Warts

What causes warts?

human papillomavirus

What is the technical term for a wart?

verrucae

Where are common warts found?

hands and knees

Where are plantar warts found?

feet

Where are flat warts found?

face

What kind of warts does the HPV vaccine cover?

genital warts

70% of warts are _______ warts.

common

What color are common warts?

skin colored or brown

What color are plantar warts?

skin colored

How thick are common warts?

hyperkeratotic

How thick are plantar warts?

callous-like

What shape are common warts?

dome shaped papules

What shape are plantar warts?

sloped sides with a central depression

What is the texture of common warts?

rough and cauliflower like

What is the texture of plantar warts?

clustered

Where are common warts located?

mainly the hands but anywhere on the body

Where are plantar warts located?

feet

Are common warts painful?

No

Are plantar warts painful?

Maybe

Who do warts occur in more frequently?

children and adolescents

True or False? Warts are a self-limiting disease so they will resolve themselves within 2 months to 2 years.

True

What are the 7 risk factors to warts?

1. previous or existing warts

2. depressed immune system

3. barefoot on wet surfaces

4. swimming pools

5. public showers

6. meat handling occupation

7. biting fingernails

What are the 10 exclusions to self-care for warts?

1. pain or bleeding
2. abnormal discoloration
3. inability to comply with regimen
4. large and multiple lesions
5. atypical location
6. immune compromised
7. unresolved after 12 weeks of treatment
8. pregnancy
9. breastfeeding
10. comorbidity that affects sensitivity, circulation, and healing

What treatment for warts is excluded for patients under 3?

salicylic acid

What treatment for warts is excluded for patients under 4?

cryotherapy

What are the 3 exclusion criteria to using salicylic products for warts?

1. immunosuppressive medications
2. contraindicated medications
3. salicylate allergy

Can you wait and see for warts to resolve themselves?

Yes

What are the 6 techniques to decrease the risk of autoinoculation and spread to others?

1. Do not pick at, cut, or shave wart off

2. Wash hands before and after treatment

3. Keep feet clean and dry

4. Separate linens

5. Minimize/do not share

6. Keep affected area covered and avoid walking barefoot, especially in public environments

What are the 5 complementary/alternative approaches?

1. Vitamin A
2. Zinc
3. Garlic
4. Essential oils
5. Duct tape

Lower concentrations of salicylic acid like 17% are used for _______ warts.

common

Higher concentrations of salicylic acid like 40% are used for _______ warts.

plantar

What is the mechanism of salicylic acid for warts?

destroys cells and trigger immune response

What are the 2 advantages of salicylic acid?

1. cost
2. availability

What are the 2 disadvantages of salicylic acid?

1. frequency of application
2. duration of treatment

Are the kids wart products and adults wart products the same?

Yes

What 2 active ingredients can cryotherapy have?

1. nitrous oxide
2. dimethyl ether and propane

What is the mechanism of cryotherapy?

freeze wart to cause a microthrombus that will ischemic necrosis which will cause those cells to die and inflammation that will trigger an immune response

After using cryotherapy, the blister should fall off after ________.

10 days

Is salicylic acid, cryotherapy or the placebo more effective for warts?

All have the same efficacy

Using cryotherapy every _________ yields the best results.

2-3 weeks

What are the 2 advantages of cryotherapy?

1. cost
2. availability

What are the 3 disadvantages of cryotherapy?

1. pain
2. damage to surrounding skin
3. adverse effects

What is the mechanism for vitamin A for warts?

may interfere with viral replication

What is the mechanism for Zinc for warts?

may improve immune response and inhibit HPV replication

What is the mechanism for Garlic for warts?

may inhibit proliferation of infected cells

What are the 7 important considerations and characteristics for the use of duct tape for warts?

1. occlusion therapy
2. cheap
3. less pain
4. stimulate immune system
5. change every 6 days
6. continue up to 2 months or until resolution
7. evidence is not overwhelming

What is an important consideration for salicylic acid use in children?

Reyes Syndrome

What are 2 comorbid considerations for warts that may be exclusion criteria?

1. diabetes
2. poor circulation

Improvement of warts should be seen within ________.

2 weeks

Self-treatment of warts should not continue beyond ________.

12 weeks

What are the 4 treatment for corns and calluses?

1. proper footwear
2. daily soaks
3. file/pumice stone
4. salicylic acid

How often and how long should you apply salicylic acid 17% for a corn or callus?

QD-BID for 12 weeks

How often and how long should you apply salicylic acid 40% for a corn or callus?

48 hours then PRN for 12 weeks

Are geriatrics at an increased risk for skin injury for salicylic acid and cryotherapy?

Yes

How often and how long should you apply cryotherapy for a corn or callus?

repeat every 10 days for 3 treatments

Is there exclusion criteria for calluses or corns?

No