Warts are a surface infection caused by human papilloma virus (HPV). They may occur on any area of the skin, including around the nose, mouth, and genitalia. Children frequently have warts, but they occur in adults as well. They are mildly contagious and may be spread from person-to-person by touching or from one part of the body to another by scratching. Warts are in the very top layer of skin and so they do not effectively trigger the body’s immune system. One can be a completely healthy person and still have warts.

COMMON WARTS

Treatment

There is no perfect way to treat warts, and no one can guarantee the success of wart treatment. Warts are stubborn and frequently more than one or two treatments are needed. Treatments vary depending on the area of skin or mucous membrane involved, the age of the patient, and the number of warts.

• Liquid nitrogen. This treatment involves a a very cold liquid that is sprayed or applied to the warts causing a small controlled area of frostbite. The frozen area usually develops a blister (sometimes a blood blister) that heals in about two weeks. Freezing is painful. It hurts for the 10-15 seconds it takes to freeze the warts and for the minute or two afterwards while the area thaws. Often children can tolerate having one or two warts frozen, but even the toughest adult may not be able to stand having many warts frozen. The Cheyenne Skin Clinic almost never freezes warts on the bottom of the foot, as this is extremely painful.

• Bleomycin. A dilute form of chemotherapy agent injected into the wart kills cells which are growing more rapidly, like those with the wart virus in them. The injection itself hurts, and there is usually a little pain afterward.

• Diphenciprone (DPCP) immunotherapy. DPCP has been useful when other treatments have been unsuccessful or when a child has had several warts and cannot tolerate other treatments. A small amount of medicine is applied to the skin and left on for two hours. Treatment begins by applying a small bandaid with medicine on it to the hip.   An area of skin covered by clothing is used because often there is a brown mark that remains for several months. A rash develops in the area indicating the body’s immune system recognizes the medication.

Three weeks later, the patient has a follow up appointment with the Cheyenne Skin Clinic for the physician or nurse to apply a dilute concentration of the DPCP to the warts. Ideally, a mild irritation develops around the warts, and they slowly go away over a period of 2-3 months. Frequently, several visits spaced every 3-4 weeks are needed. Sometimes the irritation is more pronounced, and the skin becomes very inflamed. If this occurs, one has to decrease the use of medicine tiering the amount used with the amount of irritation. This is a slow approach, but is inexpensive, a relatively painless, and can be used on any new warts that arise during the course of treatment.

• Carbon dioxide laser. This laser can be used to vaporize the stubborn warts. First the area is numbed with an injection of local anesthetic, which in itself is somewhat painful. Next the laser destroys the wart and surrounding skin leaving an ulcer which slowly heals in over a period of two to four weeks. For the first week the ulcer is often painful, and there is usually a scar when healing is complete.

• Topical Acid. This treatment comes in the form of either a liquid, gel, or pad that can be applied to the wart. This peels off the top layers of the skin where the wart lives. This is a slow approach to taking an average of one to two months, but is inexpensive, relatively painless, and can be used on any new warts that appear during the course of treatment.

GENITAL WARTS

Genital warts, caused by human papilloma virus (HPV), are moderately contagious and may be spread from person-to- person by sexual contact. Warts are in the very top layer of skin and thus do no effectively trigger the body’s immune system. One can be a completely healthy person and still have warts.

Treatment

It is very important to treat genital warts, as research shows there has been an increase in cervical carcinoma in some patients with genital warts.

• Podophyllin. This medicine is derived from   a brown liquid plant extract that kills cells that are growing rapidly. It is usually applied to warts on mucous membranes like that in the vulvar and perianal region. After the first treatment, the medication should be removed by bathing after two to four hours. (The medication will work better if it is left on longer after subsequent treatments.) Podophyllin stings a little when first applied and the areas may become more painful over the next two to three days. It can only be applied in our office as it can cause serious reactions, including seizures, if it is applied too generously.

• Condylox (podophyllotoxin). This treatment can be applied at home. The medication is applied for three days in a row followed by four days of rest, repeating this each week for four weeks.

• Liquid nitrogen. This very cold liquid is sprayed or applied to the warts causing a small controlled area of frost bite. The frozen area usually develops a blister (sometimes a blood blister) that heals in about two weeks. Freezing is painful. It hurts for the 10-15 seconds it takes to freeze the warts and for the minute or two afterwards while the area thaws.

• Carbon dioxide laser. With this treatment , the area is numbed with an injection of local anesthetic, which in itself is somewhat painful. Next the laser destroys the wart and surrounding skin leaving an ulcer which slowly heals in over a period of two to four weeks. For the first week the ulcer is often painful and there is usually a scar when healing is complete.

• Aldara Cream. This prescription cream is applied to the warts Monday, Wednesday, and Friday at bedtime for up to 12 weeks.   Unfortunately, this is a very expensive medication.

HERPES SIMPLEX (COLD SORES AND GENITAL HERPES)

Herpes is a name used for some 50 related viruses. Herpes simplex is related to the viruses for infectious mononucvleosis (Epstein-Barr Virus) and for chicken pox and shingles (varicella zoster virus). The herpes simplex virus can cause blister-like sores almost anywhere on a person’s skin. It usually occurs around the mouth and nose or the buttocks and genitals. HSV infections can be very annoying because they can reappear. The sores may be painful and embarrassing. For some chronically ill people and newborn babies, the viral infections can be serious but rarely fatal.

There are two types of HSV-Type 1 and Type 2.

• Type 1. Studies show that most people get Type 1. It affects the lips, mouth, nose, chin or cheeks during infancy or childhood. They usually catch it from close contact with family members or friends who carry the virus. If can be transmitted by kissing or by using the same eating utensils and towels. A rash or cold sores in the mouth and gums appear shortly after exposure. Symptoms may be barely noticeable or may need medical attention for relief of pain.

• Type 2. It most often appears following sexual contact with an infected person. It has reached epidemic numbers, affecting anywhere between 5 and 20 million persons in the United States, or up to 20% of all sexually active adults.

Herpes Simplex Type 1

Called fever blisters or cold sores, HSV Type 1 infections are tiny, clear, fluid filled blisters most often seen on the face. Type 1 infections may also, less often, occur in the genital area. Type 1 may also develop in wounds on the skin. Nurses, physicians, dentists, and other health care workers sometimes contract a herpetic sore after HSV enters a break in the skin of their fingers

The number of blisters varies from one to a whole cluster. Before the blisters appear, the soon-to-be affected skin may itch or become very sensitive. The blisters then break by themselves or as a result of minor injury, allowing the fluid inside the blisters to ooze. Eventually, crusts form and fall off, leaving slightly red skin. Though the primary infection heals completely, rarely leaving a scar, the virus that caused it remains in the body. It migrates to nerve cells where it remains in a resting phase

Hot news about cold sores

Some individuals suffer from "sun blisters" that develop on their lips after exposure to the sun. Boating, beaching, gardening, or bicycling are activities frequently associated with this problem in the summer. The eruption is caused by the herpes simplex virus. Its appearance may be heralded by itching, burning, or swelling of the lips, followed by the rapid outbreak of groups of blisters. The rash, which can be painful, can spread to the face, and might take one to two weeks to resolve. In some cases, infection with bacteria can complicate the problem. Professional evaluation by a dermatologist is a wise idea since other conditions can produce blisters on the lips. Treatment can include oral medications and antiviral cream. The regular use of high SPF sunscreens on the lips can help prevent outbreaks of sun blisters.

Many products that women use cosmetically now contain sunscreen. But what about men? Men need not wear lipstick to protect their lips from UV light; there are many natural looking, non-greasy lip balms that contain sunscreen. And there is no reason for men not to use a plain moisturizing lotion containing sunscreen on a daily basis.

Herpes Simplex Type 2

Infection with herpes simplex virus Type 2 usually is below the waist, on the buttocks, penis, vagina, or cervix, two to twenty days after contact with an infected person. Sexual intercourse is the most frequent means of contracting the infection. Symptoms of both primary and repeat attacks can include a minor rash or itching, painful ulcers, fever, aching muscles, and a burning sensation during urination. HSC Type 2 can also occur in locations other than the genital area.

As with Type 1, sites and frequency of return bouts vary. The initial episode can be so mild that a person does not realize that he or she has a herpetic infection. Years later, when there is recurrence of HSV, it may be mistaken for an initial attack. This can lead to unfair accusations by a sexual partner.

After the initial attack, the virus moves to nerve cells near the brain or spinal cord remaining there until set off again by a menstrual period, fever, physical contact, stress or something else. Pain or unusual tenderness of the skin may begin between one to several days before both primary and recurrent infections may develop. This is called prodrome.

How are the HSV infections diagnosed?

The appearance of HSV is often so typical that no further testing is necessary to confirm an HSV infection. However, if the diagnosis is uncertain, as it may be in the genital or cervix areas, a specimen may be taken and sent to the laboratory for analysis.

How do you prevent transmission?

Between 200,000 and 500,000 persons “catch” genital herpes each year and the number of Type 1 infections is many times higher. Prevention of this disease, which is contagious before and during an outbreak, is important.

If tingling, burning, itching, or tenderness-signs of recurrence-occur in an area of the body where you had a herpes infection, then that area should be kept away from other people. With mouth lesions, one should avoid kissing and sharing cups or lip balms. For persons with genital, this means avoiding sexual relations and oral and/or genital contact during the period of symptoms or active lesions. Towels should not be shared nor clothing exchanged. Studies have shown viral shedding between attacks.

Other serious implications of HSV

• Eye infections
• Infections in babies
• HSV and the seriously ill

Treatment

There is no vaccine that prevents this disease from occurring. Oral anti-viral medications, acyclovir and valacyclovir, have been developed for severe or frequently recurring infections. Low doses of medications are helpful in reducing the number of herpes attacks in people with frequent outbreaks.

MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a virus-caused growth which appears as a small bump on the skin, often with a small, central, dimple-like depression. It may occur on any part of the body and there may be a single growth or as many as 50 or more.

As the name suggests, these growths are contagious and are spread from place to place on the body and to other people by physical contact. Sometimes they are spread by sexual contact and if this is the case, sexual partners should be examined for presence of lesions.

Treatment

Treatment consists of physically removing these superficial growths from the skin. This may be done by curettement (scraping them off with a special surgical instrument), application of various medicines to the growths or by freezing them with liquid nitrogen. Molluscum contagiosum lesions may also become infected with bacteria and may sometimes require antibiotic therapy. Since molluscum contagiosum lesions sometimes go away by themselves, treatment by cautery or surgery requiring stitches is avoided because of the scarring that results from these methods.

Sometimes new lesions keep appearing after treatment. This is probably because some growth were in an early stage at the time of the treatment and could not be seen with naked eye. Eventually, after all visible and incubating lesions have been destroyed the appearance of new molluscum contagiosum lesions will stop.

SHINGLES (HERPES ZOSTER)

Herses Zoster, also known as shingles or zoster, is a viral infection caused by the same virus that causes chicken pox. Anyone who has had chicken pox can develop develop herpes zoster. The virus remains dormant or inactive in certain nerve root cells of the body and only when it reactivates does herpes zoster occur. About 20% of those people who have had chicken pox will get zoster at some time during their lives. Fortunately, most people will get zoster only once.

It is not clear what prompts the virus to reactivate or “awaken” in healthy people. A temporary weakness in immunity ( the bodies ability to fight infection) may allow the virus to multiply and move along nerve fibers toward the skin. Although children can get zoster, it is more common in people over age 50. Illness, trauma, and stress may trigger a zoster attack.

What are the symptoms of Zoster?

The first symptom of zoster is burning pain, tingling, or extreme sensitivity in one area of the skin usually limited to one side of the body. This may be present for one to three days before a red rash appears at that site. There may also be fever or headache. The rash soon turns into groups of blisters that look a lot like chicken pox. The blisters generally last for two to three weeks. The blisters start out clear but then pus or dark blood collects in the blisters before they crust over (scab) and begin to disappear. The pain may last longer. It is unusual but possible to have pain without blisters or blisters without pain.

Where does zoster usually appear on the body?

Zoster is most common on the trunk and buttocks but it can also appear on the face, arms, or legs if nerves in these areas are involved. Great care is needed if the blisters involve the eye because permanent eye damage can result. Blisters on the tip of the nose signal possible eye involvement. A dermatologist will usually refer the patient to an ophthalmologist (eye specialist) immediately.

What are the complications of zoster?

Post-herpectic neuralgia is constant pain or periods of pain that can continue after the skin has healed. It can last for months or even years and is more common in older people. The use of medication in the early stages of the zoster may help prevent this complication. A bacterial infection of the blisters can occur, and can delay healing. If pain and redness increase or reappear, you should return to the dermatologist. Antibiotic treatment may be needed.

Another complication is the spread of zoster all over the body or to internal organs. This can also happen with chicken pox. It occurs rarely and most often in those with weakened immunity.

How is zoster diagnosed?

The diagnosis is based on the way blisters look and a history of pain before the rash on one side of the body. The dermatologist may scrape skin cells from a blister onto a glass slide for examination. The glass slide is then examined under a microscope for changed characteristic of zoster. If there is any doubt, blister fluid containing virus can be sent to the laboratory for special testing.

Is zoster contagious?

The virus that causes zoster can only be passed on to others who have not had chicken pox and then they will develop chicken pox, not zoster. Zoster is much less contagious than chicken pox. Persons with zoster can only transmit the virus if blisters are broken. Newborns or those with decreased immunity are at the highest risk for contracting chicken pox from someone who has zoster. Patients with zoster rarely require hospitalization.

Treatment

Zoster usually clears on its own in a few weeks and seldom recurs. Pain relievers and cool compresses are helpful in drying the blisters. If diagnosed early, oral anti-viral drugs can be prescribed to decrease both viral shedding and the duration of skin lesions. They are routinely prescribed for severe cases of zoster -with eye involvement for example- or for those with decreased immunity.

Corticosteriods, sometimes in combination with anti-viral drugs, also are used for severe infection such as in the eyes and to reduce severe pain. Nerve blocks can also help to control pain.