WARTS

Question 1

Warts are caused by

Answer 1

Human papillomavirus (HPV)

(2) Infection occurs by direct skin contact, with maceration or sites of trauma
predisposing patients to inoculation.
(3) Reservoir is humans with clinical/subclinical infection
(4) The incubation period is approximately two to six months.

Question 2

Cutaneous warts may manifest as

Answer 2

(a) Common warts (verruca vulgaris)
(b) Plantar warts (verruca plantaris)
(c) Flat (plane) warts (verruca plana)
(d) Genital Warts (covered in Infectious Disease Block)

Question 3

(1) Warts are typically few in number.
(2) Common sites are the hands, periungual skin, elbows, knees and plantar
surfaces.
(3) The black dots are thrombosed capillaries.
(4) Warts may occur singly, in groups, or as coalescing warts forming
plaques.

Answer 3

Verrucae Vulgaris

Question 4

(1) Slightly elevated and flat-topped.
(2) Vary in size from 0.1-0.3 cm.
(3) May be a few or numerous and often occur grouped or in a line as a result
of spread from scratching.
(4) Typical sites are forehead, back of the hands, the chin, neck and legs.
(5) Typically asymptomatic, however, cosmetically distressing.

Answer 4

Flat (Plane) Warts

Question 5

(1) Caused by HPV infection on the plantar foot.
(2) Frequently occurs at points of maximal pressure, such as over the heads
of the metatarsal bones
(3) A cluster of many warts is called a “mosaic wart”.
(4) Black dots help discriminate from callus or corn.
(5) Corns have a hard, painful translucent central core.

Answer 5

Plantar Warts

Question 6

Wart Treatment

Answer 6

(1) Patient education
(a) The option to defer treatment should be discussed with patients (not
a deployment thing).
(b) Although most warts in immunocompetent patients eventually
resolve without treatment, warts may spread or persist and
resolution is unpredictable.
(c) Many wart therapies require prolonged treatment or multiple office
visits and have inconsistent efficacy.
(d) Clinicians should communicate expectations for the treatment
course as well as the possibility of treatment failure and recurrence.
(2) Salicylic acid
(a) Topical salicylic acid exfoliates the affected epidermis and may
also stimulate local immunity.
(b) Advantages: Self-administration, painless application, minimal
side effects.
(c) Disadvantages: Terrible Compliance
(3) Cryotherapy
(a) Cryotherapy with liquid nitrogen is a common clinicianadministered treatment.
(b) Advantage: Extremely effective and quick.
(c) Disadvantage: Pain associated with treatment.
(4) Duct Tape Application:
(a) Wart covered with duct tape for cycles lasting six days then
removed. Wart is soaked, gently debrided, and left uncovered for 1
day.
(b) Advantages: Painless, effective, and cheap.
(c) Disadvantages: Feels really unprofessional

Question 7

Differential Diagnosis

Answer 7

(1) Actinic Keratosis
(2) Squamous Cell Carcinomas
(3) Molluscum Contagiosum

Question 8

Labs/Studies/Imaging

Answer 8

None

Question 9

Disposition

Answer 9

Full duty

Question 10

Complications

Answer 10

(1) Scarring and recurrence.

(2) Some types of HPV have higher risks for Carcinoma