In immunocompromized individuals, severe affection with prolonged disease course and scarring may occur.

Second attack of herpes is rare, but in HIV-infected individuals, frequent recurrences may occur.

Treatment: Acute attack: salicylates and analgesics, sedatives, vitamins B₁, B₁₂, and C, gamma globulin injections, and interferonogens are prescribed.

Antiviral therapy: acts best if initiated within 48 hours of onset. Acyclovir (800mg 5 times a day x 7-10 days) or valacyclovir (100mg twice daily x 7 days)). Antiviral therapy reduces acute pain and inflammation, reduce duration of disease and viral shedding and may reduce frequency of PHN.

Physiotherapy is advisable, namely irradiation with ultraviolet rays, ultrasonics, indirect diathermy of the cervical sympathetic ganglia, diadynamic currents, procaine hydrochloride electrophoresis, circular procaine blockade, a 50 per cent interferon ointment phonophoresis.

Topical antiviral therapy: Irritating treatment with ointments and baths is contraindicated in acute eruptions. External application of antivirus ointments (Bonaphton, Gossypol, Tebrophenum, Zovirax, Acyclovir) together with aniline dyes has a beneficial curative effect. A patient with an eruption is not allowed to take a bath or a shower.

Prevention. Overcooling and toxicosis should be avoided.

Warts (verrucae)

Etiology and pathogenesis. Warts are caused by human papillomavirus (HPV). HPV is a circular, double-standed DNA virus. HPV infection is higly specific for epidermis, especially extremities. Certain types of HPV infection have been associated with the development of malignancy. A subclass of HPV has a malignant potential and may be found in certain cervical carcinomas.

Classification of verrucae:

1. Verruca vulgaris or common wart is caused by various strains of human papilloma virus (HPV-2, HPV-4, HPV-29);

2. Verruca palmaris or plantaris (myrmecia or palmoplantar wart) is caused by various strains of human papilloma virus (HPV-1, HPV-2, HPV-4);

3. Verruca plana (HPV-3)

4. Condyloma acuminatum (HPV 6, HPV-11).

The disease is contagious. The infection is transmitted either during direct contact from a sick individual to a healthy person or through infected objects. Traumas of the skin and its dryness, reduced pH of the skin water-lipid mantle, vegetoneurosis with acrocyanosis or hyperhidrosis facilitate the development of the disease.

Common warts (verruca vulgaris). They are mostly encountered in children and youths and grow on the hands and feet and less frequently on the face.

Clearly circumscribed, hard, painless, semispherical lesions appear, which are elevated above the skin surface. They have the colour of normal skin or are greyish or brownish and there is no inflammation. Their surface is granular and rough, sometimes with nodular structures. Their size varies from that of a pin-head to that of a lentil; large conglomerates may form when the warts coalesce. Warts on the planter surface of the foot and the palm are hardly elevated above the skin surface and are characterized by marked keratosis. The number of warts ranges from solitary lesions to several dozens.

Histopathology. The histological picture is characterized by hyperkeratosis and papillomatosis.

Treatment. Electrocoagulation or diathermocoagulation, curettage, freezing with trichloro-acetic acid, solid carbon dioxide or liquid nitrogen (cryotherapy or cryodestruction) are conducted. Carbon dioxide Laser (1-3 séances). Colchicines, 2 per cent Oxolinum, 1-3 per cent Florenal, and gossypol ointments are applied and the lesions are treated with Fowler's solution, solcoderm, or pheresol composed of 40 per cent phenol and 60 per cent tricresol.

Plane juvenile warts (verrucae planae juveniles) prevail among children and adolescents. These are slightly elevated, polygonal or rounded, flat hard lesions. They have a smooth surface and vary in size from the size of a millet to that of a lentil. In some cases they have the colour of normal skin, in others they are yellowish-pink or yellowish-brown. Multiple plane warts are usually scattered on the back of the hands, on the face (forehead), neck and forearms; less frequently they form in a line.

Histopathology. Hyperkeratosis and acanthosis are characteristic findings.

The diagnosis is made easily. The condition sometimes has to be differentiated from lichen planus in which the papules are characterized by a wax-like lustre, an 'umbilicate' depression in the centre, a violet-red colour, and itching.

Treatment. External treatment is accomplished with keratolytic ointments containing salicylic, benzoic, and lactic acids and resorcinol. Exposure to erythema doses of ultraviolet rays or Bucky's rays, and interferon, gossypol, propolis, colanchoe, oxolinum, and bonaphton are prescribed.

Plantar warts (verrucae plantares) are a variety of the common wart. Compression of the feet by footwear, traumas of the soles, and hyperhidrosis of the feet facilitate their formation. These warts occur sometimes on the nail bed on which they form hard and very painful excrescences. Plantar warts are round or oval and yellowish-brown. Because of the sharp tenderness, they make walking difficult; they resemble corns. They are usually few in number. Just as in the above-described forms of warts, the histological picture is marked by acanthosis, papillomatosis, and hyperkeratosis.

Treatment. Liquid nitrogen (cryotherapy), colchamine ointment, and painting the lesion with a 10-20 per cent podophyllin solution are prescribed. The following astringent is recommended:

Rp: Ac. salicylici 1.0

Ac. acetici 9.0

Collodii elastici 10.0

MDS. For external application

The skin around the wart is smeared with zinc paste (to protect the surrounding tissues) and a collodion preparation containing 50 per cent potent substances is applied to the wart. This is repeated once a day for three or four days. A hot foot bath with sodium hydrocarbonate is then taken after which the collodion film and the softened horny masses are removed with scissor blades. The procedure is repeated until the 'root' of the wart is removed. Curettage is an effective method for the removal of plantar warts.