JohnFerguson Posted April 23, 2014 Share Posted April 23, 2014 Is excision of a herpetic lesion a definitive treatment? Will the virus likely "pop out" in another area of the body following excision? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 23, 2014 Moderator Share Posted April 23, 2014 won't help. it's a chronic/recurrent issue. I'm guessing excision might actually make it worse at that site. HSV can be suppressed with daily or intermittent medication but can not be "healed" at the present time. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted April 24, 2014 Moderator Share Posted April 24, 2014 There is a pretty good list of treatment. Click here for the list Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 24, 2014 Moderator Share Posted April 24, 2014 ahhh no antivirals are the treatment Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 24, 2014 Moderator Share Posted April 24, 2014 ahhh no antivirals are the treatment and please, really, seriously, don't use bleach on this or any other rash ever. not kidding. Link to comment Share on other sites More sharing options...
cinntsp Posted April 24, 2014 Share Posted April 24, 2014 Not sure if serious... The virus remains in the trigeminal or sacral ganglia. Why would excision even come to mind? Link to comment Share on other sites More sharing options...
paporzelt Posted April 24, 2014 Share Posted April 24, 2014 Wait...Is this a serious question? Link to comment Share on other sites More sharing options...
cbrsmurf Posted April 24, 2014 Share Posted April 24, 2014 Perhaps OP has confused warts/HPV with herpetic lesions/HSV Link to comment Share on other sites More sharing options...
SocialMedicine Posted April 24, 2014 Share Posted April 24, 2014 yikes. are you a PA ? Link to comment Share on other sites More sharing options...
NewtonsApple Posted April 24, 2014 Share Posted April 24, 2014 I pull out my sterile skin saw and trusty grinder anytime I suspect shingles Link to comment Share on other sites More sharing options...
primadonna22274 Posted April 24, 2014 Share Posted April 24, 2014 Excision of an HSV lesion is exceedingly likely to spread the virus (even to you if not totally aseptic!) and will do nothing for that patient but create an unnecessary expense and scar--not to mention the possibility of injury, infection, etc. I also recommend that you go back to basic pathophys and relearn how viruses work. Link to comment Share on other sites More sharing options...
skyblu Posted April 24, 2014 Share Posted April 24, 2014 Ummm...really? Let's just excise the whole dermatome next time somebody presents with zoster! (After careful bleaching, of course.) Link to comment Share on other sites More sharing options...
whoRyou Posted April 24, 2014 Share Posted April 24, 2014 Link to comment Share on other sites More sharing options...
JohnFerguson Posted April 24, 2014 Author Share Posted April 24, 2014 Thanks but no thanks to all of you and your rude and worthless comments. If you'd like to know why I asked this question, maybe you will reconsider your comments. I was referred a pt from a urologist for a skin lesion that appears once a year usually after being in the sun in early spring or after a big stressor. Dermatologist diagnosed it as herpes and rx'd valtrex. Pt has had great success using this at onset since. The area was inflamed when he saw his urologist and was starting his valtrex that day. Urologist said it should be excised and referred to me. I kindly explained to the pt that excision was not the key and to continue treating with valtrex and to see me back if the area begins to not improve with valtrex in the future. So maybe you all should stop insulting me and begin questioning this urologist. I posed the question here as I was perplexed myself .... Don't be so quick to judge.....please. Link to comment Share on other sites More sharing options...
whoRyou Posted April 24, 2014 Share Posted April 24, 2014 ^ You are right, I shouldn't have been so quick Link to comment Share on other sites More sharing options...
Guest Paula Posted April 25, 2014 Share Posted April 25, 2014 Thanks but no thanks to all of you and your rude and worthless comments. If you'd like to know why I asked this question, maybe you will reconsider your comments. I was referred a pt from a urologist for a skin lesion that appears once a year usually after being in the sun in early spring or after a big stressor. Dermatologist diagnosed it as herpes and rx'd valtrex. Pt has had great success using this at onset since. The area was inflamed when he saw his urologist and was starting his valtrex that day. Urologist said it should be excised and referred to me. I kindly explained to the pt that excision was not the key and to continue treating with valtrex and to see me back if the area begins to not improve with valtrex in the future. So maybe you all should stop insulting me and begin questioning this urologist. I posed the question here as I was perplexed myself .... Don't be so quick to judge.....please. John, the responses would have been respectful if the responders knew the above scenario. Do you think the urologist thought it was an abscess that needed I&D? Goes to show that physicians in specialties are right to refer to us in primary care for stuff like this. They don't know what they don't know.....LOL!!! Link to comment Share on other sites More sharing options...
primadonna22274 Posted April 25, 2014 Share Posted April 25, 2014 Agree with Paula. You could always refer the urologist to this thread (ok maybe not). Link to comment Share on other sites More sharing options...
dmdpac Posted April 25, 2014 Share Posted April 25, 2014 Thanks but no thanks to all of you and your rude and worthless comments. If you'd like to know why I asked this question, maybe you will reconsider your comments. I was referred a pt from a urologist for a skin lesion that appears once a year usually after being in the sun in early spring or after a big stressor. Dermatologist diagnosed it as herpes and rx'd valtrex. Pt has had great success using this at onset since. The area was inflamed when he saw his urologist and was starting his valtrex that day. Urologist said it should be excised and referred to me. I kindly explained to the pt that excision was not the key and to continue treating with valtrex and to see me back if the area begins to not improve with valtrex in the future. So maybe you all should stop insulting me and begin questioning this urologist. I posed the question here as I was perplexed myself .... Don't be so quick to judge.....please. Come on, John. Had you asked your original question with the scenario you recently provided you would've gotten much more direct responses. As you did not include anything about why you were asking the answers you received, especially for a question with an easily researchable answer, were fairly tame. The more information you include when asking a question the better. As a PA you should know this by now. I must admit, though, the "let me google that for you" response was pretty funny. Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 25, 2014 Moderator Share Posted April 25, 2014 if Dx in question - 1) do viral swab of the area and culture 2) do HSV titers confirm the Dx before going any further I used to use a fair amount of viral suppression for HSV - something like 90% of days they have asymptomatic viral shedding and could spread it - hence it is a bit of a public health care issue (and they hurt like heck) confirm Dx, if HSV do viral suppression - remember to post pertinent details of a case - just like a verbal presentation on rounds - include things that matter - otherwise people will assume..... Link to comment Share on other sites More sharing options...
Guest JMPA Posted April 25, 2014 Share Posted April 25, 2014 John, are you a nurse practitioner or a chiropractor? Link to comment Share on other sites More sharing options...
Acebecker Posted April 25, 2014 Share Posted April 25, 2014 I'm with everyone else. I was initially thinking, "Huh? This is not a question anyone in practice has ever asked before because, well.... It doesn't make much sense. Unless you're thinking HPV." Now that I know a urologist was the referring provider, the question makes a bit more sense. What I have to add is this: weird lesions like this recurring in the same spot (whether they respond to antivirals or not) should often be biopsied at least to ensure that we're not missing abnormal presentations of SCC, BCC, or pyoderma gangrenosum. Don't forget to think of atypical presentations of typical things... Link to comment Share on other sites More sharing options...
problem child Posted May 3, 2014 Share Posted May 3, 2014 Is excision of a herpetic lesion a definitive treatment? Will the virus likely "pop out" in another area of the body following excision? oh my God, WHAT? uhh...NO!!! Link to comment Share on other sites More sharing options...
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