Warts

Question 1

Warts clinical presentation

Answer 1

Obscure normal skin lines

Question 2

Verruca vulgaris aka common warts tx

Answer 2

Topical salicylic acid, cryotherapy, and light electrocautery
- if recalcitrant: imiquimod or apple cider vinegar

Question 3

Filiform and Digitate warts tx

Answer 3

• usually around mouth/beard/eyes/nasal ala
• fingerlike projections
• tx: curetage

Question 4

Verruca plana aka Flat warts

Answer 4

• pink to light brown slightly elevated flat topped papules
• 2/2 HPV 3 and 10
• tx: imiquimod, cryo, 5FU (but may cause hyperpigmentation)

Question 5

Plantar warts

Answer 5

• can see them clustered together/fused called a mosaic wart

-

Question 6

Plantar wart ddx

Answer 6

1. corns: to differentiate, pare with 15 blade to reveal black/bleeding dot at center (corns have a translucent central core)
2. Black heel: ruptured capillaries/petechiae (normal skin lines and self resolving) usually seen after sports, etc
3. Black warts: undergoing spontaneous resolution

Question 7

Plantar wart tx

Answer 7

Combination approach:
salicylic acid, apple cider vinegar, 5FU, blunt dissection, or Imiquimod, suggestive therapy, cantharadin, laser, chemotherapy, formalin, or cryo

Question 8

Peri or Subungal wart tx

Answer 8

Cryo (watch for nerve damage/nail matrix damage)
Cantharidin
Blunt dissection
Duct tape occlusion