Warts n Corns

Question 1

prevalence of warts

Answer 1

population: 7-10%
school children: 20%

Question 2

peak incidence of warts

Answer 2

12-16yo
clears spontaneously in majority 5 years (6mth-2yr)

Question 3

associated factor of warts

Answer 3

1. Swimming (warm water > pH5 facilitates entry of virus int skin, abrasive surface contribute to tissue debridement)
2. use of public shower
3. immunocompromised indivuduals

Question 4

criteria for warts infection

Answer 4

infection by human papilloma virus (HPV) infection
- presence of virus
- entry into skin
- susceptibility of immune system

Question 5

spread of warts

Answer 5

1. direct person to person contact
2. indirect exposure to fomites
3. autoinoculation

Question 6

noteincubation period of warts

Answer 6

1-24mth

ave 3-4mths

Question 7

common location and appearance of common warts (verruca vulgaris)

Answer 7

hands, fingers, face
- papules/ nodules
- single or grouped
- rough, cauliflower-like appearance
- slightly scaly

Question 8

common location and appearance of plantar warts (verruca vulgaris)

Answer 8

sole of the feet

At weight-bearing areas:
- roughly circular diameter 0.5-3cm
- not raised
- greyish friable surface and thickened surrounding skin

At non-weight-bearing area: looks like normal warts

Question 9

signs and symptoms of warts

Answer 9

1. tender with pressure
2. interrupts footprint patterns
3. has black dots or seeds under karatinous surface (thromboses capillaries)
4. repeated irritation causes the lesion to continue enlarging
5. hyperkeratotic lesions associated with pressure (plantar)
6. may cause severe discomfort and limitation of function if large or occurs at weight-bearing areas

Question 10

when to refer for warts

Answer 10

1. involvement of face, nails, anogenital areas
2. extensive warts at one body site
3. painful plantar warts
4. presence of chronic, delimitating diseases that contradicts use of treatment products (DM, peripheral vascular disease, immunosuppression)
5. physical/ mental impairments that make following product direction difficult
6. no improvement after proper use of appropriate products for self treatment

Question 11

decision and urgency of treating warts

Answer 11

• desire for tx
• impact of lesion
• site and no. of warts in an area
• potential for spread
• potential for development of squaremous cell carcinoma

Question 12

treatment goal for warts

Answer 12

1. remove warts with no recurrence
2. leave no scars
3. prevent auto inoculation or transmission to others

Question 13

pharmaco treatment for warts

Answer 13

1. salicylic acid
2. cryotherapy with DMEP

Question 14

how does salicylic acid work (MOA)

Answer 14

• decrease keratinocyte adhesion (keratolytic)
• increase water binding: hydration of keratin

Question 15

application frequency of salicylic acid

Answer 15

liquid product: 1-2x/d up to 12 weeks
pads/plaster: apply new patch every 48h, up to 12 weeks

Question 16

note for treating warts

Answer 16

• higher concentration of tx for bigger warts
• take conservative method, and treat small area as salicylic acid/ DMEP can scar tissues
• do not irritate skin that are already infected/redden by other causes

Question 17

advantages and disadvantages of using salicyclic collodion vehicle

Answer 17

+ flexible, water-repellent film
+ prevents moisture evaporation
+ less likely to run onto surrounding skin

• extremely volatile and flammable
• occlusive
• abuse (solvent sniffing)

Question 18

how to apply salicylic acid solution on warts

Answer 18

1. apply solution with the brush applicator until affected area is covered
2. if medication touches healthy skin, wash off with soap and water immediately
3. allow the solution to harden so that it does not run
4. repeat 1-2x daily PRN
5. cap container tightly after each use to prevent evaporation
6. store product away from light

Question 19

how to apply salicylic acid patch on warts

Answer 19

1. plaster: trim the plaster, to follow the contours of the wart
2. pad: apply the appropriately sized disk directly on the affected area
3. replace pad/plaster after 48h with a new one, for up to 12w

Question 20

how does diethyl ether and propane DMEP cryotherapy works for warts

Answer 20

causes irritation and tissue destruction that causes the host to mount an immune response against the causative virus
- after 10d, frozen skin and wart will fall off to reveal newly formed skin underneath

Question 21

application frequency of DEMP on warts

Answer 21

max 3x in the 10d lapse

Question 22

non pharm for warts

Answer 22

• cover up since it is contagious
• consult dr if it is recurrent

Question 23

prevalence of corns and calluses

Answer 23

increases w age

men: 40
women: 50

Question 24

impact of corns and calluses

Answer 24

• decrease mobility
• may be life threatening to DM, severe arthritis, impaired circulation

Question 25

location of corns

Answer 25

over bony prominences of 4th to 5th toe with hard corns occurring on top of toes and soft corns in toe webs

Question 26

location of calluses

Answer 26

weight-bearing areas of good eg. ball, heel, sides

Question 27

appearance of corn

Answer 27

- smooth, raised sharply demarcated - hyperkeratolytic lesions with central core - hard corns are shiny, soft corns are white

Question 28

appearance of calluses

Answer 28

- smooth, raises, yellowish lesions with irregular margins and diffuse thickening of skin - may be broad based or have central core - no disruption of normal skin ridges

Question 29

size of corns

Answer 29

varies, few mm to 1cm

Question 30

size of calluses

Answer 30

few mm to several cm

Question 31

timing of onset for corn and calluses

Answer 31

variable, lesions may enlarge progressively

Question 32

causes of corn

Answer 32

friction from tight fitting shoes

Question 33

causes of calluses

Answer 33

- friction from tight fitting shoes - walking barefoot - structural biomechanics problems - improper weight distribution

Question 34

modifying factors for corns and calluses

Answer 34

- well-fitting footwear - salicylic acid

Question 35

when to refer corns and calluses

Answer 35

1. extensive pain 2. presence of chronic, delimitating diseases that contradicts use of treatment products (DM, peripheral vascular disease, immunosuppression) 3. lesions hemorrhagic or oozing purulent materials 4. anatomic defect or fault in body weight distribution 5. Hx of RA, complaint of painful metatarsal heads or deviation of great toe 6. physical/ mental impairments that make following product direction difficult 7. proper but unsuccessful self care attempts

Question 36

treatment goals for corns and calluses

Answer 36

1. provide symptomatic relief 2. remove corns and calluses 3. prevent recurrence by correcting underlying causes

Question 37

pharmacological treatment for corns and calluses

Answer 37

1. salicyclic acid (in collodion vehicle) - hard corn and calluses: apply 1-2x/d; up to 14d - soft corns: apply 1-2x/d; up to 3-6d 2. salicylic acids (in pads/plaster) - reapply every 48h as needed to 14d

Question 38

non pharm treatment for corns and calluses

Answer 38

- daily soaking of affected areas - avoid using razors or sharp knife to remove - use cushion pads to relieve painful pressure - eliminate underlying predisposing factors

Question 39

how to select footwear

Answer 39

1. proper length (go to podiatrist for help) - shoe should snug at the heel - toes should not bump into the front of the shoe 2. proper width: should not feel cramped 3. proper shape: match foot shape 4. proper height: heels <1 inch, adequate arch support and depth of toe box 5. try both shoes at the time of purchase, at the end of the day