofilox
- Local mild systemic skin irritation
- HA
- it is flammable
CI in pregnancy
What is the MOA of trichloroacetic acid (TCA)?
Burns, cauterizes, and erodes skin lesions
Triple action; literal acid
How should TCA be applied?
- Apply vaseline AROUND the lesion first
- Apply TCA to wart for 6-10 wks
- Very effective!
What is molluscum contagiosum?
Water warts, caused by poxvirus
How is molluscum contagiosum spread?
Direct skin-skin contact
- Bathing together
- Sexual encounter (2-6 weeks to incubate)
Who is molluscum contagiosum MC in?
Young children
What are the RFs for molluscum contagiosum?
- Childcare/daycare
- School
- Sports
- Risky sexual behavior
Based on MC demographics
How does molluscum contagiosum present?
- small, smooth, dome shaped papule with umbilicated center
- If adults: groin/lower abdomen area
- 3-6mm
- White, curd-like material can be expressed
- Usually no palm or sole involvement
- High risk for immunocomped or atopic patients
What are the reasons to tx molluscum contagiosum?
- Prevent spreading
- Cosmetic
- Recurrent dermatitis
- Stress
It typically regresses on its own after 6m-2y
What are the tx options for molluscum contagiosum?
- Cryotherapy/curettage
- Podofilox
- SA (compound W)
Don’t pick at it or it will spread.
Primarily containing the spread, so no imiquimod i guess
What is the cause of verrucae/warts?
HPV via direct skin contact
What are the 3 common types of verrucae seen in kids?
- Verruca vulgaris: common wart
- Verruca plantaris: plantar wart
- Verruca plana: flat wart (plain wart)
How does verruca vulgaris present?
- 1-10mm papules
- Isolated or multiple
- MCC: trauma, hands/fingers/knees
- Red and brown spots: thrombosed papilla capillary loops (seen on dermatoscope)
How does verruca plantaris present?
- Shiny plaques with a rough, hyperkeratotic surface
- Thrombosed capillaries
- Skin lines decrease
- Usually uncomfortable
- Tender
reminds me of a cigarette butt
How does verruca plana present?
- Sharply defined
- 1-5mm
- Flat surface
- Skin colored or light brown
- Round, oval, polygonal, or linear
- MC on face, beard, dorsa of hands and shins
Management options for verrucae
- Salicyclic acid
- Cryotherapy
- Imiquimod
- Cantharidin (blister beetle)
- Electrosurgery + vacuum to prevent aerosolization
Podofilox not mentioned, maybe cause it doesn’t really spread?
What does SA do?
- Desquamation of hyperkeratotic epithelium
- 10-30% conc for small
- 40% conc for big lesions
What else should you do when applying SA?
Sanding/filing
What is cantharidin?
Blister beetle substance, which causes a blister on the wart.
How does HZV present?
Dermatomal infection with immense pain
Prior hx of chickenpox as child
What are the 3 clinical phases of HZV?
- Prodrome
- Active
- PHN
How does the prodrome phase present in HZV?
- Pain (angina/acute abdomen)
- Tenderness
- Paresthesia (FLS)
How does the active phase in HZV present?
- Papules at 24h
- Vesicles/bullae at 48h
- Pustules at 96h
- Crusts at 7-10d
How do later lesions appear in HZV?
- Erythematous and edematous base
- Clear vesicles or hemorrhagic
- Erosion => crusted erosions
- Dermatome crusting normally resolves after 2-4weeks
When is HZV a big concern?
Ophthalmic involvement, affecting V1 (hutchinson sign)
How do we diagnose the active phase of HZV?
- Clinically
- Tzanck smear
- DFA
- Viral culture
- PCR (most sensitive)
DFA = direct fluorescent antibody
Antiviral therapy for HZV
- Valcyclovir 1000mg TID x 1 week
- Famciclovir 500mg q8 x 1 week
- Acyclovir 800mg x5 a day for x1 week (up to 10d for immunocompromised)
FAV antivirals
What can help with PHN?
- NSAIDs
- Gabapentin
- Pregabalin
- TCAs
- Nerve block (Severe)
Most sensitive test for HZV?
PCR
