Warts

1
Warts

• Caused by human papillomaviruses (HPVs)--at least
  80 HPVs identified
• Three necessary factors in wart development
• HPV must be present
• Break in the skin for viral entry
• Immune system must be susceptible to the virus
• Usually not permanent--can spontaneously clear
  without treatment in 6 months to 5 years

2
Types of Warts for OTC Treatment

• Common warts
• Usually on hands, but can be found
• on any skin surface
• Raised, cauliflower-like appearance
• Often skin-colored, but can be darker,
• with tiny black dots (small blood vessels)
• Plantar warts
• Usually on weight-bearing surfaces of foot
• Not raised, diameter 0.5 to 3 cm, grayish
• in in center with thickened skin surrounding
• the wart and tiny black dots

3
When to Refer

• If warts are numerous, painful or debilitating
• If warts are on face, around toenails or
  fingernails, or genital area
• If patient has diabetes, poor circulation or is
  immunocompromised

4
Why treat warts?

• Relief of pain associated with the wart
• Aesthetics
• Prevent transmission to others!

5
OTC Wart Treatment

• Salicylic Acid
• In Colloidion Vehicle 5-17
• Apply drop by drop to cover wart, up to 2
  times daily
• Plaster/Pads 12-40
• Cut plaster to wart size or choose
  appropriately-sized pad, apply and cover with
  occlusive tape, every 48 hours
• In Karaya Gum-Glycol Vehicle 15
• Apply plaster at bedtime, remove in am, every
  24 hours

6
Duct Tape for Warts?

• Study published in Archives of Pediatric and
  Adolescent Medicine found duct tape occlusion
  therapy more effective than cryotherapy in the
  treatment of common warts.
• Cut duct tape to size of wart, apply for 6 days,
  then remove. Soak in water, then gently debride
  with emery board or pumice stone. Reapply tape
  the following morning.
• Focht III DR, Spicer C, Fairchok M. The efficacy
  of duct tape vs cryotherapy in the treatment of
  verruca vulgaris (the common wart). Arch Pediatr
  Adolesc Med. 2002156971-974.

7
Bunions

• Big toe angled toward outer toes causes
  inflammation and discomfort
• Usually caused by ill-fitting shoes (like high
  heels), but also genetic factors

8
Treatment

• Wear flat, roomy toe-box shoes
• Padding such as moleskin or bunion pads can be
  applied to, or around, bunion to help relieve
  pressure
• Apply to clean, dry skin
• Cut pad to appropriate size
• Adhesive backing can be irritating to skin

• Refer
• Patients with diabetes
• Discharge or bleeding from bunion