Condyloma acuminatum

Condyloma acuminatum (syn. moist warts, pointed warts) occur in individuals with poor hygienic habits. The virus may be transmitted during sexual intercourse. Gonorrheal, trichomonad, and discharges of other origin are important in the pathogenesis of the disease. Pointed warts are usually localized on the genitals and in the perianal region and in rare cases in the axillae and under the breasts in women. Small, soft, filiform pink warts form. When they coalesce, papillomatous growths resembling cauliflower or raspberries form. These growths may macerate and ulcerate. Some lesions have a pedicle (a narrow base). Secretion with an offending odour often accumulates between the condylomata.

Diagnosis. It is important to differentiate moist condylomata from flat (syphilitic) condylomata. The latter have a wide base, a hard-elastic consistency, and no lobate structure, and very many Treponema pallidum organisms are found in their secretions. Other symptoms of the secondary syphilitic period and positive results of serologic blood tests help in making the diagnosis. Both pointed and flat condylomata may be found in a patient with syphilis at the same time.

Treatment. Diathermocoagulation, electro-incision, cryotherapy, and curettage with Volkmann's sharp spoon are carried out. Condyloma acuminatum may be cauterized with a strong solution of potassium permanganate, trichloro-acetic acid, and a 20 per cent podophyllin solution or painted with a mixture of four parts of phenol and six parts of tricresol (pheresol). Cauterizing powder (resorcinol and talc in equal amounts) and colchamine ointment are prescribed. Factors favoring the development of condylomata acuminata are removed.

Molluscum contagiosum

Molluscum contagiosum (MC) is a common, self-limited, benign viral infection of the skin caused by a member of the pox-virus group. MC is transmitted by close personal contact including sexual contact. The condition typically involves young children. In adults, the infection occurs with increased frequency in presence of HIV infection. The lesions of MC have a distinct appearance of firm papules and nodules with central depressions. MC is caused by molluscum contagiosum virus (MCV), which belongs to the pox-virus group of DNA viruses. It is one the largest known pathogenic viruses. There are more than one types of MCV , MCV1 being the most common type of virus causing MC worldwide, particularly among the children, while MCV2 is the common type found in HIV infected individuals. Transmission occurs by close personal contact and often through fomites – towels, bath, and swimming pools. The virus replicates within the cytoplasm of infected epidermal cells, pathologic changes induced by the virus leads to formations of large hyaline acidophilic masses inside the cytoplasm (known as molluscum bodies of Henderson-Paterson bodies). Localized hypertrophy of epidermis extends into the dermis without disrupting the basement membrane and also projects above the skin as a visible lesion. Secondary infection may lead to an inflammatory reaction. The incubation period is two to eight weeks. A nodule the size of a pea and the colour of normal skin or pearly-grey (mother-of-pearl) in appearance forms. It is semispherical with a crateriform depression in the centre and a caseous-like content. There are no subjective sensations. The nodules may be solitary or may occur in dozens (disseminated lesions).

The favoured localization in children is on the face (around the eyes), neck, chest, and the back of the hands. In adults the lesions occur mostly on the external genitals, the pubis and abdomen which testifies to the possibility of the sexual route of infection. The following clinical variants are distinguished: Molluscum contagiosum miliare with multiple tiny lesions; Molluscum contagiosum pediculatum marked by pedunculated lesions; Molluscum giganteum with giant lesions formed after coalescence of smaller ones.

Diagnosis. The following characteristic sign helps in making the diagnosis: a white gruel-like caseous mass of keratotic cells and moluscous (ovoid) bodies is expressed from the central part of the nodule when it is compressed from the sides with forceps. Warts have neither a central depression nor a mother-of-pearl surface.

Treatment. The nodules are expressed with forceps or removed by curettage with a sharp spoon after which the area of the affection is painted with a 5-10 per cent iodine tincture and a 3 per cent Oxolinum or interferon ointment is applied. Diathermocoagulation and cryotherapy are also conducted.

Prevention: Avoidance of skin-to-skin contact with infected persons. Treatment of lesions prevents further spread and autoinoculation. Chlorination of swimming pools.