Cutaneous warts

Question 1

What is the difference between common wart and verruca?

Answer 1

Common wart - papules with a rough and hyperkeratotic surface. Usually found on backs of fingers, toes, around nails.

Verrucas - hard raised warts with rough surface, which appear on feet.

Filiform warts - long slender, appear on face, neck, armpits.

Question 2

What is this?

Answer 2

Common wart

Question 3

Where do warts usually appear?

Answer 3

more likely to occur in damaged or wet skin

Question 4

Do most warts require treatment or sel-resolve?

Answer 4

Most warts do not require treatment and resolve within several months to two years.

Question 4

Are warts more common in adults or children?

Answer 4

Children

They are rarely seen in adults

Question 5

What is the medical management of common warts?

Answer 5

First line options:

• 1. debridement + salicylic acid 17%
• duct tape occulusion
• cryotherapy
• silver nitrate solution

Second line:

• 2. cryotherapy + local immunotherapy or chemotherapy -
• e.g. intralesional Candida antigen
• e.g. topical Imiquimod 5%
• e.g. topical fluorouracil 2-5%

Third line: surgery - cold scalpel or laser

Question 6

What should you do before applying salicylic acid treatment?

Answer 6

Soak in warm water for 10-15min before applying the treatment

Question 7

What is this?

Answer 7

Keratoacanthoma - raipdly growing lesion which is a low grade tumour that doesn’t invade or metastasise. May follow trauma.

Question 8

What is the prognosis with keratoacanthomas?

Answer 8

They grow rapidly, often over 6 weeks.
They may become necrotic and spontaneously resolve after several months.

Question 9

What must be excluded with keratoacanthomas?

i.e. what cancer?

Answer 9

SCC - sometimes present as a nodule with a central crater and a well-defined edge so can look similar