Warts, Herpes Simplex, And Other Viral Infections Health Article

Figure 12-1.  Cryosurgery for warts. Excessive, prolonged freezing with liquid nitrogen resulted in a huge blister that healed with scarring.

Figure 12-2.  Warts form cylindrical projections. They diverge when the wart grows in thin skin.

Figure 12-3.  The cylindrical projections are partially fused together in this larger wart.

Figure 12-5.  Thrombosed black vessels are trapped in the cylindrical projections. They appear as black dots when only the surface of the projections can be seen.

Figure 12-7.  Common warts on the back of the hand.

Figure 12-8.  A common wart with black dots on the surface.

Figure 12-9.  Cryosurgery produced the expected hemorrhagic blister.

Figure 12-10.  A side effect of cryosurgery. The wart spreads to the blister edge.

Figure 12-11.  Filiform wart with fingerlike projections. These are most commonly observed on the face.

Figure 12-14.  Lesions may be numerous and often appear in a linear distribution as a result of scratching.

Figure 12-15.  Plantar warts. Warts on weight-bearing surfaces accumulate callus and may become painful.

Figure 12-16.  Plantar wart. Fusion of numerous small warts to form a mosaic wart. Examination with a hand lens shows a highly organized mosaic pattern on the surface (see Figure 12-3 ).

Figure 12-19.  Spontaneous resolution. Warts in the process of resolving may be painful and turn black. They are easily removed without anesthesia with a curette.

Figure 12-20.  Plantar wart. This large mosaic wart is not on a pressure area. It has very long projections. Cryosurgery combined with other treatments would be appropriate.

Figure 12-21.  Plantar wart. Warts off the plantar surface are elevated and exophytic like common warts in other locations and could be treated with cryosurgery and other techniques.

Figure 12-22.  Periungual wart. Warts may extend under a nail. Cuticle biting may spread warts.

Figure 12-23.  Molluscum contagiosum. Individual lesions are 2- to 5-mm, flesh-colored, dome-shaped umbilicated papules.

Figure 12-24.  Molluscum contagiosum. Inoculation around the eye, a typical presentation for children.

Figure 12-25.  Molluscum contagiosum spreads rapidly in eczematous skin. This patient has atopic dermatitis of the popliteal fossa.

Figure 12-27.  Primary infections in children typically begin in or about the oral cavity. Blisters are numerous and confluent.

Figure 12-28.  A particularly extensive eruption involving the mouth, lips, and nasal orifice.

Figure 12-29.  A small group of vesicles on an erythematous base are the primary lesion.

Figure 12-30.  Vesicles evolve to pustules and become umbilicated.

Figure 12-31.  Sun exposure triggered this extensive recurrence.

Figure 12-32.  Recurrent herpes in an HIV patient.

Figure 12-33.  Recurrent herpes begins with a prodrome of itching or burning. A group of vesicles appears on an erythematous base. Previous episodes in the same area are typical.

Figure 12-34.  Vesicles of recurrent herpes evolve in a few days to form crusts. The diagnosis is suspected because crusts are small, round, and grouped. Previous episodes support the diagnosis.

Figure 12-36.  Herpes simplex of the skin: vesicular stage. The uniform size of the vesicles helps differentiate this from herpes zoster, in which vesicles vary in size.

Figure 12-37.  Infections in this area are unusual and mimic other blistering eruptions such as poison ivy or bites.

Figure 12-38.  Herpetic whitlow. Inoculation followed examination of a patient

Figure 12-41.  Eczema herpeticum. Numerous umbilicated vesicles of the face.

Figure 12-42.  Eczema herpeticum. First crop of lesions has formed crusts; a new lesion has appeared on the ear.

Figure 12-44.  Numerous lesions on the trunk (centripetal distribution).

Figure 12-45.  Lesions present in all stages of development.

Figure 12-46.  Hemorrhagic chickenpox. Numerous vesicular and bullous lesions with hemorrhage at the base.

Figure 12-48.  Dermatome areas.

Figure 12-49.  A group of vesicles that vary in size. Vesicles of herpes simplex are of uniform size.

Figure 12-50.  Vesicles become umbilicated and then form crusts.

Figure 12-51.  Confluent groups of vesicles in a highly inflamed case.

Figure 12-52.  Vesicles evolve to crusts and may eventually scar if inflammation is intense.

Figure 12-53.  Herpes zoster may involve any dermatome. Patients are confused by this presentation. They think that ?shingles? can appear only on the trunk.

Figure 12-54.  Herpes zoster may involve one, two, or three adjacent dermatomes.

Figure 12-55.  A common presentation with involvement of a single thoracic dermatome.

Figure 12-56.  Unilateral single-dermatome distribution involving the mandibular branch of the fifth nerve.

Figure 12-57.  Several scars localized to a dermatome.

Figure 12-58.  Hypertrophic scars. Pl#8727ic surgery was required to improve mobility of the neck.

Figure 12-59.  Herpes zoster (ophthalmic zoster). Involvement of the first branch of the fifth nerve. Vesicles on the side of the nose are associated with the most serious ocular complications.

Figure 12-60.  Herpes zoster (ophthalmic zoster). A virulent infection of the skin and eye.

Figure 12-63.  .

Figure 12-64.  Herpes zoster. Massive involvement of a dermatome: numerous vesicles have been replaced by large crusts.

Figure 12-65.  Herpes zoster mimicking poison ivy. A group of blisters on a broad base is often mistaken for an acute eczematous eruption.

Figure 12-66.  Tzanck smear. A cytologic smear of the base of a herpetic blister. The multinucleated giant cells are characteristic of herpes simplex and herpes zoster.

Figure 12-67.  Herpes zoster. A skin biopsy showing multinucleated giant cells at the base of a vesicle.