VIRAL INFECTIONS

Common warts (Verruca vulgaris) due to human papillomavirus (HPV-2 and 4) are seen in ~5-10% of all children at some point of time, though more common in immunocompromised states, e.g.

Clinically, warts appear as well-circumscribed papules with rough, keratotic and irregular surface, mainly over fingers, dorsum of hand and knees (Fig. 25.5J). Paring away of the papule reveals many black dots representing thrombosed dermal capillary loops. Warts are rarely painful except when on pressure areas, e.g. soles or palms. Genital warts are rare in children except in early infancy due to passage from infected birth canal or in sexually active adolescents.

Treatment: Over 50% warts disappear spontaneously within 2 years, but infection may spread to other sites. Large disfigurative lesions may be destroyed by keratolytic therapy (daily application of 10% salicylic acid/lactic acid in a collodion) for 2-4 weeks, cryotherapy (liquid nitrogen application for 6-9 seconds) or light electro-dessication.

Molluscum contagiosum due to pox-virus (mainly type 1) is not uncommon in school-children, though recurrent or multiple lesions indicate immunocompromised state, e.g. HIV. Infection is acquired by direct contact with an infected person or fomites and spreads by autoinoculation.

Clinically, these lesions are discrete dome-shaped, skin-colored papules (1-5 mm) with typical central umbilication, from which a plug of cheesy material can be expressed. Lesions are more common over face, eyelids, neck, axilla and thighs. HIV-infected children tend to have large and numerous lesions.

Treatment: While molluscum contagiosum is self-limiting (6-9 months), infective nature and risk of spread by auto­inoculation demands early treatment with cryotherapy (treatment of choice) or expression of plug by a sterile needle, curette or comedo extractor.

Herpes zoster due to reactivation of previous varicella infection is rare in children, except in immunocompromised hosts.

Clinically, these cases present as sudden eruption of grouped vesicular lesions over an erythematous patch, with typical dermatomal distribution (Fig. 25.5K). New vesicles may continue to erupt for next 3-5 days, while older vesicles dry and crust, which fall after 10-14 days leaving a hyperpigmented lesion. Prodromal pain and post-herpetic neuralgia is rare in children.

Treatment: Although lesions are self-limiting, oral acyclovir therapy is indicated in most cases, starting as early as possible, specially in severe disease or underlying immunodeficiency.

Herpes labialis is a common and usually recurrent manifestation of dormant HSV1 infection after many years of clinical or latent primary disease. Lesions are often precipitated by a febrile illness (herpes febrilis), viral infection or cold stress.

Clinically, these lesions present as grouped, small, clear vesicles on an erythematous base, usually over upper/ lower lip (Fig. 25.5L).

Treatment: While most cases are mild and self-limiting, topical application of 5% acyclovir cream in early erup­tive phase may reduce severity or duration of attack.

25.3.4