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U N I T 1 3
Integumentary Function
where they appear as small, grayish-white to tan, flat
to convex papules with a rough, pebblelike surface (Fig.
46-8). Verrucae plana, or flat warts, are common on
the face or dorsal surfaces of the hands. These warts
are slightly elevated, flat, smooth, tan papules that are
slightly larger than verrucae vulgaris. Verrucae plantaris
and verrucae palmaris (i.e., plantar and palmar warts,
respectively) occur on the soles of the feet and palms
of the hands, respectively. They appear as rough, scaly
lesions that may reach 1 to 2 cm in diameter, coalesce,
and be confused with ordinary calluses.
Transmission of HPV infection is largely by direct con-
tact between individuals or by autoinoculation, usually
through breaks in skin integrity. For example, plantar
warts, which occur on the soles of the feet, frequently are
transmitted to the abraded, softened heels of children in
swimming areas. Common hand warts can be transmit-
ted by biting the cuticles surrounding the nail.
Treatment is usually directed at inducing a “wart-
free” period without producing scarring. Warts resolve
spontaneously when immunity to the virus develops.
12
The immune response, however, may be delayed for
years. Because of their appearance or discomfort,
people usually desire their removal, rather than wait-
ing for immunity to develop. Removal is usually done
by applying a keratolytic agent, such as salicylic acid,
which works by dissolving intercellular cement and
producing desquamation of the horny layer of skin
without affecting normal epidermal cells. Duct tape
or “Ducto-Therapy” has been found effective for
treatment of common warts. Intralesional bleomycin
injections have been effective for recalcitrant warts.
12
Various types of laser surgery, electrosurgery, cryother-
apy, immunotherapy (e.g., oral zinc sulfate), and anti-
viral therapy (e.g., cidofovir) also have been successful
in wart eradication.
Herpes Simplex.
Herpes simplex virus (HSV) infec-
tions of the skin and mucous membrane (i.e., cold sores
or fever blisters) are common.
13
Two types of HSV infect
humans: type 1 and type 2. HSV-1 is usually associated
with oropharynx infections (labial herpes), and the
organism is spread by respiratory droplets or by direct
contact with infected saliva. Genital herpes usually is
caused by HSV-2 (see Chapter 41). HSV-1 genital infec-
tions and HSV-2 oral infections are becoming more
common, perhaps because of oral–genital sex.
Infection with HSV-1 may present as a primary or
recurrent infection. Primary HSV-1 symptoms include
fever, sore throat, painful vesicles, and ulcers of the
lips, tongue, palate, and buccal mucosa. Primary infec-
tion results in the production of antibodies to the virus
so that recurrent infections are more localized and less
severe. After an initial infection, the herpesvirus persists
in the trigeminal and other dorsal root ganglia in the
latent state, periodically reactivating as recurrent infec-
tions. The symptoms of a primary HSV-1 infection most
often occur in young children (1 to 5 years of age).
The recurrent lesions of HSV-1 are often found in the
vicinity of the primary infection and usually begin with
a burning or tingling sensation. Umbilicated vesicles and
erythema follow and progress to pustules, ulcers, and
crusts before healing (Fig. 46-9). Lesions are most com-
mon on the lips, face, mouth, nasal septum, and nose.
When a lesion is active, HSV-1 is shed and there is risk
of transmitting the virus to others. Pain is common, and
healing takes place within 10 to 14 days. Precipitating
factors include stress, menses, or injury. In particular,
ultraviolet B exposure seems to be a trigger for recur-
rence. Individuals who are immunocompromised may
have severe attacks.
There is no cure for oropharyngeal herpes; most treat-
ment measures are palliative.
13
Over-the-counter topical
preparations containing antihistamines, antipruritics,
and anesthetic agents along with aspirin or acetamino-
phen may be used to relieve pain. Topical medications
are best applied gently with a cotton-tipped applicator
to prevent increased viral shedding and viral inoculation
to another anatomic site. Oral acyclovir, valacyclovir,
FIGURE 46-8.
Common warts (verruca vulgaris).This
young boy has multiple common warts. (From Goodheart
HP. Goodheart’s Photoguide to Common Skin Disorders.
Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams &
Wilkins; 2009:141.)
FIGURE 46-9.
Recurrent herpes simplex virus infection
(herpes labialis). Lesions are evident on the vermilion border
of the lip and beyond. (From Goodheart HP. Goodheart’s
Photoguide to Common Skin Disorders. Philadelphia, PA:
Wolters Kluwer Health | Lippincott Williams &Wilkins;
2009:157.)
