Warts

Question 1

What is the common causative organism for warts?

Answer 1

Human Papilloma Virus (HPV)

Question 2

Usual modes of HPV transmission

Answer 2

1. Direct contact
2. Environment, especially water (e.g. showers, swimming pools)

Question 3

What are the host factors that predispose patients to cutaneous warts?

Answer 3

1. Children and young adults
2. Compromised immunity
3. Oversweating (at hands and feets)

Question 4

What are the general predisposing factors to cutaneous warts, other than host factors?

Answer 4

1. Contact (e.g. person-to-person contact)
2. Damage to skin (e.g. biting nails)
3. Moisture (e.g. sweat, showers)

Question 5

What are the exclusion for self-treatment in cutaneous warts?

Answer 5

1. Involves face, nails, anus, genitals
2. Painful plantar warts
3. Extensive warts at one site
4. Chronic diseases which contraindicate use of foot products (e.g. PAD, DM)
5. Meds that contraindicate salicylic acid use (e.g. immunosuppressants)
6. Unable to follow administration directions

Question 6

GSL options for cutaneous warts

Answer 6

1. Salicylic acid solution/plaster 12-40% OD for 6-12w
2. Cryotherapy (Dimethyl ether and propane) q2w, three applications

Question 7

POM options for cutaneous warts

Answer 7

1. Imiquimod 5% 3x/week for non-genital warts
2. Fluorouracil 0.5% soln BD-TDS for 6 weeks
3. Bleomycin injection 0.15u (0.3 mL) q3-4w

Question 8

Counselling points for salicylic acid?

Answer 8

1. Use daily until warts is removed
2. Will take about 3 months before warts is completed removed
3. Avoid broken skin. Can apply a thin layer of petroleum jelly around the area of warts to protect those parts of the skin
4. See a doctor if warts remains after 12w of tx or if it gets worse

Question 9

Counselling points for cryotherapy?

Answer 9

• Place applicator in spray can, then place the very cold can on warts for 20s (or duration specified by manufacturer)
• For wartner, use q2w up to 3 application on a single wart
• Do not use on face, armpit, buttock, genital, irritated skin or mucous membrane

Question 10

Age restriction for cryotherapy

Answer 10

Cannot use under 4y of age

Question 11

Who is cryotherapy not suitable for?

Answer 11

1. DM
2. Preg
3. Immunocompromised
4. Breastfeeding
5. Children under 4