Warts, Corns, and Calluses

Warts (verrucae)

1. HPV infection: person to person contact, autoinoculation, or fomites on contaminated surface

2. Warts can affect skin and mucous membranes anywhere on body

3. Manifestation of warts depends on immune response of infected individual

*more frequent in children and adolescents than in infants and adults

True or False: Warts often resolve without treatment

true they are considered benign

True or False: warts can spread systemically

false they are limited to the epidermal tissue

Common location for common-type warts (verruca vulgaris)?

Hands

Common location for plantar warts (verruca plantaris)?

Feet

How do common warts present?

1. Skin-colored or brown

2. Dome-shaped

3. Hyperkeratotic papules w/ rough surface

4. *Cauliflower* textured

5. Often painless

How do plantar warts present?

1. Skin-colored

2. Flat

3. Callus-like

4. Hyperkeratotic lesions

5. Disruption of normal skin markings

6. May be painful in weight bearing locations

Treatment Goals: Warts

There is no one single treatment that is universially effective, but the goals are

1. Eliminate associated signs and symptoms

2. Remove the lesion without scarring

3. Prevent recurrence of the warts

4. Prevent spread of HPV through autoinoculation or transmission to others

Exclusion Criteria for Self treatment of Warts

<3 years of age – salicylic acid products (systemic absorption and skin damage)

<4 years of age – cryotherapy products (skin damage concern)

Chronic conditions (diabetes, neuropathy) that cause poor blood flow or Immunocompromised

True or False: Geriatrics cannot self treat using SA or cryotherapy

False; yes they can, just be careful with surrounding tissues

True or False: children/teens recovering from the flu can use salicylic acid to treat warts

False; risk of Reyes Syndrome

T/F: Pregnant or breastfeeding women are eligible for self-treatment of warts.

False; effects to mother and unborn child/infant unknown

T/F: Painful plantar warts cannot be self-treated.

True

T/F: Warts located on the face, breasts, armpits, fingernails, toenails, anus, genitalia, or mucous membranes are not eligible for self-treatment.

True

Two preventative methods (nonpharmacological) for wart transmission?

1. Prevent spreading warts through autoinoculation:

-don't shave, cut, pick at warts

-wash hands after treating or touching them

-use a towel dedicated to wart

2. Prevent transmission of the virus to others:

-avoiding sharing

- keep wart covered

-don't walk barefoot

Nonpharmacological therapy options for wart treatment?

1. Vitamin A

2. Dietary Zinc

3. Garlic

4. Occlusion with duct tape: less painful for warts than other treatments (good for kids)

Salicylic acid in the treatment of warts

Keratolytic agent that causes the area to desquamate.

17% = common warts

40%= plantar warts

How soon can a patient expect to see results when using salicylic acid to treat a wart?

1. Improvements in 1-2 weeks

2. Complete clarity at 6-12 weeks

*Refer if self treatment = longer than 12 weeks

Cryotherapy in the treatment of warts

Dimethyl ether and propane

-Causes irritation and tissue destruction (painful) - affected cells will slough off.

Blister forms and then falls off 10 days later

Outcomes in Cryotherapy for warts

Procedure may be repeated in 2 weeks

•Product should not be used >12 weeks or repeated >4x = refer pt

Corns

prolonged pressure/friction applied to a focused location with a hard central core

-prevalent in females

Callus

Prolonged forces/friction distributed over a broad area

What does the pressure/ friction induce

Hyperkeratinization --> thickening of the stratum corneum

Clinical Presentation of Calluses

Found on weight-bearing areas of the feet

-Raised,yellowish thickening of the skin; broad-based with diffuse borders;

normal pattern of skin ridges

Clinical Presentation of Corns

Found on bony prominences in the feet. Often caused by narrow toed heels

soft vs hard

-painful

Soft vs hard corn

Treatment goals for Calluses and corns

1. symptom relief

2. remove corn/callus

3. prevent recurrence

Exclusion for Self treatment of calluses and corns

-Diabetes, pherpheral arterty disease, osteoarthritis and rheumatoid arthritis

Nonpharmacological therapy for Corns and Calluses

-Properly fitted shoes

• Soak daily in warm water

• Removal of dead tissue

• File or pumice stone

• Cushioning pads

• Silicone toe sleeve

• Foam spacer

• Lamb's wool

Pharmacological Therapy for Corns and Calluses

1. SA: 12-17% collodion like vehicle (CV) * light sensitive OR 12-40% plasters

2. Urea based creams 40%

Special Considerations for Calluses and Warts

- avoid in pregnant/ lactating females

-kids >2 = SA 1.8-6%

- OK in geriatrics

-avoid in diabetes

When to refer for calluses and corns

1. Swelling, reddening, or irritation after product application

2. Corn or callus is not removed after 14 days