Warts
Warts: Excerpt from Professional Guide to Diseases (Eighth Edition)
Warts, also known as verrucae, are common, benign, viral infections of the skin and adjacent mucous membranes. The prognosis varies: Some warts disappear readily with treatment; others necessitate more vigorous and prolonged treatment. Some warts demonstrate spontaneous resolution.
Causes and incidence
Warts are caused by infection with the human papillomavirus, a group of ether-resistant, deoxyribonucleic acid-containing papovaviruses. Mode of transmission is probably through direct contact, but autoinoculation is possible.
Although their incidence is highest in children and young adults, warts may occur at any age.
Signs and symptoms
Clinical manifestations depend on the type of wart and its location:
❑ common (verruca vulgaris): rough, elevated, rounded surface; appears most frequently on extremities, particularly hands and fingers; most prevalent in children and young adults
❑ condyloma acuminatum (moist wart or genital wart): usually small, pink to red, moist, and soft; may occur singly or in large cauliflower-like clusters on the penis, scrotum, vulva, cervix, vagina, and anus; can also occur on oral mucosa following oral-genital exposure; considered a sexually transmitted disease
❑ digitate: fingerlike, horny projection arising from a pea-shaped base; occurs on scalp or near hairline
❑ filiform: single, thin, threadlike projection; commonly occurs around the face and neck
❑ flat (also known as juvenile or verruca plana): multiple groupings of up to several hundred slightly raised lesions with smooth, flat, or slightly rounded tops; common on the face, neck, chest, knees, dorsa of hands, wrists, and flexor surfaces of the forearms; usually occur in children but can affect adults; often linear distribution because of spread from scratching or shaving
❑ periungual: rough, irregularly shaped, elevated surface; occurs around edges of fingernails and toenails; when severe, may extend under nail and lift it off nail bed, causing pain
❑ plantar: slightly elevated or flat; occur singly or in large clusters (mosaic warts), primarily at pressure points of feet.
Diagnosis
CONFIRMING DIAGNOSIS Visual examination usually confirms the diagnosis. Plantar warts can be differentiated from corns and calluses by certain distinguishing features. Plantar warts obliterate natural lines of the skin, may contain red or black capillary dots that are easily discernible if the surface of the wart is shaved down with a scalpel, and are painful on application of pressure. Both plantar warts and corns have a soft, pulpy core surrounded by a thick callous ring; plantar warts and calluses are flush with the skin surface.
Anal warts require anoscopy or sigmoidoscopy to rule out internal involvement, which may necessitate surgery. Women with vulvar lesions require examination of the vagina and cervix, including a Papanicolaou smear.
Treatment
Treatment for warts varies according to the location, size, number, pain level (present and projected), history of therapy, the patient’s age, and compliance with treatment. Most persons eventually develop an immune response that causes warts to disappear spontaneously and require no treatment.
Treatment may include:
❑ Electrodesiccation and curettage: High-frequency electric current destroys the wart and is followed by surgical removal of dead tissue at the base and application of an antibiotic ointment (such as polysporin), covered with a bandage, for 48 hours. This method is effective for common, filiform and, occasionally, plantar warts. (See Removing warts by electrosurgery.)
❑ Cryotherapy: Liquid nitrogen kills the wart; the resulting dried blister is peeled off several days later. If initial treatment isn’t successful, it can be repeated at 2- to 4-week intervals. This method is useful either for periungual warts or for common warts on the face, extremities, penis, vagina, or anus.
❑ Acid therapy (primary or adjunctive): The patient applies plaster patches impregnated with acid (such as 40% salicylic acid plasters) or acid drops (such as 5% to 16.7% salicylic acid in flexible collodion or trichloroacetic or dichloroacetic acids), every 12 to 24 hours for 2 to 4 weeks. This method isn’t recommended for areas where perspiration is heavy, for those parts that are likely to get wet, or for exposed body parts where patches are cosmetically undesirable.
❑ 25% podophyllin in compound with tincture of benzoin (for venereal warts): The podophyllin solution is applied on moist warts. The patient must lie still while it dries, leave it on for 4 hours, and then wash it off with soap and water. Treatment may be repeated every 3 to 4 days and, in some cases, must be left on a maximum of 24 hours, depending on the patient’s tolerance. Avoid using this drug on pregnant patients.
During acid or podophyllin therapy, the patient should protect the surrounding area with petroleum jelly or sodium bicarbonate (baking soda). A small amount of 25% to 50% trichloroacetic acid (for venereal warts) is applied to the wart. After the wart turns white, the acid is neutralized with baking soda or water.
❑ Carbon dioxide laser therapy: This treatment has successfully treated genital warts.
The use of antiviral drugs is under investigation; suggestion and hypnosis are occasionally successful, especially with children. Patients can apply topical imiquimod cream to sites that aren’t thickly keratinized. It’s applied at bedtime three times per week. Imiquimod can be used alternately with a topical retinoid such as tazarotene, which may increase effectiveness.
Occlusion may be beneficial to persistent warts.
Special considerations
❑ Conscientious adherence to prescribed therapy is essential. The patient’s sexual partner may also require treatment. Encourage the patient to seek counseling if applicable.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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