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LETTER TO EDITOR
Year : 1997  |  Volume : 63  |  Issue : 6  |  Page : 390-391

Widespread dissemination of warts in prexisting dermatoses




Correspondence Address:
Somesh Gupta


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Source of Support: None, Conflict of Interest: None


PMID: 20944392

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How to cite this article:
Gupta S, Gupta U, Tiwari N K, Saraswat P K. Widespread dissemination of warts in prexisting dermatoses. Indian J Dermatol Venereol Leprol 1997;63:390-1

How to cite this URL:
Gupta S, Gupta U, Tiwari N K, Saraswat P K. Widespread dissemination of warts in prexisting dermatoses. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2019 Sep 15];63:390-1. Available from: http://www.ijdvl.com/text.asp?1997/63/6/390/4630


To the Editor

It is equally, if not more, common to see the eczema herpeticum or Kaposi's varicelliform eruption-like widespread dissemination of viral warts (V.W.) in pre-existing dermatoses. We have seen cases of disseminated viral warts in pemphigus foliaceous, atopic dermatitis, and scabies. In our first case, the VW appeared first time when the patient was under steroid and other immunosuppressive drugs therapy. The dis­semination involved only areas of dermatosis affected skin PAS). Hundreds of common warts appeared with unusual rapidity i.e. within a period of a week.

In our second case although the atopic dermatitis was present before the first appear­ance of common warts, the dissemination took place before the commencement of ste­roid and other therapies. The number of VW in this patient were also many hundreds and they involved again only the areas of DAS. In the third patient common warts were present in beard area before the patient had suffered from scabies. Within 2 weeks of onset of pruritus the warts spread to involve all the areas affected by scabies - i.e., inter­digital webs, flexors of wrists, axillae, but­tocks and genitalia [Figure 1].

Although our cases were affected from dif­ferent dermatoses, they had some striking similarities. All three cases had same mor­phological type of V W i.e. common warts, all had severe pruritus, all responded poorly to therapy for V W with recurrences, even after effective control of dermatosis and in all 3 cases the dissemination of V W was confined to DAS only.

It seems that the mechanisms of dissemina­tion are same as seen in eczema herpeticum or kaposi's varicelliform eruption, except in the latter the possibility of hematogenous spread is more likely. In dissemination of V W local inoculation of virus due to trauma of itching and compromised skin defence mechanisms are more important. This view is strengthened by the observation that the eczema herpeticum frequently disseminates beyond the DAS while V W usually remain confined to the affected skin only.

Local factors alone can not explain such a large number (many hundreds) of V W and cell-mediated immune suppression due to dermatosis may be partly responsible. Ste­roid and immunosuppressive therapy, as in our first case, may also be one of the respon­sible factors.

Such dissemination of warts, although not less common than dissemination of herpes simplex, is far less studied till now. An ec­zema herpeticum-like terminology (? eczema verrucum) to this condition will emphasize it and attract attention of dermatologists[3].

 
  References Top

1.Lowy DR, Androphy E J Warts. In : Dermatol­ogy in General Medicine, 4th edn Edited by Fitzpatrick T B, Eisen A Z, et al eds.) New york Mc Graw-Hill, 1993; 2611-19.  Back to cited text no. 1    
2.Crumpacker C S, Gulick R M. Herpes Simplex. In : Dermatology in General Medicines 4th edn. Edited by Fitzpatrick T B, Elisen A Z , et al eds.) Mc Graw-Hill New york 1993; 2531-2542.  Back to cited text no. 2    
3.Highet A S, Kurtz J Viral infections. In Text Book of Dermatolgy 5th edn, Edited by Champion RH, Burton J L, Ebling F J G, Blackwell, London : 1992; 867-951.  Back to cited text no. 3    




 

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