Viral Derm Flashcards
HPV/Verrucae confined to where?
- epithelium
- They hijack the keratin for their own purposes and reproduce
transmission of HPV
auto-inoculation, contact, contagious
incubation period of HPV
incubation period 2-18 months
Epidemiology of HPV
- age
- prevalence
- any age, most common 12-16yo
- 16% general population
- common in pts. on immunosuppressive drugs, lymphoma
differential diagnoses forHPV
corns, calluses, skin tags, carcinoma, syphilis
verruca vulgaris
flesh colored warts, with papillate, hyperkeratotic surface
Verruca vulgaris (plantar)
plantar warts, common in communal showers
-painful
verruca plana
flat warts are pink, light brown or tan
-forehead, mouth, etc
HPV impact
- major cause of cervical cancer
- men are asymptomatic carriers
- gardasil for prevention
HPV: Condyloma Acuminata
- veneral warts
- most common viral STD in the world
- incubation avg 3 mos
- most infections are transient and clear within 2 yrs
Condyloma acuminata presentation
usually asymptomatic/ painless
-plantar warts can be painful
risk factors for condyloma acuminata
sexual activity, # partners, types of sex, HIV status
Diagnosis for condyloma acuminata
- warts dx usually clinical
- aceto-whitening
- colposcopy, anoscopy
- pap smear
treatment for condyloma acuminata
cryosurgery, electrosurgical excision (LEEP)
Provider administered treatments for HPV warts/ condyloma acuminata
- cryocautery (liquid nitrogen freeze)
- electro-dissection and curettage (scarring concern)
- laser
patient administered treatments for condyloma acuminata
-podophyllin, trichloroacetic acid (compound W), home remedies
Filiform warts
put picture here
Pearly penile papules (PPP)
NOT a wart,
don’t treat,
leave them alone –it’s a normal variant
Molluscum contagiosum
Discrete, flesh colored, 2-5mm dome shaped, UMBILICATED papules
- very common pox virus
- incubation-2 wk to 2mos
- self limiting 6-9mos
molluscum contagiosum
contraction?
direct skin contact, fomites, autoinoculation
Molluscum contagiosum dx and tx
usually clinical dx by visual inspection
- conservative treatment preferred
- may need cryotherapy, curettage
Herpes! HSV-1 and HSV-2
-epidemiology
common!
- HSV 1 in childhood
- HSV2 after sexual activity
Pathogenesis of HSV-1
(DNA virus)
-usually spread through close contact of oral secretions and genital herpes is usually spread through oral-genital contact
pathogenesis of HSV-2
primarily spread through contact with genital secretions/tissues
HSV-1 associated with which location of lesions
oral lesions
HSV-2 associated with which location of lesions
genital lesions
primary infection of Herpes
established in root ganglion
most common blister lesions are caused by what
herpes
secondary phase of herpes
recurrent disease at same site
HSV concepts
latency/recurrence, viral shedding, incurable
- a lot of asymptomatic viral shedding
- start to shed 4-5 days prior to outbreak
Classic clinical features of HSV
- highly variable
- prodrome, malasia
- eruption of superficial, pain, sometimes itchy, clustered vesicles (*blister)
- turn to pustules than ulcerate and scab
- may have lymphadenopathy
- primary outbreak most painful
- secondary outbreak shorter
- contagious
Clinical features of HSV (not classical features, but realistic features)
-90% of pts. test HSV-2+, have no symptoms!
Recurrent infections of HSV
shorter, milder
- male more likely to infect female than vice versa
- 7-% during asymptomatic viral shedding
Herpes diagnosis
- H&P
- Tzanck smear (but nobody does it anymore)
- viral culture
- serology to distinguish 1&2 Abs
Herpes differential
- chancroid
- aphthous ulcer
- herpangina
- syphilis
- impetigo
Herpes tx
- acyclovir/antivirals in acute phase
- decreases viral excretion, new lesion formation and vesicles, &promotes healing - possible prophylactic antivirals for recurrent disease
ophthalmic herpes
refer to ophthalmologist!
Herpetic whitlow
around fingernail-see picture
Varicella
- chickenpox
- highly contagious, vaccine for children
- causes VESICULAR eruption usually on torso
- progresses to crusted
Herpes Zoster
- Shingles
- Increases with age
Clinical presentation of Herpes Zoster
- dew drops on a rose petal
- promdrome itch tingling then severe sharp pain
- radicular pain in a dermatomal distribution
- unilateral involvement (virtually never crosses the midline)
Zoster Diagnosis
inspection, Tzank smear, rising Ab titer
Zoster Therapy
- antivirals
- dry the lesion
- prevent secondary pain syndrome complications
- vaccine >50yo
