COMMON

VIRAL INFECTION OF SKIN

DR. Ram Sharan Mehta, MSND, CON, BPKIHS

 Common viral infections of skin
1. Warts: different types
2. Molluscum Contagiosum
3. Herpes Simplex
4. Herpes zoster
5. Opthalmic Zoster
6. Other Viral infections:
- Rubeola (Red Measles)
- Rubeola (German Measles)
- Chicken Pox
- Eczema Herpeticum
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS
1. Wart (Verruca)
Caused by Human Papilloma virus (80
types)
Age group: childhood
Incubation period 1 to 20 months
(average 4months)

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
Different types of warts
1. Verruca vulgaris
2. Verruca plana
3. Filiform warts
4. Digitate warts
5. Planter warts
6. Mosaic warts
7. Genital warts (condyloma acuminta)
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS
1. Verruca vulgaris:
Painless, elevated, circumscribed
Hyperkeratotic papules and plaques
Common sites extremities
2. Verruca plana:
Flat papules over face
Common sites face, back of hands
3. Filiform warts:
Occurs at angle of mouth
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS
Verruca vulgaris

DR. Ram Sharan Mehta, MSND, CON,

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Verruca vulgaris
DR. Ram Sharan Mehta, MSND, CON,
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Verruca plana (flat warts)
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 Filiform warts
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 Wart
HPV (DNA)
Common wart
Hand
Child

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
4. Digitate warts :
- site: scalp
5. Planter warts:
Painful
Site planter surface of sole
Precipitating factor: Trauma
Associated with hyperhydrosis
6. Mosaic wart :
- plaque of grouped lesions
7. Genital warts
Soft, pink, elongated, acuminate mass over glans
penis & other mucocutaneous area
DR. Ram Sharan Mehta, MSND, CON,
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Verruca plantaris
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Condylomata acuminata - penis
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Condylomata acuminata: vulva
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Condylomata acuminata: uterine cervix

DR. Ram Sharan Mehta, MSND, CON,

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Genital wart

DR. Ram Sharan Mehta, MSND, CON,

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Genital warts

DR. Ram Sharan Mehta, MSND, CON,

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8. Other type
Warts in buccal, gingival, labial, tongue
Oral condyloma acuminata
Respirating laryngeal papillomatosis

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
Treatment
Self limiting
Hypnotherapy & suggestion therapy
Electrocautery
Chemical cautery TCA, salicylic acid, lactic
acid
Cryotherapy
Laser therapy
25% podophyllin & purified podophyllotoxin
for genital warts
Immunotherapy (Interferon)
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS
 Warts: Treatment
Salicylic acid 25% ointment twice daily
followed by cutting or scraping
Preparation of salicylic acid 5-20%
Electrodessication and curettage
Freezing with liquid nitrogen if available.

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
 Rx Genital warts
Podophyllin 10-25% solution. Protect the skin
around the wart with Vaseline apply the
podophyllin with a match stick carefully on the
top of the war and wash after 6 hours. Repeat
every week. It is contraindicated in pregnancy.
Phenol 80% can be used in the same fashion to
Podophyllin.
Cauterization
Topical 5% 5-fluoro-uracil cream (efudex)
Cryotherapy with liquid nitrogen
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS
Rx. Summary

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
2. Molluscum contagiosum
Water blister, common in childhood.
Etiology: Pox virus
Incubation period : 2-7 weeks
Age group: childhood
Sex: Male > Female
Way of spread skin to skin contact,
fomites, sexual transmission
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 Clinical manifestations
Asymptomatic, smooth, pearly to flesh
coloured, dome shaped papules with
central unbilication
Size: 3-6 mm
Number: Multiple
Site: Any area, usually extremities
Immuno-compromised patient: Severe
Adult age: big growth
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS
Molluscum contagiosum
DR. Ram Sharan Mehta, MSND, CON,
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Molluscum contagiosum

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
 Treatment: Molluscum contagiosum
In children not touching, is probably the
best approach.
Cryosurgery - Using liquid nitrogen to
freeze the lesion
Salicylic Acid (Compound ) - A solution
applied to the lesion with or without tape
occlusion
Self limiting
DR. Ram Sharan Mehta, MSND, CON,
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 3. Herpes simplex
Etiology- Herpes simplex virus (HSV) I & II
Incidence increasing in developed country
It is either primary or recurrent

Clinical types: Facial oral herpes (HSV)

Genital herpes (HSV II & I)

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
 Primary facial oral herpes
Incubation period: 5-10 day
Onset with fiver, sore throat
Painful grouped blister, ulcerative
erosion on tongue, palate, lips,
gingival and buccal mucosa
Lymphadenopathy

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Primary gingivostomatitis
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 Primary genital herpes
Source of infection sexual exposur (95%)
Incubation period 3-14 days
Multiple painful grouped vesicles with painful
inguinal lymphadenopathy
Newer lesions continue to occur till 1 week
May last for 18-21 days
Few cases: develop aseptic meningitis
In female - cervicitis

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
Genital herpes: primary vulvar infection
DR. Ram Sharan Mehta, MSND, CON,
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 Herpes infection: Treatment

Lips: Gentian violet 0.5% is effective and if

available sunblocks reduces recurrence. Eg.
Zinc oxide paste , zinc oxide ointment or zinc
oxide and topical antiseptic or antibiotic e.g
betadine ointment 3 times daily for bacterial
super infection.
For recurrent infections : Acyclovir 200mg PO
for 5 days can be given.

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
 Genital herpes
Betadine or potassium solutions sitz baths 3 times daily.
Gentian violet 0.5%, Zinc oxide and castor oil to sooths.
Alternatively betadine ointment or oxytetracycline
ointment 3 times daily.
Acyclovir cream can also be given 5 times daily.
Severe infections or infection in immunodeficient
patients: if available give acyclovir 200 -400 mg 5 times
daily for 5-10 days OR
Famciclovir 250mg orally three times a day for 7--10
days, OR
Valacyclovir 1 g orally twice a day for 7--10 days.
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BPKIHS
Other type of herpes simplex infection
Herpetic whitlow, herpetic glandorium
Keratoconjunctivities, Herpes simplex
encephalitis
Risk factor for acquiring HIV

Diagnosis
1. Culture, Tzanck preparation
2. Serology by using monoclonal antibodies
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Herpetic whitlow
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Treatment
Recurrent genital and facial oral herpes
Oral Acyclovir of any form limited success
Topical Acyclovir little value
To suppress recurrency
Acyclovir 400 mg BD x 1 years (recurrence >
6 years)

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
4. Herpes zoster
Virus: Varicella zoster virus (VZV)
Prodromal symptoms +
Multiple painful vesicles in a dermatomal
distribution
Pain papule vesicles pustules
crusting healing
Healing within 3 weeks
Regional lymphadenopathy +
Pain persists till 30 days from the onset of
skin lesions DR. Ram Sharan Mehta, MSND, CON,
BPKIHS
 Herpes Zoster.
Localized eruption, unilateral, typically
confined to one dermatome
Prodromal paraesthesia and pain in the
area supplied by affected nerve are
common before skin lesions develop
Post herpetic neuralgia
Most common complication of zoster
50% risk in patients aged over 60 years
pain persisting for 1 month or more after
the rash
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BPKIHS
Herpes Zoster
Local desinfection
Acyclovir 800 mg 5x/day,
7-14 days
Analgetics
Amitriptyllin

DR. Ram Sharan Mehta, MSND, CON,

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Herpes Zoster

DR. Ram Sharan Mehta, MSND, CON,

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Herpes zoster with cluster of grouped vesicles
DR. Ram Sharan Mehta, MSND, CON,
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DR. Ram Sharan Mehta, MSND, CON,
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DR. Ram Sharan Mehta, MSND, CON,
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herpes zoster (shingles)

DR. Ram Sharan Mehta, MSND, CON,

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Diagnosis
Culture, Tzanck smear

Treatment
Self limiting
Symptomatic treatment: Analgesia, drying
agent
Tab Acyclovir 800 mg 5 times daily x 5-7 day

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
 5. Ophthalmic zoster
Involvement of ophthalmic division of
the trigeminal nerve
corneal ulceration
permanent scarring and loss of sight

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
 Laboratory Diagnosis
Early vesicular lesions are the best diagnostic
material
Virus isolation takes from 5 days to 3 weeks
More rapid detection is possible with
centrifugation-enhanced cultures
Direct immunofluorescence
DNA amplification by PCR

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
 Treatment
Acyclovir

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
6. Other Viral Infections

DR. Ram Sharan Mehta, MSND, CON,

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Rubeola (red measles)

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Rubella (german Measles)

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 Chicken Pox
Clinical Features
Incubation period: 14 15 days

The patient is infectious for 2 days before and up to 5

days after onset

The rash is most dense on the trunk and head

Macules ---- Papules ---- Vesicles ---- Pustules

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Varicella (chickenpox)

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Chicken Pox

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 Complications
Secondary bacterial infection
(commonest)
Pneumonia
CNS
cerebellar syndrome
acute encephalitits
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 Eczema herpeticum
(kaposi varicelliform eruption)
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 Management: Summary
1. Local disinfection
2. Acyclovir 800 mg 5times/day x 7-14 days
3. Analgesics
4. Amitrptyllin
5. Topical 5% Acyclovir 4 times x 7 days

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
 Prevention and control of Viral skin
infection
1.Early detection and treatment
2.Enforcing the practice of good personal
hygiene, such as regular bathing, laundering
clothes, not sharing towels, soaps and wearing
sandals in communal showers.
3.Avoid contact with vesicles.
4.Herpes lesions must be completely dry and
crusted and should be covered until completely
resolved.
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS
 Prevention and control ..
5.Cover all warts until completely resolved.
6.Care providers should wear gloves.
7.Educating the people about prevention
strategies is an important task.
8.Warm showers are recommended in herpes
simplex in order to cleanse the infected area.
Afterwards, towel dry gently, or dry the area
with a hair dryer on a low or cool setting.
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS
 Practice in BPKIHS: D-OPD
COMMON VIRAL INFECTIONS ARE:
CHICKEN POX
HERPES ZONSTER
HERPES SIMPLEX
VIRAL EXANTHIN ( RASHES)
WARTS (HPV): GENITAL , VERICA VULGARIS
MOLLOUSCUM CONTAGISUM

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
 Rx prescribed
1. Antiviral: Acyclovir
2. Symptomatic
3. Teaching: prevent transmission
and care

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
Summary:
1. Warts: different types
2. Molluscum Contagiosum
3. Herpes Simplex
4. Herpes zoster
5. Opthalmic Zoster
6. Other Viral infections:
- Rubeola (Red Measles)
-Rubeola (German Measles)
-Chicken Pox
-Eczema Herpeticum
7. Management Summary
8. Prevention and control of viral skin infection
9. Practices in BPKIHS D-OPD
DR. Ram Sharan Mehta, MSND, CON,
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Thank You
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Extra Slides

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BPKIHS
 Recurrent herpes
Less severe
Follows primary infection
Short duration
2 type : Facial oral herpes infection
Genital herpes infection

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
 Recurrent facial oral infection (Cold sore)
Triggering factors Photoexposure,
trauma, infection
Recurrence rate 3 to 4 year
Itching & burning at lip papules
vesicles ulcers crusting healing
Healing in 8 9 days

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BPKIHS
Recurrent herpes labialis
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 Recurrent Genital herpes
More in male
Recurrence rate: 3-4 years
Severity, duration, symptoms: less
Burning/tingling-vesicles

DR. Ram Sharan Mehta, MSND, CON,

BPKIHS
Genital herpes: recurrent infection of the penis
DR. Ram Sharan Mehta, MSND, CON,
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