verruca vulgaris (warts)
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Etiology
- all warts are caused by human papilloma virus (HPV)
Epidemiology
- school classrooms & family members are common reservoirs for transmission of human papillomavirus[5]
Clinical manifestations
- generally painless papule or cluster of papules
- skin-colored with black punctate on close inspection (capillary loops)
- exophytic, hyperkeratotic papules or nodules[4]
Laboratory
- diagnosis generally based upon clinical findings
- consider biopsy of suspect lesions or lesions resistant to therapy
Differential diagnosis
- skin tags or seborrheic keratosis
- epidermal nevi & nevus sebaceous
- malignant & premalignant lesions
Management
- watch & wait, most disappear with time
- 30% within 3 months
- 70% within 2 years
- 90% within 3 years[4]
- chemical destruction
- presoak in warm water for 5 minutes
- remove loose wart with emery board, pumice, or scalpel
- apply agent to wart, avoid normal skin, cover with tape to improve penetration
- repeat QD or BID for 2-3 months until adequate response
- agents
- salicylic acid 15-40% (local irritation may occur)
- formalin, especially plantar warts (drying & fissuring of skin may occur & occasional allergic reaction)
- trichloroacetic acid 50% washed off after 2 hours (occasional scarring of surrounding tissue)
- cryotherapy
- soak the lesion, then scrape excess keratin with scalpel blade
- using cotton tip, apply liquid nitrogen until a whitened halo of 1-2 mm appears around the base of the lesion
- after the lesion has thawed, reapply a 2nd time
- initially lesion will have erythematous ring, then a blister may form with clear, cloudy or hemorrhagic fluid
- may use sterile needle to puncture blister
- blister or wart will crust & fall off after 1 week
- reapply if needed in 2-3 week cycles
- burning & throbbing, especially during the thaw phase
- generally well tolerated
- occasional scarring, depigmentation or hyperpigmentation
- occasional sensory loss
- NO better than placebo or no treatment[2]
- duct tape[3] (see common wart)
- pharmacologic agents
- surgery for recalcitrant warts
- electrosurgery
- CO2 surgery
More general terms
More specific terms
- common wart
- condyloma acuminata (anogenital wart)
- epidermodysplasia verruciformis
- laryngeal wart
- plantar wart
- verruca plana (flat wart)
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 958
- ↑ 2.0 2.1 2.2 Journal Watch 22(21):156, 2002
- ↑ 3.0 3.1 Prescriber's Letter 9(12):70 2002 Cryotherapy Versus Duct Tape for Treating Warts Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=181216&pb=PRL (subscription needed) http://www.prescribersletter.com
Rumor vs. Truth: Duct tape can eliminate the common wart. Prescriber's Letter Nov 17, 2006 - ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16. 17, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2022
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 5.0 5.1 Bruggink SC et al. Warts transmitted in families and schools: A prospective cohort. Pediatrics 2013 May; 131:928. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23610204
- ↑ Warts (image) American Academy of Dermatology https://www.aad.org/public/diseases/contagious-skin-diseases/warts
- ↑ DermNet NZ. Viral warts (images) http://www.dermnetnz.org/viral/viral-warts.html
- ↑ DermNet NZ. (histopathology images) Verruca vulgaris pathology http://www.dermnetnz.org/pathology/verruca-vulgaris-path.html