Viral Skin Infections Lecture Powerpoint Flashcards
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Wart definition
Benign roliferation of skin and mucosa caused by HPV transmitted via direct or indirect contact
HPV subtypes associated with malignancy (6)
6, 11, 16, 18, 31, 35
Heck disease/focal epithelial hyperplasia
A rare manifestation of HPV of the oral mucosa with an infecetion of some subtypes of HPV
Common warts on the hands and feet are typically what subtype? (2)
2,4
Deep palmoplantar warts/myrmecia and what subtype causes it?
Sharp calloused warts that grow deep and are more painful than common warts, tend to occur in weight bearing areas, caused by subtype 1 predominantly
Butcher’s wart and what subtype causes it?
Cutaneous skin condition among butchers and other meat handlers caused by HPV subtype 7 that infects the skin
Most warts spontaneously resolve within…
…2 years
When should warts be treated? (4)
-if present for more than 2 years -if spreading or symptomatic -if psychosocial or employment ramifications -if concern for malignancy
First line of treatment for warts
Salicylic acid topical repeatedly (might supplement with adhesiotherapy as well)
Cryotherapy
Use of liquid nitrogen in multiple treatment sessions to destroy a wart often done in conjugation with other treatments
Verruca vulgaris
Common wart, usually asymptomatic but painful at times and appears as a hyperkaratotic papule with rough irregular surface and often seen on hands and knees but can occur anywhere, resoves without intervention
Verruca plantaris
Plantar warts that typically manifest as small growths on sole of foot, may be painful, often occur at pressure points, typically treated if painful or spreading
Filform (digitate) warts
Long slender growths with stalk like appearance that manifest on areas of thin skin (such as face) and commonly bleed, often need treatment
Some rare forms of warts or those that do not resolve are common feature of a ___ patient
HIV positive
Verruca planus
Flat warts that frequently appear on back of hands, shins, and face, appear as flesh colored flat topped papules and can become very confluent
Subungal and periungal warts
Warts that appear around or under the fingernail, more resistant due to barrier and painful to treat due to proximity to sensitive nail bed, laser therapy might be an option
Whats the concern of untreated subungal or periungal warts?
Damage to nail matrix causes permanent and irreversible nail disfigurement
Genital warts (condylomata acuminata) are most often these 2 subtypes
6 and 11
Condylomata acuminata
Genital warts, can be found in any area of sexual contact, can be asymptomatic or cause burning, itching, tenderness
Concerns of pregnancy and genital warts
-Neonates may acquire infection when passing thru infected birth canal so depending on number of lesions may advise C section to avoid transmission to neonate
2 biggest treatments for genital warts
-surgical excision (lowest recurrence rate) -cryotherapy (safe even during pregnancy)
Molluscum contagiosum
Caused by a DNA poxvirus strictly in humans, has distinct appearance of single or multiple umbilicated (caseous plug, distinct clinical diagnosis) papular lesions round, dome shaped and waxy
Majority of molloscum contagiosum infections are caused by type ___ poxvirus
1
How is molluscum contagiosum spread? What are 3 distinct disease patterns prevalent?
-Direct contact or fomites -children (fomites), immunocompetent adults (STI), and immunocompromised children or adults (widespread)
Both molluscum contagiosum and HPV can undergo spread to different parts of the body via…
…autoinoculation
Molluscum contagiosum spares the ___ and ___ (most of the time)
palms, face
Most effective treatment for molluscum contagiosum
Curettage, most of the time spontaneously resolves tho
HSV 1 is typically presenting as ___ and HSV 2 as ____, but….
orofacial, genital, starting to see more and more crossover
Herpes simplex virus
An infectious DNA virus of which humans are the only natural reservoir, invades NS and goes into latency until reactivation, spread via close personal contact, 90% of adults seropositive for HSV1 by 50’s and don’t realize it (very VERY common)
HSV primary infection
Tends to be accompanied by systemic signs, sometimes not even manifesting lesions and thus aren’t diagnosed
Herpes labialis
Herpes around the lips, most common recurrent HSV 1 infection
Herpetic whitlow Herpes gladiatorum
-HSV of finger following inoculation from self or other -Face, arms, neck, and trunk infection from contact sport players
HSV gold standard diagnositc test
Isolation of virus by culture
Tzank smear
A quick rapid means of testing HSV but does not distinguish between 1 and 2
A serologically negative patient but viral culture positive patient for HSV indicates the patient is undergoing…
…primary infection
Treatments for HSV (4 of the same family and 1 fun fact about each(
-Pencyclovir (only topical prep) -Acyclovir (5 times a day dosing) -valancyclovir (better dosing) -famciclovir (better bioavailablilty)
Varicella zoster virus causes these 2 infections with skin manifestations
Varicella (chicken pox, initial exposure) herpes zoster (shingles) reactivation of virus
Characteristic rash of varicella zoster virus
“Dewdrop on roses” maculopapular lesions
Herpes zoster appearance
Vesicular rash in a single dermatome that almost never crosses dermatomes and rarely crosses to multiple dermatomes
Post herpatic neuralgia
Complication of herpes zoster that can last for years
Herpes zoster opthalmicus
Reactivation of the herpes zoster virus in trigem nerve that can cause occular involvement
Starting antiviral therapy within 72 hours of shingles outbreak…
…can limit risk of post herpatic nerualgia
What condition is this?
Filiform wart
What condition is this?
Molluscum contagiosum
