Warts typically are self-limited and resolve spontaneously over years without specific treatment. Treatment options are available for common and flat warts as well as condylomata acuminata. Topical preparations for common and flat warts disrupt infected epithelium (using salicylic acid, liquid nitrogen, or laser therapy) and result in the cure of approximately 75% of patients. Treatment of anogenital warts is complex, and specific treatments ( www.cdc.gov/std/hpv/default.htm ) may include topical podophyllotoxin or imiquimod. Additional treatment methods include laser ablation and immunotherapy with intralesional interferon; immunotherapy may result in significant toxicities.
The most serious consequence of HPV infection is cervical cancer (more than 12,000 new cases annually), vulvar, vaginal, penile, and anal cancers. A quadrivalent, recombinant HPV vaccine against serotypes 6, 11, 31, and 33 is recommended for all children at 11 to 12 years of age but may be given to children between 9 and 26 years of age. The three-dose regimen has 98% to 100% efficacy in preventing the precancerous dysplasia that precedes cervical cancer.
Molluscum contagiosum virus, a poxvirus that replicates in host epithelial cells, produces discrete, small (2 to 4 mm), pearly flesh-colored or pink, nontender, dome-shaped papules with central umbilication. Papules occur most commonly in intertriginous regions, such as the axillae, groin, and neck. They rarely occur on the face or in the periocular region. The infection typically affects toddlers and young children and is acquired through direct contact with infected individuals. Spread occurs by autoinoculation. Infection with molluscum contagiosum may be complicated by a surrounding dermatitis. Severely immunocompromised persons or persons with extensive atopic dermatitis often have widespread lesions.
Diagnosis is made clinically. Lesions are self-limited, resolvingover months to years, and usually no specific treatment is recommended. Available treatment options are limited to destructive modalities, such as cryotherapy with topical liquid nitrogen,vesicant therapy with topical 0.9% cantharidin, or removal bycurettage, and should be reserved for extensive disease.
Available @ StudentConsult.com
Lymphoid tissue steadily enlarges until puberty and subsequently undergoes progressive atrophy. Lymph nodes aremost prominent in children 4 to 8 years of age. Normallymph node size is 10 mm in diameter, with the exceptions of15 mm for inguinal nodes, 5 mm for epitrochlear nodes, and2 mm for supraclavicular nodes, which are usually undetectable. Lymphadenopathy is enlargement of lymph nodes andoccurs in response to a wide variety of infectious, inflammatory, and malignant processes. Generalized lymphadenopathy is enlargement of two or more noncontiguous lymphnode groups, whereas regional lymphadenopathy involves one lymph node group only.
Lymphadenitis is acute or chronic inflammation of lymph nodes. Acute lymphadenitis usually results when bacteria and toxins from a site of acute inflammation are carried via lymph to regional nodes. Numerous infections cause lymphadenopathy and lymphadenitis (Tables 99-1 and 99-2). Causes of inguinal regional lymphadenopathy also include sexually transmitted infections (see Chapter 116). Regional lymphadenitis associated with a characteristic skin lesion at the site of inoculation defines various lymphocutaneous syndromes. Lymphangitis is an inflammation of subcutaneous lymphatic channels that presents as an acute bacterial infection, usually caused by Staphylococcus aureus and group A streptococci.