**3.6 Verruca vulgaris (viral wart)**

Verruca vulgaris is an infection caused by human papilloma virus (HPV). There are more than 70 types of HPV which are identified by type numbers, and types that infect the human skin are different from those that infect the mucous of the oropharynx and genitalia. Therefore, doctors should inform the patients that the disease is not sexually transmitted. The pathogen is not included in the microbiota of AD skin, so it is a simple infection from other patients or the environment. The condition is frequent in healthy children and also in patients (children and adults) with AD. The clinical picture is different in patients with AD and the management strategy is also different, so it is discussed in this chapter.

The lesions are slightly elevated papules with obvious margins. Sometimes the lesions grow like cauliflower with a rough surface. The colour is more yellowish-white than the uninfected skin (Fig. 10). HPV promotes the growth of capillaries for their survival. Therefore, small black dots are often seen within a lesion. HPV is observed in piles within the lesion by electron microscopy.

Fig. 8. Molluscum contagiosum on the chest of a patient with AD.

Verruca vulgaris is an infection caused by human papilloma virus (HPV). There are more than 70 types of HPV which are identified by type numbers, and types that infect the human skin are different from those that infect the mucous of the oropharynx and genitalia. Therefore, doctors should inform the patients that the disease is not sexually transmitted. The pathogen is not included in the microbiota of AD skin, so it is a simple infection from other patients or the environment. The condition is frequent in healthy children and also in patients (children and adults) with AD. The clinical picture is different in patients with AD

The lesions are slightly elevated papules with obvious margins. Sometimes the lesions grow like cauliflower with a rough surface. The colour is more yellowish-white than the uninfected skin (Fig. 10). HPV promotes the growth of capillaries for their survival. Therefore, small black dots are often seen within a lesion. HPV is observed in piles within

and the management strategy is also different, so it is discussed in this chapter.

**3.6 Verruca vulgaris (viral wart)** 

the lesion by electron microscopy.

When the skin of the face and the neck is affected in AD patients, the lesions often become itchy, and scratching releases HPV into the nearby skin. It results in an assembled manner of the lesions (Koebner phenomenon). The itching of the lesions is often ignored because the lesions are not itchy in patients without AD. Patients often apply topical anti-inflammatory drug to the lesion but it should be avoided because it promotes the proliferation of HPV. Therefore, the treatment for such HPV is often complex and difficult.

The first step of treatment should include cryotherapy using liquid nitrogen. When the lesion successfully drops off as a consequence, it is appropriate to apply topical antiinflammatory ointment immediately.

Fig. 9. Severe molluscum contagiosum in an infant with AD.

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