Skin Infections (Part 2): Viral

Hello everybody! Today we will be resuming our discussion about skin infections. Besides bacteria, viruses are also a common cause of skin infections. Without further ado, let’s jump straight into the dirty details:

Viral Infections

Viral warts

These common and non-cancerous warts are caused by the Human papilloma virus (HPV). HPV infects the epidermal cells of the skin. Infection with HPV occurs by direct skin contact. Minor skin trauma predisposes patients to infection, though infection may also occur in normal skin. Patients may also spread a wart to an uninfected part of their own skin.  The time period between infection and the appearance of the warts is approximately two to six months.

Viral warts are divided into three main categories: common warts (verruca vulgaris), plantar warts (verruca plantaris), and flat (plane) warts (verruca plana)

Common warts


What to look out for:

  1. Dome-shaped thickening of skin that grows outwards
  2. Most common on fingers, top of the hands, knees or elbows but may occur anywhere
  3. Black dots (key defining feature distinguishing it from a corn) on the surface of the warts which can be seen when skin debris on the wart is scraped of with a blade or file. The black dots are actually capillaries and thus bleeding may occur if you pick at the wart

The natural tendency to pick or scratch at existing warts can spread them to unaffected skin, a process known as autoinoculation.

Flat warts

Most common on the top of the hands, arms and face


What to look out for:

  1. Small smooth-surfaced bumps on the skin
  2. Slightly elevated
  3. Flat-topped
  4. Skin-coloured or pink.

Damaging a flat wart (e.g., shaving the neck) may cause the virus to spread, eventually leading to crops of several hundred flat warts.

Plantar warts


What to look out for:

  1. Thick wart that grows inwards (rather than outwards like a common wart)
  2. On the soles of the feet
  3. Black dots (capillaries)
  4. Several plantar warts may accumulate beneath the surface of the epidermis, with the surface resembling one large wart.
  5. Plantar warts may be painful when walking

Plantar warts may be mistaken for calluses. Skin lines pass around a wart while they pass through a callus. Warts have the characteristic black dots while calluses do not.

Infection can occur when someone who already has a wart walks barefoot, leaving behind viral particles. The particles can then be picked up by another person who is walking barefoot.

Treatment of viral warts

Most viral warts will go away on their own. For most people, treatment of viral warts is not mandatory. However, it is highly recommended that grapplers avoid training and get their warts removed by a doctor, so that they do not infect their training partners.

A variety of interventions are available for treatment. Common methods include chemical or physical destruction of infected tissue (e.g. salicylic acid, cryotherapy, surgery, laser), or other stronger medications. In general, the approach is dependent upon the type of wart  and influenced by consideration of wart location, treatment side effects, clinician skill, and patient preference.

Molluscum Contagiosum

Molluscum contagiosum is another virus that can infect the skin. It is a common disease of childhood. The disease also occurs in healthy adolescents and adults, often as a sexually transmitted disease (on the genitals) or in relation to participation in contact sports.

Molluscum is spread by direct skin-to-skin contact and thus can occur anywhere on the body. The virus can be transmitted via autoinoculation by scratching or touching a lesion. For example, if the lesions develop on the face, shaving may spread the virus.

Infection can also be spread via fomites (any object or substance capable of carrying and transferring infectious organisms) on bath sponges or towels or through skin contact during participation in contact sports  An association of molluscum with swimming pool use also has been reported.

The time period between infection and the appearance of the characteristic bumps on the skin is between two and six weeks.


What to look out for:

  1. Firm, dome shaped bumps (2 to 5 mm in diameter) on the skin
  2. Shiny surface and central indentation
  3. May appear anywhere on the body except the palms and soles. The most common areas of involvement include the torso, armpit, crook of elbow, behind the knee, and inner thigh

Treatment of molluscum

In most patients, individual lesions usually spontaneously resolve within two months and the infection often clears completely within six to twelve months. In a minority of cases, disease persists for three to five years

It is technically possible to continue training while infected with molluscum. Care must be taken to reduce the risk of transmission to others. Bumps in areas that are likely to come in contact with others should be covered with a watertight bandage and a rashguard.

The main issue with this is that smaller bumps that are harder to notice may not be covered up, and your partners may still end up getting infected. Therefore, train at your  own (or your partners’) risk.

Regardless of whether you decided to stop training, it is recommended that grapplers get their molluscum treated by a doctor. Like viral warts, there are many methods available (cryotherapy, lasers etc.)

Herpes Simplex Virus

Herpes simplex virus type 1 (HSV-1), also known as herpes labialis, is the virus responsible for “cold sores” on the mucosa of the mouth. (HSV-2 is responsible for herpes on the genitals)

HSV-1 may be associated with combat sports, where it is often called Herpes gladiatorum (a.k.a. wrestler’s pox, mat pox). Transmission is primarily by direct skin-to-skin contact and abrasions may facilitate a portal of entry.


What to look out for:

  1. Early stage (<6 hours): Itching, tingling or burning sensation followed by:
  2. Clustered, small, painful, fluid-filled blisters on a red base which heal with crusts over about 1 to 2 weeks.
  3. Headache, generalized illness, sore throat and fever may be reported.
  4. May lead to recurrent infections, as the virus can hide and remain dormant within your nerves

Herpes simplex may be confused with early impetigo. Accurate diagnosis requires laboratory testing by the doctor.

Treatment of Herpes gladiatorum

It is important to stop training as soon as possible and see the doctor. Treatment of herpes gladiatorum is with oral aciclovir or similar agents and is most effective if commenced at the first symptoms of an outbreak (<48 hours after onset of blisters). Topical aciclovir may also be given.

How to prevent viral skin infections

Besides the general guidelines that were recommended in Part 1 of the series, here are a couple more recommendations:

  1. Do not share towels or bath sponges
  2. Wear flip-flops in communal showers. While this may seem a little extreme, walking barefoot on a wet floor may put you at risk. It is worth mentioning that my microbiology tutor, a part-time rugby coach in his free time, insists on wearing flip-flops in communal gym showers.
  3. If you do have a viral skin infection, do not pick and scratch at the bumps. This is a good way to avoid autoinoculation.


Viral skin infections can be a real pain. However they tend to be a little less serious than bacterial infections. With appropriate treatment, they are usually easy to deal with. Stay tuned for the final part of the series, where I’ll be talking about fungal infections!




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