Warts and Footcare

Question 1

T/F: presence of warts is a risk factor for developing additional warts

Answer 1

T

Question 2

Warts are caused by…

Answer 2

human papillomavirus (HPV)

Question 3

What 3 criteria must be met to develop a wart?

Answer 3

• virus must be present
• open avenue must exist
• immune system has to be susceptible

Question 4

How can warts spread?

Answer 4

• person to person
• autoinoculation: you give it to yourself
• indirect exposure

Question 5

Signs and symptoms of warts:

Answer 5

• brown
• rough
• cauliflower-like appearance
• pinpoint bleeding
• rough papules

Question 6

What does pinpoint bleeding look like?

Answer 6

black dots scattered across surface

Question 7

T/F: warts are not defined by their location

Answer 7

F, they are

Question 8

Common warts (verruca vulgaris) are located on…

Answer 8

• hands
• single or grouped
• skin colored/brown/rough

Question 9

Periungal and subungual warts are located…

Answer 9

• around and underneath nail beds
• nail biters have this
• cauliflower like skin around nail plates

Question 10

Flat warts (verruca plana) are located on…

Answer 10

• face
• smooth
• flat topped
• yellow, brown papules

Question 11

Venereal warts (condyloma lata and acuminate) are located on…

Answer 11

• genitalia region

- STD

Question 12

Plantar warts (verruca plantaris) are located on…

Answer 12

• soles of feet
• skin colored callous like lesions
• causes pain while walking

Question 13

Which kinds of warts can you self treat?

Answer 13

• common

- plantar

Question 14

Which kinds of warts need to be referred?

Answer 14

• periungal and subungual
• flat
• venereal

Question 15

Exclusions to self treatment of warts:

Answer 15

• on face, toenails/fingernails, genitalia
• extensive warts at one body site
• painful plantar warts
• diabetes, peripheral vascular disease
• physical or mental impairments that make following directions difficult
• immunosuppressive meds that contraindicate use of salicylic acid
• < 4 YO

Question 16

Non-pharmacologic therapy of warts:

Answer 16

• wash hands before and after touching wart area
• avoid skin to skin contact with infected people
• don’t probe, poke, or cut wart
• don’t walk barefoot if wart is on the bottom of foot

Question 17

Pharmacologic therapy of warts:

Answer 17

• salicylic acid

- cryotherapy

Question 18

Types of ways to administer salicylic acid:

Answer 18

• plaster vehicle
• collodion-like vehicle
• karaya gum-glycol plaster vehicle

Question 19

After using salicylic acid, patients should notice visible improvement within…

Answer 19

1st or 2nd week of treatment

Question 20

When should you stop self-treating after using salicylic acid?

Answer 20

past 12 weeks

Question 21

What concentrations of salicylic acid are used for common warts?

Answer 21

< 17%

Question 22

What concentrations of salicylic acid are used for plantar warts?

Answer 22

above 17% but under 40%

Question 23

How to apply plasters of salicylic acid (12-40%):

Answer 23

trim plaster to follow the contours of the wart

- apply to skin and cover with adhesive tape

Question 24

How to apply pads of salicylic acid (12-40%):

Answer 24

apply directly to area and cover with pad

- most are these

Question 25

How to apply collodion vehicle of salicylic acid (17%):

Answer 25

- apply max of BID - apply solution one drop at a time - wash off solution that touch healthy skin - allow solution to harden - repeat up to 12 weeks - store away from sun or heat

Question 26

How to apply karaya gum-glycol vehicle of salicylic acid (15%):

Answer 26

- apply to wart at HS and leave for 8 H - remove and discard in morning - repeat every 24 H up to 12 weeks

Question 27

Advantages to topical salicylic acid containing products:

Answer 27

- low cost - ease of access - few adverse effects - reasonable effectiveness

Question 28

Disadvantages to topical salicylic acid containing products:

Answer 28

- need for consistent, frequent application - potential for damage to healthy skin surrounding wart - duration of treatment needed to see a response

Question 29

Cryotherapy can cause...

Answer 29

irritation leading the host to mount an immune response against the virus - freezes wart tissue

Question 30

Advantages of cryotherapy:

Answer 30

- easy access - lower cost - one treatment might be enough

Question 31

Disadvantages of cryotherapy:

Answer 31

- pain - potential for healthy skin damage surrounding wart - may not be as effective as liquid nitrogen

Question 32

T/F: you can't use cryotherapy and salicylic acid together

Answer 32

F

Question 33

Duct tape and warts:

Answer 33

- leave tape for 6 days and then replace | - local irritation can cause stimulation of patient's immune response

Question 34

Warts are...

Answer 34

contagious and can spread to other parts

Question 35

Warts can reappear...

Answer 35

months after initial treatment

Question 36

Alleviation of the symptoms will...

Answer 36

not occur overnight

Question 37

Wart removal can take from...

Answer 37

4-12 weeks | - follow up should be in 4 weeks

Question 38

Refer to MD when warts persist after...

Answer 38

12 weeks of self-treatment

Question 39

3 groups of patients who have foot problems:

Answer 39

- children w/ congenital malformation or deformity - adolescents who have rapid growth - older patients

Question 40

Why does diabetes contribute to foot problems?

Answer 40

- poor circulation - peripheral neuropathy - poor foot hygiene

Question 41

Why does peripheral vascular disease contribute to foot problems?

Answer 41

- decreased blood flow and poor circulation - skin ulcerations - cold - numbness

Question 42

What medical illnesses contribute to foot problems?

Answer 42

- diabetes - peripheral vascular disease - arthritis

Question 43

What are corns and calluses?

Answer 43

excessive growths of the upper keratinized layer of the skin - natural protective mechanism - nothing wrong, just not nice looking

Question 44

Corns specifically are...

Answer 44

small, raised, sharply demarcated lesions caused by pressure - can be hard or soft - usually on or between toes

Question 45

Calluses specifically are...

Answer 45

diffuse thickening of skin | - forms on joints and weight beating areas (bottom of foot and hands)

Question 46

Non-pharmacologic therapy for corns and calluses:

Answer 46

- daily soak affected area for at least 5 minutes in warm water - dead tissue should be removed gently - use pad to relieve pressure - wear well-fitting, nonbinding footwear

Question 47

Pharmacologic therapy for corns and calluses:

Answer 47

salicylic acid - plaster/pad vehicle - collodion like vehicle

Question 48

Counseling points for corns and calluses:

Answer 48

- OTC products are not recommended for those with diabetes or circulatory problems - patient progress should be checked after 2 weeks

Question 49

Bunions are ____ more common in ______

Answer 49

10x in females than males

Question 50

T/F: bunions are linked with family history

Answer 50

T

Question 51

Treatment of bunions:

Answer 51

- can't be treated by topical drugs - refer - routine and chronic use of analgesic is not recommended - management of bunion is best thing

Question 52

How to manage a bunion:

Answer 52

- avoid high heels - use protective padding - take oral analgesics on short-term basis

Question 53

What is the most frequent cause in ingrown toenails?

Answer 53

incorrect trimming of nails

Question 54

What is the correct method of cutting toenails?

Answer 54

- cut straight across | - don't taper ends

Question 55

What is the best way to prevent development of ingrown toenails?

Answer 55

education