This document discusses common viral skin infections, including warts caused by HPV, molluscum contagiosum virus, herpes simplex virus, varicella zoster virus, and others. It provides details on the etiology, clinical presentation, diagnosis, and treatment of each infection. Prevention methods are also summarized, such as practicing good hygiene and avoiding contact with infected areas until lesions are fully resolved.

1. COMMON
VIRAL INFECTION OF SKIN
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

2. 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

3. 1. Wart (Verruca)
Caused by Human Papilloma virus (80
types)
–Age group: childhood
–Incubation period – 1 to 20 months
(average 4months)
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BPKIHS

4. 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)
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BPKIHS

5. 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

6. Verruca vulgaris
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7. Verruca vulgaris
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8. Verruca plana (flat warts)
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9. Filiform warts
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10. Wart
HPV (DNA)
Common wart
• Hand
• Child
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11. 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
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12. Verruca plantaris
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13. Condylomata acuminata - penis
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14. Condylomata acuminata: vulva
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15. Condylomata acuminata: uterine cervix
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16. Genital wart
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17. Genital warts
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18. 8. Other type
–Warts in buccal, gingival, labial, tongue
–Oral condyloma acuminata
–Respirating laryngeal papillomatosis
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BPKIHS

19. 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)
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BPKIHS

20. 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

21. 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

22. Rx. Summary
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BPKIHS

23. 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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BPKIHS

24. • Clinical manifestations
–Asymptomatic, smooth, pearly to flesh
coloured, dome shaped papules with
central unbilication
–Size: 3-6 mm
Size:
–Number: Multiple
–Site: Any area, usually extremities
–Immuno-compromised patient: Severe
–Adult age: big growth
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BPKIHS

25. Molluscum contagiosum
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26. Molluscum contagiosum
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27. 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
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BPKIHS

28. 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

29. • 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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30. Primary gingivostomatitis
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31. • 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
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BPKIHS

32. Genital herpes: primary vulvar infection
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33. 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.
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BPKIHS

34. 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.
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

35. 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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36. Herpetic whitlow
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37. •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

38. 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

39. 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
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

40. Herpes Zoster
•Local desinfection
•Acyclovir 800 mg 5x/day,
7-14 days
•Analgetics
•Amitriptyllin
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BPKIHS

41. Herpes Zoster
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42. Herpes zoster with cluster of grouped vesicles
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43. DR. Ram Sharan Mehta, MSND, CON,
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44. DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

45. herpes zoster (shingles)
DR. Ram Sharan Mehta, MSND, CON,
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46. 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

47. 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

48. 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
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BPKIHS

49. Treatment
• Acyclovir
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50. 6. Other Viral Infections
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BPKIHS

51. Rubeola (red measles)
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52. Rubella (german Measles)
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53. 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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BPKIHS

54. Varicella (chickenpox)
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55. Chicken Pox
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56. Complications
• Secondary bacterial infection
(commonest)
• Pneumonia
• CNS
–cerebellar syndrome
–acute encephalitits
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BPKIHS

57. Eczema herpeticum
(kaposi varicelliform eruption)
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

58. 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

59. 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

60. 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

61. 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

62. Rx prescribed
1. Antiviral: Acyclovir
2. Symptomatic
3. Teaching: prevent transmission
and care
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

63. 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,
BPKIHS

64. Thank You
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65. Extra Slides
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66. • 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

67. • 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
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

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

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