Lifestyle Choices

Viruses

Viruses are even smaller than bacteria and fungi and they are not usually found on normal skin. Many viruses can cause a rash – e.g. measles and glandular fever – but these diseases are not dealt with here. This section describes some virus infections in which either the only signs or the commonest signs of the disease are on the skin.

Warts

It is now known that there are several strains of wart virus and each tends to produce its own type of wart. Some cause the ordinary wart on the hands, others painful warts on the feet; and still others warts on the face or genitals. Warts are caught from other people. This happens easily in children who have not had time to develop immunity to the virus but adults are more resistant. Even when the virus has gained access to the skin it may lie dormant for weeks or months before the wart itself appears.

Common warts are most frequently seen on the hands, fingers and knees. These may be one or many and a group may form into a large single wart. Because the virus spreads most easily into damaged skin it can take hold around the nail in nail biters: the appearance of multiple warty masses growing round many nails is typical of nail biters and pickers or people who manicure their fingers to excess,

Plane warts are almost flat and smooth and are colored like skin or slightly gray-brown. In some lights they may be difficult to see at all. Most often affected are the backs of the hands, face and shins and in some instances, large numbers may be found.

Filiform warts are slender, pointed warts often occurring singly and usually affecting the face, eyelids or nostrils.

Plantar warts, commonly known as verrucae, are found on the soles of the feet. There may be one or several. One type looks like multiple verrucae grouped together and is called a mosaic wart. Plantar warts are often picked up when the feet or floor is wet at swimming baths or showering after sport. Sometimes they are painful when walking. Another painful lump on the foot is a corn and this has a different treatment. Corns have a smooth surface and the normal pattern of skin markings (dermatoglyphics) is preserved. To distinguish the two a doctor or chiropodist may trim the surface with a scalpel and find that only warts have little black specks on the surface.

Rarely a wart may be removed under local anesthetic or injected with a drug which kills the virus. Fortunately this is rarely needed.

Genital warts are nearly always sexually transmitted and require a different line of treatment. This should include an examination of sex partners as well as looking for other sexually-acquired diseases. Various methods of treatment may be tried but it has to be regular and under supervision of a doctor.

Molluscum contagiosum

This is another common viral infection, sometimes referred to as `water warts‘. It is usually children who are affected and particularly those who have a tendency to eczema. The tiny spots are a whitish color and when looked at through a magnifying glass can be seen to have a small dimple in the center – like a doughnut. Multiple spots often appear and there may be some at different stages of development. Scratching fingers may spread the infection.

Treating warts

The treatment of warts depends on the age of the individual and on the type of wart. Wart paints are the mainstay for common and plantar warts and when used properly go a are simple keratolytics, containing salicylic acid, which will gradually dissolve away the bulk of the wart. The wart is an overgrowth of keratin in response to the virus. Salactol, Duofilm and Verrugon all work in this way.

Cold sores

Herpes simplex is the name given to an infection of the skin caused by a herpes virus. It is seen most often on the lips and face and called a cold sore. Almost any body site can be affected including the fingers and the eyes. Genital herpes is due to the same virus but will only be mentioned briefly here. With all herpes there is a so-called primary infection that may cause fever and general ill-health for a few days. After that the infection may reappear, at the same site, for the rest of life. The virus remains in the nerves supplying that part of the skin and can be reactivated by a number of factors, e.g. acute illness, sunlight, injury. The attack is often preceded by a few hours or a day of localized burning and tingling. The infection then reappears on the skin as small blisters on a red base in roughly the same place each time. They last for about four days, dry up and disappear without a blemish.

There is a specific treatment now available for herpes simplex that interferes with the replication of the virus. It cannot prevent future attacks but it can cut short the present one. Acyclovir (Zovirax is the trade name) is more effective as tablets than as a cream. It is often reserved for people who have severe attacks and must be taken at the first sign of itching or soreness to be effective. Genital herpes is acquired sexually and while it is active you should not have sex without a condom.

Shingles

Herpes zoster is the virus which causes both shingles and chickenpox. Having had chickenpox earlier in life the virus lives on close to the spinal cord in the nerves which supply the skin. At a later date, either when the resistance is low or for other unknown reasons, the virus spreads through the nerves and onto the skin supplied by that nerve. This explains why the rash is in a line, either down a limb or round the trunk. The attack is normally preceded for a day or two by burning or pain then the skin forms blisters on a red base that after a few days become pus- filled before turning into scabs. There may be some scarring. It is most worrying when the eye is involved.

Shingles is usually an unpleasant experience although some people have little or no pain. All ages may be affected but it is far commoner in the elderly. It does recur like cold sores. It may, however, give rise to a pain called post-herpetic neuralgia which appears within a week or two and may go on for months or years.

If the attack is recognized early the severity may be reduced if the doctor gives you acyclovir (Zovirax). However, if the blisters have been present for a day or two the medicine will be less effective.

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