Page 34 - LECTURE NOTES
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The etiologic agents are various strains of Human papilloma virus (HPV). The
incubation period of a wart is 2 to 9 months during which time an excessive
proliferation of skin growth slowly develops. They can be spread by direct or indirect
contact or autoinoculation. The hosts’ immunity clears the warts within two years in
2/3 of the cases so treatment is often unnecessary
Most types of HPV have an affinity for the skin and produce common warts (verruca
vulgaris), flat warts (verruca plana), and plantar or foot warts (verruca plantaris).
Several other types of HPV have an affinity for mucous membranes and some of these
cause ano-genital warts (condyloma acuminata) which is mostly sexually transmitted
infection. Certain strains of HPV increase the risk of cervical cancer.
In immunodeficiency states warts can become fulminantly wide spread and difficult to
treat.
There is no single effective treatment for warts. Management is based on the age of
the individual as well as the size, number, and location of warts. Common warts,
especially in children, do not necessarily need to be treated, because they exhibit a
high rate of spontaneous remission. Without treatment, however, spread can occur.
Treatment
Salicylic acid 25% ointment twice daily followed by cutting or scraping
Preparation of salicylic acid 5-20% and lactic acid 5-20 in collodion are easier to use
Electrodessication and curettage
Freezing with liquid nitrogen if available.
For genital warts
Podophyllin 10-25% solution. Protect the skin around the wart with Vaseline apply
the podophyllin with a match stick carefully on the top of the war and wash after 6
hours. Repeat every week. It is contraindicated in pregnancy.
Phenol 80% can be used in the same fashion to Podophyllin.
Cauterization
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