Viral infections are extremely common and can affect a wide range of ages including young children. They vary in seriousness and how aggressive treatment needs to be depends on the clinical presentation and symptoms. The common viral infections presenting to GPs and dermatologists are discussed here.

Viral Warts

Common viral warts are caused by the human papilloma virus types 1, 2 and 4 and can present on the fingers, hands and feet (Figure 19.1). Plane (flat) warts may also occur on the dorsum of the hands and face. Typically, warts have dark pinpoint areas which are thrombosed capillaries more obvious when the wart is pared down (Figure 19.1e). This sign is essential to differentiate a wart from an area of callus that could be mistakenly treated as a wart.

Warts are usually asymptomatic and treatment is not essential, particularly in children. In children, the pain of liquid nitrogen cryotherapy is usually not tolerated. Warts around the nail folds (Figure 19.2) or plantar warts can be treated with salicyclic acid-based preparations which cannot be used on the face.

In adults presenting with multiple warts, immunosuppression should be considered including HIV infection. Patients on long-term immunosuppressives such as azathioprine and ciclosporin can also be affected. Adults are likely to tolerate more aggressive treatment such as cryotherapy or curettage.

Genital warts are treated usually in the genito-urinary department with topical imiquimod or podophyllotoxin.

Hyperkeratotic warts are ideally pared down to remove the thickening prior to any treatments.