Makindo Medical Notes

Description

Cutaneous warts are benign skin growths caused by the human papillomavirus (HPV). They typically affect the hands, feet, and other areas prone to minor trauma. Warts can appear as rough, raised bumps or flat lesions and are commonly found in children and young adults.

Clinical Presentation

• Common warts (verruca vulgaris): Rough, raised papules, commonly on hands or knees.
• Plantar warts: Located on the soles of feet, often painful due to pressure.
• Flat warts (verruca plana): Smaller and smoother, typically found on the face, neck, and hands.
• Filiform warts: Finger-like projections, usually on the face or around the mouth.

Clinical Tests

• Visual Examination:Warts are generally diagnosed based on clinical appearance alone. Key features include a rough, scaly surface and interrupted skin lines.
• Dermatoscopy:May be used to distinguish warts from other lesions such as seborrheic keratosis or squamous cell carcinoma. Dermatoscopy of warts shows thrombosed capillaries (black dots).

Management

• First-Line Management: Topical Salicylic Acid: Applied daily for several weeks. It softens and removes layers of the wart. Salicylic acid plasters or paints can be used.
• Cryotherapy: Freezing the wart with liquid nitrogen. Multiple sessions may be required (every 2-3 weeks). Effective for common and plantar warts.
• Second-Line Management: Topical Imiquimod or 5-Fluorouracil: Used for resistant warts or in cases where first-line treatments fail.
• Laser Therapy: Used for recalcitrant warts. Targets and destroys the blood supply to the wart.

Other Management Options

• Duct Tape Occlusion Therapy:Apply duct tape to the wart continuously may lead to gradual resolution, but evidence is mixed.
• Surgical Curettage:Reserved for severe or resistant cases, but carries a risk of scarring.
• Patient Education and Follow-Up: Warts are contagious, so patients should avoid sharing towels and wear protective footwear in communal areas (e.g., swimming pools).
• Emphasize that warts often resolve spontaneously within 1-2 years, especially in children, and treatment is not always necessary.