Warts

Question 1

What are the clinical feature of verruca vulgaris?

Answer 1

hyperkeratotic, exophytic, dome-shaped papule or nodule

koebnerize

Question 2

What is the most common location of verruca vulgaris?

Answer 2

fingers, dorsal hands, knees, elbows

Question 3

What do the black dotes mean in verruca vulgaris?

Answer 3

thrombosed capillaries

Question 4

What is koebnerize?

Answer 4

look up

Question 5

What causes verruca vulgaris?

Answer 5

HPV 2, 4

Question 6

What is the pathology of HPV wartz?

Answer 6

hyperplasia of epithelium

Question 7

What does HPV infect?

Answer 7

basal keratinocytes of cutaneous and mucosal epithelium

Question 8

How is HPV transmitted?

Answer 8

skin to skin or contaminated objects, wart to unaffected skin

Question 9

What causes verrucae plana - flat warts?

Answer 9

HPV 3, 10

Question 10

What causes palmoplantar warts?

Answer 10

HPV 1

Question 11

What causes condylomata acuminata - external genital warts?

Answer 11

HPV 6, 11, 16, 18, 31

Question 12

When is peak prevalence of warts?

Answer 12

13-16 yo adolescence, can also be younger and older

Question 13

What percentage of warts resolve in 2 years?

Answer 13

75% but not realistic

Question 14

How do you treat warts?

Answer 14

multiple tx, laser, acids, cryotherapy

Question 15

What is the only FDA approved treatment for genital warts?

Answer 15

imiquimod

Question 16

What are primarily irritating or destructive txs for warts?

Answer 16

cryotherapy, salicyclic acid, tretinoin cream, shave removal, adhesive tape, laser

Question 17

What is the primarily immune stimulating tx for warts?

Answer 17

imiquimod, candida antigen (IL), immunotherapy (squaric acid or DCNB)

Question 18

When do you use the candida antigen?

Answer 18

when other things fail

Question 19

What are the side effects of cryotherapy?

Answer 19

PIPA (postinflammatory pigment alteration), scar, pain, blister, nail dystrophy

Question 20

What are the clinical features of external genital warts?

Answer 20

not hard or hyperkeratotic, sessile papules, may be papules or large confluent plaque

Question 21

Where are genital warts present?

Answer 21

external genitalia, perineum, perianal, inguinal fold

Question 22

How do you do cryotherapy?

Answer 22

white ring 2-3 mm outside bump 2x

Question 23

Who has the highest incidence of EGW?

Answer 23

20-34 yo

Question 24

What are risk factors for EGW?

Answer 24

sex at early age, numerous partners, unprotected exposure

Question 25

What is used for prevention of EGW?

Answer 25

HPV vaccine

Question 26

What type of HPV infection does immunosuppressed pt get?

Answer 26

frequent, persistent, difficult to treat | higher risk of anal squamous cell carcinoma

Question 27

Which of the following tx would you use for genetial warts?

Answer 27

cryotherapy, immiquimod, pdophyllin

Question 28

What are the surgical tx for EGW?

Answer 28

laster, electrocautery, scissor, shave

Question 29

How does verrucae planae present?

Answer 29

skin colored or pink, smooth surfaced slightly elevated

Question 30

Where does verrucae planae occur?

Answer 30

dorsal hands, arms, face (exposed surfaces)

Question 31

How does palmoplantar verruca present?

Answer 31

thick, endophytic (depressed into skin of soles) papules, mosaic warts --> large plaques --> thick callus over and around wart,

Question 32

Are plantar warts painful?

Answer 32

yes when walking

Question 33

What treatments do you start with?

Answer 33

ones that minimize side effects and risk of scarring

Question 34

If you have few warts on your hand or foot, how do you treat?

Answer 34

salicyclic acid, adhesive tape, cryotherapy, laser

Question 35

If you have few warts on face, how do you treat?

Answer 35

cryotherapy, shave (surgical) removal

Question 36

If you have few warts at other sites, how do you treat?

Answer 36

cryotherapy and salicyclic acid

Question 37

If you have many hand and foot warts, how do you treat>

Answer 37

salicyclic acid, cryotherapy, squaric acid or DCNB laser

Question 38

If you have many face warts, how do you treat?

Answer 38

cryotherapy, tretinoin cream

Question 39

If you have many warts at other sites, how do you treat?

Answer 39

imiquimod, tretinoin cream, squaric acid or DCNB

Question 40

What is the mechanism of salicyclic acid?

Answer 40

keratolytic loosens connections btw keratinocytes, infected with HPV

Question 41

What improves cure rate?

Answer 41

combo salicyclic acid and cryotherapy

Question 42

What are the adverse effects of salicyclic acid?

Answer 42

erythema, peeling, irritation, maceration (due to occlusion)

Question 43

Approximately what proportion of pt are wart free at 2 years w/o treatment?

Answer 43

60%

Question 44

How do you do cryo?

Answer 44

two freeze cycles for 30 seconds or more, remove any thick overlying callus is removed

Question 45

Smooth, dome shaped papules with central umbilication in genital area

Answer 45

molluscum contagiosum

Question 46

papillomatous, exophytic papules and plaques in genital area

Answer 46

external genital warts

Question 47

What are the surgical treatment for EGW?

Answer 47

laser, electrocautery, scissor or shave debulking

Question 48

Who is gardasil FDA approved for?

Answer 48

M and F 9-29 yo

Question 49

What vaccine is quadrivalent?

Answer 49

gardasil

Question 50

What vaccine is bivalent against 16 and 18?

Answer 50

ceravix

Question 51

Who is ceravix approved for?

Answer 51

females 10-25 (NO MALES)