This document discusses several viral infections: Herpes viruses including HSV1, HSV2, varicella zoster virus; human papillomavirus which can cause warts; and molluscum contagiosum virus. It provides details on herpes zoster (shingles) symptoms, risk factors, treatment and warts caused by HPV including common, plantar, and plane warts and their treatments. Molluscum contagiosum is described as a self-limiting skin disease caused by a pox virus, often affecting children and sexually active adults, presenting as small dome shaped papules that can be treated with destruction or antiviral creams.

1. DR. BIJAY KR.YADAV
Holly vision technical campus
Shankhamul, Kathmandu

2. Viral infection
 Human Herpes virus.
 HHV1 Herpes Simplex.(orofacial)
 HHV2 Herpes simplex(genital)
 HHV3 Chicken pox.
Herpes Zoster.
 Human Papilloma virus.
 Warts
 Pox virus.
 Molluscum Contagiosum.

3. HERPES ZOSTER
Caused by Varicella zoster virus (VZV)
 Produced by reactivation of latent varicella Zoster virus from the
posterior (dorsal) root ganglion and cranial nerve ganglia, in the
partially immune host.
Common sites :
The eruption is characteristically limited to single neural segment & is
strictly unilateral.
Thoracic - 55%
Risk factors :
i. Physical injuries
ii. Mental trauma
iii. Febrile illiness
iv. Leukaemia
v. UV radiation
vi. Lymphoproliferative Malignancies
vii. Immunosupressive therapy
viii. Old age

4. Clinical feaatures
 Incubation period: 7-12 days
 Severe continuous pain or paresthesia in the distribution of the
nerve root
 Skin becomes erythematous ( redness of the skin or mucous
membranes, caused by hyperemia of superficial capillaries)
 Eruption of several group of vesicles on erythematous &
edematous base.
 Early vesicles contain a clear serum but after few days,the content
become purulent & dry to produce crusts after rupturing ( within 7-
10 days)
 Other vesicles dry up without rupturing, some may become
hemorrhagic or necrotic & may ulcerate.
After 3-4 days
After 3-5 days

5. Treatment :
Herpes zoster is a self limiting condition
1. Uncomplicated cases
 Drying compresses
 Analgesics to relieve pain
2. Localized Hepes zoster
 Acyclovir 800 mg orally five times a day for 7 days
 Cold compresses ( using 1 in 20 burrows solution)
 Topical application of 5% acyclovir
 Ibuprofen 400 mg TDS
Disseminated and complicated cases refer to the
higher centre

6. Warts
 It is benign epidermal proliferation, caused by human
papilloma virus (HPV)
 it is also knows as Verrucae
 The infection is limited to the epidermis
 It is common in children most commonly occur between
12-16 years but also in adult with immune deficiency may
daevelop extensive warts
 The appearance of warts can diffeer based on the type of
warts & where it is located on the body

7. Common Warts( Verruca vulgaris )
 Firm papules with
verrucous hyperkeratotic
surface occurring singly or
in groups
 Commonly on the dorsal
aspects of fingers & hands.
Periungual warts are
common.

9. Planter Warts
 Affects sole of the foot
 Sharply defined, rounded &
slightly elevated lesions with
keratotic surface.
 Pain is a common symptom.
 Mosaic wart: multiple warts
coalescence into a large papule

10. Plane warts
 slightly elevated, flat,
smooth papules.
 Linear arrangement in
scratch marks may be
present “Koebner
phenomenon”.

11. Treatment
1. Home care is effective in making the wart or warts go away.
Warts disappear 60-70 % of the time.
2. Tape therapy :
 Use several layers of water proof adhesive tape over the
warts region.
 Do not remove the tape & open the area to the air for 12
hours.
 Reapply tape for another 6-7 days
 The tape works best in the region around the fingernail
 The tape works bcoz the air tight, moist environment under
the tape doesn’t allow the virus to grow & reproduce.

12. 3. Salicyclic acid therapy : it is available by different trade
name.
 It comes either as a liquid to paint on the warts or as a
plaster to be cut out & placed on the wart tissue
 The area with the warts should be soaked in warm
water for 5-10 mins.
 The warts should be pared down with razor. A simple
razor worls fine for this, then throw it away
 Apply the salicyclic acid preparation to the wat tissue
 Do not apply it to the other skin bcoz of salicyclic acid
potential to injure normal tissue ( follow directions on the
package for how to apply )
4. Cryosurgery : Liquid nitrogen or cryotherapy.
5. Laser therapy
6. Shave removal

13. Molluscum Contagiosum
 It is a self-limited epidermal contagious skin
disease.
 Caused by pox virus infection.
 Transmission is by direct contact.
 Epidemiology:
• Children (a common childhood disease)
• and sexually active adults (20-29 years).
• Males > females.

14. Clinical Picture
• IP: 2 wks – 6 ms.
• Sites: face, hands, trunk & axillae.
• Lesions are shiny, white or pink and hemispherical,
grow slowly upto 0.5 cm in diameter.
• Affection of genital area, lower abdomen or upper
thighs occur after sexual transmission.

15.  Single or multiple skin colored
or pearly-white, waxy, dome-
shaped, small (1-5 mm)
papules umbilicated center
 Curd-like substance can be
expressed from its center.
 Sometimes the lesions
inflammatory(17%)
 Spontaneous disappearance of
the lesions usually occur within
6-9 ms.

16. HIV

17. Treatment
 Spontaneous disappearance may occur.
 Physical destruction:
 Laser.
 Cryosurgery.
 Electrocautery.
 Curettage.
 Chemical destruction:
 Salicylic acid 20%, TCA, Phenol.
 Topical antiviral: Imidquimod5%, Cidovir 1-3%