Warts Diagnosis and Treatment Rick Lin, DO MPH First Year Dermatology Resident

Warts
Diagnosis and Treatment
Rick Lin, DO MPH
First Year Dermatology Resident
Texas Division of KCOM
Dermatology Residency Program
Background Information
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Warts are small harmless lesions of the skin
caused by a virus: the human papilloma virus.
The appearance of warts can differ based on
the type of wart and where it is located on the
body.
Warts are common in children. Most cases
occur between ages 12-16 years.
Up to 30% of warts disappear by themselves
within 6 months. Most will disappear without
any treatment within 3 years.
Background Information
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Warts are caused by the DNA-containing
human papillomavirus (HPV). There are at
least 63 genetically different types of HPVs.
 The virus enters the skin after direct contact
with recently shed viruses kept alive in warm,
moist environments such as a locker room, or
by direct contact with an infected person.
 The entry site is often an area of recent injury.
The incubation time—from when the virus is
contracted until a wart appears—can be 1-8
months.
Background Information
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Contrary to popular mythology, touching
a frog will not give you warts.
Types of warts
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Common warts (verrucae vulgaris):
These common warts typically develop
on the hand, especially around the nail.
They are gray to flesh colored, raised
from the skin surface, and covered with
rough, hornlike projections.
Types of warts
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Plantar warts (verrucae plantaris): Plantar
warts, by definition, occur on the plantar
surface, or bottom, of the foot.
 They usually occur in high pressure areas
such as the heel and the metatarsal heads
(just behind the toes).
 They usually grow into the skin, not outward
like common warts.
 This growing into the skin makes them more
difficult to treat.
Types of warts
Flat warts (verrucae plana): Flat warts
are most commonly seen on the face,
the back of the hands, and lower legs.
 They usually appear as small individual
bumps about 1/4 inch across.
 Flat warts may spread rapidly on the
face and lower legs from the activities
involved in shaving.
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Histopathology
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Verruca vulgaris (common wart) is caused by
varous strains of human papilloma virus (HPV
1, 2, 4, 7, 26-29).
 Macroscopically verruca vulgaris may
present as hard, rough surfaced papule
2 – 20 mm (solitary or multiple).
 Microscopically, this is an exophytic,
symmetric, papillomatous lesion with large
keratohyaline granules and characteristic
inturning of the rete ridges.
Histopathology
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Parakeratotic columnar tiers of stratum
corneum overlie the papillomatous surface.
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Small amounts of hemorrhage may be
present within the columns of parakeratosis.
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Other characteristic features include
koilocytosis, hypergranulosis and presence
of multinucleated cells.
Treatment
Home care is effective in making the
wart or warts go away. No matter what
technique you use, warts will disappear
60-70% of the time.
 Techniques may be done with and
without medication.
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Treatment
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The ultimate goal of the medical
therapies (not the surgical treatments) is
to get your body to recognize the wart
as something foreign and to destroy it,
much like the body destroys a cold
virus.
Adhesive tape therapy
Place several layers of waterproof
adhesive tape over the wart region
(even duct tape).
 Do not remove the tape for 6-1/2 days.
Then take off the tape and open the
area to the air for 12 hours.
 Reapply tape for another 6-1/2 days.
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Adhesive tape therapy
The tape works best in the region
around the fingernail.
 Tape works because the air-tight, moist
environment under the tape does not
allow the virus to grow and reproduce
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Salicylic acid therapy
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Salicylic acid is available by many different
trade names at the drug store.
– Dual Film
– Wart-Off
– Dr. Scholl’s Wart Medication
– Medi-Plast
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It comes either as a liquid to paint on the wart
or as a plaster to be cut out and placed on
the wart tissue.
Salicylic acid therapy
The area with the wart should be
soaked in warm water for 5-10 minutes.
 The wart should then be pared down
with a razor. A simple razor works fine
for this, then throw it away.
 Do not shave far enough to make the
wart bleed.
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Salicylic acid therapy
Apply the salicylic acid preparation to
the wart tissue.
 Do not apply it to other skin because of
salicylic acid's potential to injure normal
tissue.
 Follow directions on the package for
how long to apply the acid.
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Cryosurgery
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Liquid nitrogen or cryotherapy is used to deep
freeze the wart tissue.
 With liquid nitrogen applied to the wart, the
water in the cells expands, thus exploding the
infected tissue.
 The exploded cells can no longer hide the
human papillomavirus from the body's
immune system.
 The immune system then works to destroy
the virus particles.
Cryosurgery
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Periungual area may scar if cryotherapy
with liquid nitrogen is used improperly.
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Scarring could lead to permanent nail
disfiguration.
Laser Therapy
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Laser therapy: Lasers are simply very
intense light sources.
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This light has an enormous amount of
energy that heats the tissue enough that
it vaporizes.
Shave Removal
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Shave removal and electrodessication
of the base may be necessary when
other treatment methods fail.
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This would involve numbing the region
around the wart and shaving the wart
flat with the surface and light
electrodessication of the base.
Prognosis:
Most warts will disappear without
treatment anywhere from 6 months to 3
years.
 Warts may recur after treatment and
require additional treatments.
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Prevention:
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Avoid touching warts on others or touching
them on yourself (refrain from rubbing a warty
finger across your face).
 Children needs to avoid biting or chewing
warts.
 Wear shower shoes in the gym locker room to
lower your risk of picking up the virus that
causes plantar warts from the moist
environment.
When to Refer
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If you feel uncomfortable treating warts.
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Warts that are resistant to your
treatment
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Unsure of diagnosis
Questions and Answers