|LETTER TO EDITOR
|Year : 1997 | Volume
| Issue : 6 | Page : 390-391
Widespread dissemination of warts in prexisting dermatoses
Somesh Gupta, Usha Gupta, NK Tiwari, PK Saraswat
Source of Support: None, Conflict of Interest: None
|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.
| References|| |
|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. |
|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. |
|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. |