Mouse
Derma
Viral Infections
Dr. Robert Manlapig
2009
Viral Infections
Warts
Molluscum contagiosum
Herpes simplex
Varicella
WARTS
Benign epidermal neoplasms
Different iruses causes different t!pes of
"arts
At least #0 distant t!pes of $uman papilloma
irus %H&V' $ae (een identified (! t$eir D)A
composition
*ac$ of t$e H&V t!pe is associated "it$ a
particular set of clinical and pat$ologic entities
+ommonl! occur in c$ildren and !oung adults
Ma! appear at an! age
+ourse is $ig$l! aria(le
o Most resole spontaneousl! in "ee,s or
mont$s
o -t$ers ma! last !ears or a lifetime
Are transmitted simpl! (! touc$
)ot unusual to see "arts on ad.acent toes
%/,issing lesions0'
+ommonl! appear at1
o Sites of trauma
o Hands
o &eriungual regions
o &lantar surface
2ndiidual ariations in cell3mediated immunit!
ma! explain differences in seerit! and
duration
-ccurs more fre4uentl!5 last longer5 and
appear in greater num(er in patients "it$1
o A2DS
o 6!mp$omas
o 2mmunosuppressie drugs
Atopic ec7ema patients ma! not (e at
increased ris, for iral "arts as "as once
suspected
Some t!pes of "arts respond 4uic,l! to routine
t$erap!5 "$ereas ot$ers are resistant
2t s$ould (e explained to patients t$at "arts
often re4uire seeral treatment sessions
(efore a cure is reali7ed
+onfined to t$e epidermis
+an (e remoed "it$ little scarring
Treatment s$ould (e conseratie in order to
aoid scarring
&ATH-&H8S2-6-98
Viral "arts are tumors initiated (! a iral
infection of ,eratinoc!tes
T$e cell proliferate to form a mass
Mass remains confined to t$e epidermis
T$ere are no /roots0 penetrating into t$e
dermis
Seeral t!pes of "arts form c!lindrical
pro.ections
T$ere pro.ections are clearl! seen in digitate
"arts t$at occur on t$e face
T$e pro.ections (ecome fused toget$er in
common "arts n t$ic,er s,in
T$e pro.ections form a $ig$l! organi7ed
mosaic pattern on t$e surface
&age 1 of 6
&attern is uni4ue to "arts
A useful diagnostic sign
T$rom(osed (lood essels (ecome trapped n
t$e pro.ections
Seen as (lac, dots on t$e surface of some
"arts
Alt$oug$ "arts remain confined to t$e dermis5
t$e gro"ing mass can protrude and displace
t$e dermis
:ndersurface of a "art is a smoot$ round
mass
Common Warts (Verruca Vulgaris)
Begins as smoot$5 fles$3colored papules
*ole into dome3s$aped5 gra!3(ro"n5
$!per,eratotic gro"t$s
Blac, dots on t$e surface
o T$rom(osed capillaries
o :seful diagnostic sign
Derma
Viral Infections
Dr. Robert Manlapig
2009
Warts ma! (e found
on an! s,in surface
Hands are t$e most commonl! inoled area
9enerall!5t$e "arts are fe" in num(er
)ot unusual for common "arts to (ecome so
numerous
o T$e! (ecome confluent
o -(scure large areas of normal s,in
Treatment
o Topical salic!lic acid preparation
o 6i4uid nitrogen
o *lectrocauter!
o Blunt dissection %for resistant or er! large
lesions'
o +r!ot$erap!
Filiform and Digitate Wart
9ro"t$ consisting of a fe" or seeral
fingerli,e5 fles$3colored pro.ections emanating
from a narro" or (road (ase
Most common o(sered
o Around t$e mout$ and e!es
o Ala nasi
o Beard
Are t$e easiest "arts to treat
Treatment
o +urettage
o *lectrocauter!
;lat Warts %Verruca &lana'
&in,5 lig$t (ro"n5 or lig$t !ello"5 and slig$tl!
eleated5 flat3topped papules
Var! in si7e from 0<= to 0<>cm
Ma! (e onl! a fe"5 (ut generall! t$e! are
numerous
T!pical sites of inolement
o ;ore$ead
o Around t$e mout$
&age 3 of 6
o Bac,s of t$e $ands
o S$aed areas
Beard areia in men
6o"er legs in "omen
;lat "arts ma! (e spread in a linear
distri(ution (! scratc$ing
;lat "arts spread oer a "ide area follo"ing
an a(rasion
;lat "arts present a special t$erapeutic
pro(lem
Duration ma! (e lengt$!
Ma! (e er! resistant to treatment
9enerall! located in cosmeticall! important
areas "$ere aggressie scarring procedures
are to (e aoided
Treatment1
o Tretinoin cream
0<02?@5 0<0?@ or 0<=@
Applied at (edtime oer t$e entire
inoled area
;re4uentl! of application is
su(se4uentl! ad.usted in order to
produce a fine scaling "it$ mild
er!t$ema
Ma! re4uire "ee,s or mont$
2s not often not effectie
o +r!ot$erap!
6i4uid nitrogen
o *lectrocauter!
o ?3flurouracil cream %*fudex ?@'
Applied once or t"ice a da! for >3?
"ee,s
Ma! produce dramatic clearing of flat
"arts
2t is "ort$ t$e attempt if ot$er
measures fail
&ersistent $!perpigmentation ma!
occur follo"ing use
Warts ma! reappear in s,in inflamed
(! ?3flurouracil
&lantar Warts
;re4uentl! occur at
points of maximum pressure5 suc$ as oer t$e
$eads of t$e metatarsal (ones or $eels
T$ic,5 painful callus forms in response to
pressure
6ittle "art cause a lot of trou(le
;oor is repositioned "$ile "al,ing
o Ma! result in distortion of posture and pain
in ot$er parts of t$e foot5 leg or (ac,
Ma! appear an!"$ere on t$e plantar surface
+luster of man! "arts t$at appears to fuse is
referred to as a mosaic "art
Derma
Viral Infections
Dr. Robert Manlapig
2009
Differential diagnosis
o +orns %clai'
Warts lac, s,in lines crossing t$eir
surface
o Blac, $eel
+luster of (lue3(lac, dots %ruptured
capillaries'
Ma! appear on t$e $eel or an!"$ere
on t$e plantar surface
;ollo"ing t$e s$earing trauma of
sports t$e inole sudden stops or
position c$anges
Blac, "arts
o Warts in t$e process of undergoing
spontaneous resolution ma! turn (lac,
o ;eel soft "$en pared "it$ a (lade
o Studies suggest t$at specific cell3mediated
immunit! against irus3infected
,eratinoc!tes ta,es place in t$e process of
regression of some "arts
o Treatment
Do not re4uire t$erap! as long as t$e!
are painless
2t is sometimes (est simpl! to explain
t$e natural $istor! of t$e irus infection
and "ait for resolution rat$er t$an
su(.ect t$e patient to a long treatment
program
Minimal discomfort
+an (e relieed (! periodicall!
remoing t$e callus "it$ a (lade or
pumice stone
&ainful "arts must (e treated
Tec$ni4ue t$at does not cause
scarring s$ould (e used
Scars on t$e soles of t$e feet
Ma! (e painful
6asting source of discomfort
Aeratol!tic treatment %salic!lic acid'
+onseratie initial t$erap!
Treatment is nonscarring
Relatiel! effectie
Re4uires persistent application of
medication once eac$ da! for
man! "ee,s
Blunt dissection
Surgical alternatie
;ast5 effectie %90@ cure rate'
:suall! noscarring
Superior to (ot$
electrodesiccation3curattage and
excision (ecause normal tissue is
not distur(ed
+$emot$erap!
Acids $as (een successfull!
emplo!ed to treat plantar "arts
&age 5 of 6
2s occasionall! used to treat "arts
t$at $ae recurred follo"ing
treatment "it$ ot$er tec$ni4ues
;ormalin
Ma! (e considered for resistant
cases
Mosaic "arts or ot$er large
inoled areas ma! (e treated "it$
dail! soa,ing for >0 minutes in
B@formalin solution
6a7erformalde$!de solution %=0@
formalde$!de'
+ommerciall! aaila(le for direct
application to "arts
T$ere is a ris, of inducing
sensiti7ation to formalin
+r!osurger!
Ma! produce a deep5 painful
(lister and interfere "it$ mo(ilit!
Repeated lig$t applications of
li4uid nitrogen are preferred to
aggressie treatment
2mmunot$erap!
Has (een reported to (e er!
successful for treatment of
resistant "arts
Dinitroc$loro(en7ene %D)+B'
Dip$en!lc!clopropenone
2ntralesional Bleom!cin
Ma! (e considered "$en all ot$er
treatments fail
333 mouse %made (! nine.ams CC'
