PHA 425 Warts, Corns and Calluses

What is the pathophysiology of Warts?

-caused by HPV

-Direct transmission

-auto inoculation

-contaminated surfaces/objects

Risk Factors for Warts

-history

-exposure to other warts

-immunocompromised status

-presence of chronic skin cond.

-walking barefoot

-swimming pools or public showers

-biting nails

Clinical Presentation of Warts

-common wart

-plantar wart

-mosaic wart

-filiform wart

-flat wart

-periungual wart

Common wart clinical presentation

-hands

-children/adolescents

-skin colored or brown

-dome or cauliflower-like

Plantar wart clinical presentation

-feet

-adolescents or young adults

-skin-colored, callus like

-flat but disrupt normal foot markings

-painful in weight bearing area

Mosaic wart clinical presentation

-feet

-adolescents or young adults

-multiple closely grouped plantar warts

Filiform wart clinical presentation

-face

-flesh colored, thread-like projections

-rapidly growing

Flat wart clinical presentation

-face

-children

-yellow-brown papules

-smooth or flat

Periungual wart clinical presentation

-around nail plate

-bite their nails

-thick or cracked

-cauliflower textured

Exclusions to self care

-location other than hands or feet

-large or painful warts

-poor circulation or decreased skin sensitivity

-immunocompromised

-pregnancy or breastfeeding

-children less than 3 for SA

-children less than 4 for cryotherapy

-unresolved after 12 weeks

Non-pharm therapy to prevent further auto inoculation

-avoid cutting, shaving, or picking wart

-wash hands before/after touching and treating wart

-use designated towel to dry wart-affected areas

Non-pharm therapy to prevent transmission to others

-avoid sharing towels, razors, socks, shoes

-keep wart covered

-avoid walking barefoot in bathrooms and public spaces

Non-pharm therapy to manage discomfort

padding over pressure points

(lamb's wool or moleskin)

Characteristics of Salicyclic acid

-keratolytic agent

-break down outer layer of the skin

-17% liquid/gel for common warts

-40% plaster/pads or sticks/strips for plantar warts

Considerations for Salicyclic acid

-salicylate allergy

-do not give to <18 recovering from chicken pox or flu

-avoid broken skin

-skin irritation (burning)

-potential systemic toxicity

Directions for Salicyclic Acid 17%

-apply 1 drop to cover wart while protecting nearby healthy skin

-cover wart with self-adhesive discs or occlusive tape

-repeat 1-2 times/day until wart resolves

-up to 12 weeks

Directions for Salicyclic Acid 40%

-make sure stick is only on wart

-bandage and cover after application

-remove after 48 hours

-repeat up to 12 weeks

Characteristics of Cryotherapy

-freezing of tissue creates localized ischemic necrosis of HPV-infected keratinocytes

-DMEP and nitrous oxide active ingredients

Directions for OTC Cryotherapy

-follow package for up to 12 weeks or max 3 sessions

-wart will fall out in 10 days if effective

-treat every 2 weeks if ineffective

Considerations for Cryotherapy

-do not apply to broken skin

-pain/damage to healthy skin surrounding the wart

-blistering, scarring, hypo/hyperpigmentation

-tendon/nerve damage with aggressive treatment

General Guidelines for Cryotherapy

-wash hands before/after use

-soak affected area in warm water for 5 minutes prior

-wash/dry thoroughly

-avoid heat

-do not hold canister close to face, body or clothing

Directions for Cryotherapy

-prepare and activate device

-apply to wart until halo appearance (20 seconds common; 40 seconds plantar)

-discard single-use applicators

Pathophysiology of Corns and Calluses

-hyperkeratosis of stratum corneum

-friction/pressure increase mitotic activity in basal cell layer

Describe corn appearance

-small, raised, sharp demarcated hyperkeratotic lesion with hard, central core

-flesh-colored to white to yellowish gray

Describe types of corns

Hard corn

- helm durum

-polished, shiny, dry

-bulb of great toe, top of 4th or 5th toe

Soft Corn

-heloma molle

-whitish thickenings of the skin, painful

-between adjacent toes

-common between 4th and 5th

Appearance of Calluses

-broad base with thickening of skin

-indefinite broders

-raised and yellow with normal skin pattern

Location and cause of calluses

-heel, ball of foot, toes and sides of foot

-friction on joints or weight-bearing areas

Corn/Callus self care excursions

-conditions causing poor circulation (peripheral circulatory disease)

-conditions with neuropathy (diabetes)

-lesions hemorrhaging or oozing purulent material

-anatomic defect in weight distribution

-extensive pain

-pregnancy or breastfeeding

-unsuccessful self-care treatment

-history of RA and painful metatarsals

Non-pharm therapy to corns and calluses

-daily soaking for 5 minutes in warm water

-gently remove dead tissue with callus file or pumice stone

-cushioning pads to relieve pressure

-use well fitted footwear or orthotics

Salicyclic acid characteristics for corns/calluses

-strength varies per formulation

-soak in warm water for 5 minutes

-treat up to 14 days