Warts and Corns, Alopecia Flashcards
Types of warts/corns
- Basal cell carcinoma (type of skin cancer)* Corn (clavus/heloma): top or side of toes (painful)* Callus (tyloma): soles (rarely painful)* Flat wart: face, back of hand, legs* Plane wart: face, hand, shin* Seborrhoeic wart (basal cell papilloma)* Verruca/Plantar wart/verruca plantaris: sole, painful
HPV and its associated warts
HPV 1,2,4: plantar warts, common warts (usually hands)HPV 2,7: common wartsHPV 6,11: genital wartsHPV 3,10: flat/plane warts (usually face or hands)
Causes of wart-like lesions in community pharmacy
Most likely: common warts and verrucasLikely: corns, molluscum contagiosumUnlikely: Plane warts, seborrhoeic keratosisVery unlikely: Basal cell carcinoma
Hx taking questions for common warts and verrucae
Age: warts are unusual in infants. young children and adolescents are more likely as this is the age grp where molluscum contagiosum is most prevalent Location: warts are common on hands and knees. verrucas are usally on weightbearing parts of the sole.Assoc smx: itching and bleeding is not assoc w warts and verrucas. pain on walking is often assoc with verrucasColour,appearance: warts have cauliflower appearance and are raised and pale (blood vessels may appear as tiny black dots). warts with reddish hue or change colour shld be referred. lesions that are raised, smooth and have central dimple suggest molluscum contagiosum
Clinical presentations of molluscum contagiosum (viral infection)
Clusters of small round papules (1-6mm). pink or brown colour. papules have a small central pit that may contain caseuous plug, has a waxy and shiny look
How does a plantar wart (verruca) look like?
Pale, natural lines of foot does not go through the papule. Black dots suggest thrombosed blood vessels. If press on papule, it will be painful
Differential diagnosis of common warts and verruca
Plane warts (flat warts or verruca plana): very small, flat, skin coloured papule. common on face and hands. easily spread when shaving for menMolluscum contagiosum Seborrhoeic keratosis/warts (basal cell papilloma): risk factors- amt of warts increase w age, genetic, sun exposure, seen all over body and not just seborrhoeic regions. refer if it starts to bleed. Basal cell carcinoma: older people, hx of prolonged sun exposure, fresh coloured and non-scaly papules
When to refer for common warts and verrucae
- Anogenital warts- multiple and widespread warts- diabetic pts- lesions on face- >50y/o presenting w a first time wart- warts that itch or bleed without provocation- warts that have grown and changed colour
Evidence-based treatment for common warts and verrucae
- chemical tx- occlusion (eg. duct tape)- cryotherapy (liquid N2 so freeze off wart)- electrotherapy- laser vaporisation
Chemical tx for common warts and verrucae
1.Salicylic acid: may take 12wks to remove warts2. salicylic acid and lactic acid3. glutaraldehyde (not rec)4. silver nitrate (not rec)
Prevalence and etiology of corns and calluses
- Corns and calluses are common skin lesions in which there is a localised area of thickened skin.* A corn (clavus, heloma) is inflamed and painful. They are known as ‘soft corns’ (heloma molle) if the surface skin is damp and peeling, for example between toes that are squashed together.* A callus (tyloma) is an area of painless hard skin* common in women esp if they wear high heels
Differential diagnosis of corns and callouses
Location: lesions on tops or btw toes suggest corn compared with verrucas which are on plantar surface of footAggravating or relieving factors: pain experienced with corns is due to pressure btw footwear and toes. if footwear is removed, pain is relieved. pain assoc with verrucas will be felt w or w/o footwearAppearance: corns and calluses appear as white or yellow, hyperkeratinised areas of skin, unlike verrucas which show black thrombosed capillaries seen as black dots on surface of verrucaPrevious history: pts with corns will often have previous hx of foot problems.
Difference btw corn and verruca
Corn:- develops over months or years- localised under bony prominences- skin lines pass through the lesion- max. pain felt with direct pressure- slow reccurence at least a week after shavingVerruca (plantar wart):- relatively rapid onset- may or may not be found under bony prominences- skin lines pass around the lesion- max. pain felt on squeezing side to side- rapid reccurence after shaving and padding- black dots
Clinical presentation of different types of corns
Hard corn: firm, dry mass, maybe found below nail or on top of toeSoft corn: extremely painful, accumulation of spongy hyperkeratotic tissue btw opposing surfaces, usually gound in 4th and 5th toe whr it absorbs moisture leading to mascerations -> sec infectionSeed corn: cluster of prokeratotic cells, embedded, scattered around the heel, usually not painful
When to refer for corns and calluses?
- discomfort, pain causing difficulty in walking- soft corns present- treatment failure- impaired peripheral circulation (eg. with diabetes)
