Viral Skin Infections

PREVENTING OUTBREAKS IN SPORTS SETTING

Contact sport can be resumed 48 hours after resolution.Caution should still be advised in the treated areas, because some lesions may not yet be clinically apparent.

WARTS

Verrucae are epithelial tumors,hyperkeratotic plaques, and cauliflower-shaped papules caused by infection with various forms of the human papillomavirus (HPV).These lesions are commonly seen on the hands and feet, but they may accur on other skin surfaces.Warts are divided into varios types by typical appearance and location,including common,periungual,flat(verrucae plana), filiform(frondlike), and deep palmoplantar.on exposed skin,warts tend to be hart and have verrucous surface.

After the initial infection,warts frequently are spread by autoinoculation from shaving, scratching, or other skin trauma. Rowing crew members are more likely to have hand warts than track runners, particularly if they do not wear protective gloves for rowing and weight lifting.

Gymnast, football players,wrestlers, and swimmers can all develop warts.Palantar warts can be painful and impede performance, and they should be treated.

DIAGNOSIS

Visual inspection is usually sufficient to make a diagnosis.Warts do not retain the normal fingerprint lines on the hand and feet that corns and calluses do. A wart on the surface of the foot can be distinguished from a callus by paring the lesion down with a No.15 blade. Warts will have 10 to 15 pinpoint black spotsthat are thrombosed capillaries.

TREATMENT

Because warts are confined to the epidermis, they can be removed with little scarring.The treatment options for warts are similar to those for molluscum contagiosum-mechanical, chemical, or immunologic.The most common mechanical methods are freezing with liquid nitrogen, electrocautery, excision, or laser treatment. The wart is frozen until 1 to 2 mm of surrounding skin has turned white, and the treatment is repeated once after the skin thaws. The area should be reexamined in approximately 3 to 4 weeks, because retreatment is commonly needed.

The chemical options range from over-the-counter salicylic acid preparations available in plasters containing 40%, or liquid containing 17% trichloroacetic acid or verrusol applied by a physician. For plantar warts, soaking in the foot, paring down the dead skin or using a pumice stone before applying the medication will increase the effectiveness of topical preparations. Intralesional injection of the chemotherapy agent bleomychin has been used in recalcitrant plantar warts.Bleomycin causes acute tissue necrosis and must be used with extreme caution.

The immunologic methods to induce an immune response to suppress warts include injected agents (eg, candida or mumps antigen), topical agents(eg, imiquimod), or oral agents(eg, 30 to 40 mg/kg/day of cimetidine).


GENERAL PREVENTION POINTERS
For all the viral infections discussed, some common strategies that coaches,athletic trainers, and team physicians can use to prevent disease transmision among physiclly active patients are :

- Enforcing the parctice of good hygiene, such as showering after every athletic event; laundering clothing and uniforms after each use; not sharing towels,soaps,or water bottles; and wearing sandals in comunal showers.

- Examining the athletes skin routinely for scratches, abrasions, and lacerations and keeping these areas securely covered with bandages.

- Remainding players to use sunscreen and lip balm with sunscreen during prolonged exposure to the sun.

- Disqualifying from play any athlete who has active herpes simplex, herpes zoster, or molluscum contagiosum lesions until the conditions have been appropriately treated.Herpes lesions must be completely dry and crusted and should be covered until completely resolved.

- Covering all warts until completely resolved.

share