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Tuesday, February 14, 2012

Warts, Herpes Simplex, And Other Viral Infections  Health Article

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Illustrations
Figure 12-6. The undersurface of a wart. Contrary to p...
Figure 12-6. The undersurface of a wart. Contrary to popular belief, warts do not have roots. The undersurface is round and smooth. The wart is confined to the epidermis, but it expands and displaces the dermis, giving the impression that it extends into the dermis or subcutaneous tissue.
Figure 12-22. Periungual wart. Warts may extend under a nail. Cuticle biting may spread warts.
Figure 12-22. Periungu...
Figure 12-23. Molluscum contagiosum. Individual lesions are 2- to 5-mm, flesh-colored, dome-shaped umbilicated papules.
Figure 12-23. Molluscu...
Figure 12-24. Molluscum contagiosum. Inoculation around the eye, a typical presentation for children.
Figure 12-24. Molluscu...
Figure 12-25. Molluscum contagiosum spreads rapidly in eczematous skin. This patient has atopic dermatitis of the popliteal fossa.
Figure 12-25. Molluscu...
Figure 12-26. Herpes simplex?the evolution of lesions. A, Vesicles appear on a red base. B, The center becomes depressed (umbilicated). C, Crusts form and the lesions heal with or without scarring.
Figure 12-26. Herpes s...
Figure 12-27. Primary infections in children typically begin in or about the oral cavity. Blisters are numerous and confluent.
Figure 12-27. Primary ...
Figure 12-28. A particularly extensive eruption involving the mouth, lips, and nasal orifice.
Figure 12-28. A partic...
Figure 12-29. A small group of vesicles on an erythematous base are the primary lesion.
Figure 12-29. A small ...
Figure 12-30. Vesicles evolve to pustules and become umbilicated.
Figure 12-30. Vesicles...
Figure 12-31. Sun exposure triggered this extensive recurrence.
Figure 12-31. Sun expo...
Figure 12-32. Recurrent herpes in an HIV patient.
Figure 12-32. Recurren...
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 12-33. Recurren...
Figure 12-1. Cryosurgery for warts. Excessive, prolonged freezing with liquid nitrogen resulted in a huge blister that healed with scarring.
Figure 12-1. Cryosurge...
Figure 12-2. Warts form cylindrical projections. They diverge when the wart grows in thin skin.
Figure 12-2. Warts for...
Figure 12-3. The cylindrical projections are partially fused together in this larger wart.
Figure 12-3. The cylin...
Figure 12-4. The cylindrical projections are tightly packed together, confined by the surrounding skin. This uniform mosaic surface pattern is unique to warts and is a useful diagnostic sign. The pattern can be easily seen with a hand lens.
Figure 12-4. The cylin...
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 12-5. Thrombose...
Figure 12-6. The undersurface of a wart. Contrary to popular belief, warts do not have roots. The undersurface is round and smooth. The wart is confined to the epidermis, but it expands and displaces the dermis, giving the impression that it extends into the dermis or subcutaneous tissue.
Figure 12-6. The under...
Figure 12-7. Common warts on the back of the hand.
Figure 12-7. Common wa...
Figure 12-8. A common wart with black dots on the surface.
Figure 12-8. A common ...
Figure 12-9. Cryosurgery produced the expected hemorrhagic blister.
Figure 12-9. Cryosurge...
Figure 12-10. A side effect of cryosurgery. The wart spreads to the blister edge.
Figure 12-10. A side e...
Figure 12-11. Filiform wart with fingerlike projections. These are most commonly observed on the face.
Figure 12-11. Filiform...
Figure 12-12. Small digitate and filiform warts in the beard area. Shaving spreads the virus over wide areas of the beard. Recurrences are common after cryotherapy or curettage. The infection may l#8727 for years.
Figure 12-12. Small di...
Figure 12-13. Flat warts. A, Lesions are slightly elevated, flesh-colored papules that often appear grouped. B, The face, back of the hands and shins are the most common areas. Flatter lesions are brown.
Figure 12-13. Flat war...
Figure 12-14. Lesions may be numerous and often appear in a linear distribution as a result of scratching.
Figure 12-14. Lesions ...
Figure 12-15. Plantar warts. Warts on weight-bearing surfaces accumulate callus and may become painful.
Figure 12-15. Plantar ...
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 12-16. Plantar ...
Figure 12-17. A, Corns (clavi) on the plantar surface are frequently mistaken for warts. B, Plantar surface depicted in A with soft and hard callus removed from the corn to reveal a deep depression. Examination with a hand lens shows no organized surface pattern as is seen in a plantar wart.
Figure 12-17. A, Corns...
Figure 12-18. A, Black heel. Trauma causes capillaries to shear, resulting in a group of black dots; appearance may be confused with warts. B, Paring the skin over the black dots in A reveals normal skin lines, proving that a wart is not present.
Figure 12-18. A, Black...
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 12-19. Spontane...
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 12-20. Plantar ...
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 12-21. Plantar ...
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 12-34. Vesicles...
Figure 12-35. Recurrent oral-labial herpes can appear on the lips or surrounding skin. Patients unaware of this do not understand that lesions on the chin, nose, or cheeks can be ?cold sores.? The typical grouped crusts support the diagnosis. Impetigo is often suspected. Impetigo does not present as a group of highly uniform small crusts.
Figure 12-35. Recurren...
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 12-36. Herpes s...
Figure 12-37. Infections in this area are unusual and mimic other blistering eruptions such as poison ivy or bites.
Figure 12-37. Infectio...
Figure 12-67. Herpes zoster. A skin biopsy showing multinucleated giant cells at the base of a vesicle.
Figure 12-67. Herpes z...
Table 12-2
Table 12-2
Table 12-4
Table 12-4
Figure 12-38. Herpetic whitlow. Inoculation followed examination of a patient's mouth.
Figure 12-38. Herpetic...
Figure 12-39. Herpes of the buttock. The diagnosis is suspected because of the classic presentation of recurrent disease with highly characteristic grouped vesicles of uniform size on an erythematous base. This presentation is seen almost exclusively in women. Recurrences may be frequent and very annoying; suppressive therapy can greatly improve the quality of life.
Figure 12-39. Herpes o...
Figure 12-40. Recurrent herpes of the buttock. Recurrent lesions in the same area that progress from vesicles to crusts make the clinical diagnosis. Patients with herpes of the buttock may have recurrences in several different areas of the buttock. Groups of small round scars may be the only evidence of p#8727 recurrences.
Figure 12-40. Recurren...
Figure 12-41. Eczema herpeticum. Numerous umbilicated vesicles of the face.
Figure 12-41. Eczema h...
Figure 12-42. Eczema herpeticum. First crop of lesions has formed crusts; a new lesion has appeared on the ear.
Figure 12-42. Eczema h...
Figure 12-43. Chickenpox?the evolution of lesions. A, ?Dewdrop on a rose petal?: a thin-walled vesicle with clear fluid forms on a red base. B, The vesicle becomes cloudy and depressed in the center (umbilicated), the border is irregular (scalloped). C, A crust forms in the center and eventually replaces the remaining portion of the vesicle at the periphery.
Figure 12-43. Chickenp...
Figure 12-44. Numerous lesions on the trunk (centripetal distribution).
Figure 12-44. Numerous...
Figure 12-45. Lesions present in all stages of development.
Figure 12-45. Lesions ...
Figure 12-46. Hemorrhagic chickenpox. Numerous vesicular and bullous lesions with hemorrhage at the base.
Figure 12-46. Hemorrha...
Figure 12-47. Varicella in newborns. For neonates, the risk of varicella infection and its associated complications is greatest when maternal onset of disease occurs in a 7-day period from 5 days before delivery to 2 days after delivery.
Figure 12-47. Varicell...
Figure 12-48. Dermatome areas.
Figure 12-48. Dermatom...
Figure 12-49. A group of vesicles that vary in size. Vesicles of herpes simplex are of uniform size.
Figure 12-49. A group ...
Figure 12-50. Vesicles become umbilicated and then form crusts.
Figure 12-50. Vesicles...
Figure 12-51. Confluent groups of vesicles in a highly inflamed case.
Figure 12-51. Confluen...
Figure 12-52. Vesicles evolve to crusts and may eventually scar if inflammation is intense.
Figure 12-52. Vesicles...
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 12-53. Herpes z...
Figure 12-54. Herpes zoster may involve one, two, or three adjacent dermatomes.
Figure 12-54. Herpes z...
Figure 12-55. A common presentation with involvement of a single thoracic dermatome.
Figure 12-55. A common...
Figure 12-56. Unilateral single-dermatome distribution involving the mandibular branch of the fifth nerve.
Figure 12-56. Unilater...
Figure 12-57. Several scars localized to a dermatome.
Figure 12-57. Several ...
Figure 12-58. Hypertrophic scars. Pl#8727ic surgery was required to improve mobility of the neck.
Figure 12-58. Hypertro...
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 12-59. Herpes z...
Figure 12-60. Herpes zoster (ophthalmic zoster). A virulent infection of the skin and eye.
Figure 12-60. Herpes z...
Figure 12-61. Ilioinguinal and sacral zoster. Zoster of T12, L1-L2, and S2-S4 dermatomes can occasionally cause a neurogenic bladder. Acute urinary retention and polyuria are the most common symptoms.
Figure 12-61. Ilioingu...
Figure 12-62. Herpes zoster may not be expected when lesions appear in unusual areas. The prodrome of pain and sudden appearance of grouped vesicles, crusts, or erosions support the diagnosis. Vesicles are macerated to form erosions in intertriginous areas.
Figure 12-62. Herpes z...
Figure 12-63. .
Figure 12-63. .
Figure 12-64. Herpes zoster. Massive involvement of a dermatome: numerous vesicles have been replaced by large crusts.
Figure 12-64. Herpes z...
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 12-65. Herpes z...
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 12-66. Tzanck s...
Table 12-1
Table 12-1
Table 12-3
Table 12-3
Box 12-1
Box 12-1
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