Warts (Viral Skin Infection)

Question 1

Background

Answer 1

Benign proliferations of the skin and mucosa are caused by infection with the Human papillomavirus (HPV).

Spread by direct contact or indirectly via contact with contaminated floors or surfaces (swimming pools etc)

Question 2

Signs and Symptoms/ Diagnosis

Answer 2

Painful, embarrassing, discomfort.

Diagnosis made via appearance and where they are.
Each type looks distinct.

Question 3

Treatment (cutaneous warts)

Answer 3

Many resolve on their own within years. (Bnf says 2 years)
Treatment is required only if the warts are painful, unsightly, persistent, or are causing distress and the patient requests treatment.

(Cks) Primary care -
Facial warts require refferal.

Non facial:
Adults and older children options:-
- Topical salicylic acid (15–50%) applied daily for up to 12 weeks.
- Cryotherapy with liquid nitrogen (usually done every 2 weeks until the wart is gone, MAX six treatments).
only suitable for older children who can tolerate.
- Combination therapy with salicylic acid and cryotherapy (applying topical salicylic acid preparations between cryotherapy sessions once the scabbing from cryotherapy has resolved).
- Shorter cryotherapy freeze (for example 5–10 seconds) or a weaker strength topical salicylic acid preparation (eg <17%) is recommended for plane warts on the back of the hands, as scarring is more likely to occur.
- Plantar warts are difficult to treat and cryotherapy is unlikely to help — as pain caused by plantar warts is usually due to thickening of the skin regular paring (trim) can help make the feet more comfortable. Care should be taken when paring to avoid abrading the surrounding normal skin, as this may lead to spread.

Young children:
Topical salicylic acid applied daily for up to 12 weeks.

Secondary care options -
- Physical ablation, such as surgery, laser treatment, photodynamic
- Antimitotic treatments, eg, topical podophyllotoxin, topical or oral retinoids, or intralesional bleomycin.
- Immunomodulatory treatments, such as topical sensitizers (eg, squaric acid dibutylester), topical imiquimod 5%, or intralesional interferon.
- Virucidal treatments, eg, formaldehyde and glutaraldehyde.
- Cantharidin (a potent blistering agent extracted from blister beetles).

Question 4

Treatment (angiogenital warts)

Answer 4

BNF
Topical podophyllotoxin may be used to treat soft, non-keratinised external anogenital warts.

Topical imiquimod cream may also be used to treat external anogenital warts; it is suitable for both keratinised and non-keratinised lesions.

Cryotherapy or other forms of physical ablative therapy (e.g. surgery, laser treatment) may also be considered, particularly for patients with a small number of low-volume warts, irrespective of type.

Camellia sinensis ointment is licensed for the treatment of external anogenital warts.

Question 5

Drug info

Answer 5

Topical salicylic acid:
Contraindicated - DONT USE ON:
- The face.
- Intertriginous or anogenital regions.
- Moles or birthmarks.
- Mucous membranes.
- Warts with hair growing out of them, red edges, or an unusual colour.
- Open wounds, irritated or reddened skin, or any area that is infected.
- Areas of poor healing, eg, neuropathic feet, or in those with impaired blood circulation.
- Children <2 years.
- Children or teenagers during or immediately after chickenpox, influenza, or other viral infections = risk of Reye’s syndrome.
- Avoid applying to normal skin.
- some products the AVOID in P, BF
AE: burns and irritation of skin, rare skin discolouration

Cryotherapy
AE - pain, blister, swelling, scarring, leg ulcers,

Anogenital meds:
Avoid self applying any if pregnant.