Warts and Footcare Flashcards
T/F: presence of warts is a risk factor for developing additional warts
T
Warts are caused by…
human papillomavirus (HPV)
What 3 criteria must be met to develop a wart?
- virus must be present
- open avenue must exist
- immune system has to be susceptible
How can warts spread?
- person to person
- autoinoculation: you give it to yourself
- indirect exposure
Signs and symptoms of warts:
- brown
- rough
- cauliflower-like appearance
- pinpoint bleeding
- rough papules
What does pinpoint bleeding look like?
black dots scattered across surface
T/F: warts are not defined by their location
F, they are
Common warts (verruca vulgaris) are located on…
- hands
- single or grouped
- skin colored/brown/rough
Periungal and subungual warts are located…
- around and underneath nail beds
- nail biters have this
- cauliflower like skin around nail plates
Flat warts (verruca plana) are located on…
- face
- smooth
- flat topped
- yellow, brown papules
Venereal warts (condyloma lata and acuminate) are located on…
- genitalia region
- STD
Plantar warts (verruca plantaris) are located on…
- soles of feet
- skin colored callous like lesions
- causes pain while walking
Which kinds of warts can you self treat?
- common
- plantar
Which kinds of warts need to be referred?
- periungal and subungual
- flat
- venereal
Exclusions to self treatment of warts:
- on face, toenails/fingernails, genitalia
- extensive warts at one body site
- painful plantar warts
- diabetes, peripheral vascular disease
- physical or mental impairments that make following directions difficult
- immunosuppressive meds that contraindicate use of salicylic acid
- < 4 YO
Non-pharmacologic therapy of warts:
- wash hands before and after touching wart area
- avoid skin to skin contact with infected people
- don’t probe, poke, or cut wart
- don’t walk barefoot if wart is on the bottom of foot
Pharmacologic therapy of warts:
- salicylic acid
- cryotherapy
Types of ways to administer salicylic acid:
- plaster vehicle
- collodion-like vehicle
- karaya gum-glycol plaster vehicle
After using salicylic acid, patients should notice visible improvement within…
1st or 2nd week of treatment
When should you stop self-treating after using salicylic acid?
past 12 weeks
What concentrations of salicylic acid are used for common warts?
< 17%
What concentrations of salicylic acid are used for plantar warts?
above 17% but under 40%
How to apply plasters of salicylic acid (12-40%):
trim plaster to follow the contours of the wart
- apply to skin and cover with adhesive tape
How to apply pads of salicylic acid (12-40%):
apply directly to area and cover with pad
- most are these
How to apply collodion vehicle of salicylic acid (17%):
- apply max of BID
- apply solution one drop at a time
- wash off solution that touch healthy skin
- allow solution to harden
- repeat up to 12 weeks
- store away from sun or heat
How to apply karaya gum-glycol vehicle of salicylic acid (15%):
- apply to wart at HS and leave for 8 H
- remove and discard in morning
- repeat every 24 H up to 12 weeks
Advantages to topical salicylic acid containing products:
- low cost
- ease of access
- few adverse effects
- reasonable effectiveness
Disadvantages to topical salicylic acid containing products:
- need for consistent, frequent application
- potential for damage to healthy skin surrounding wart
- duration of treatment needed to see a response
Cryotherapy can cause…
irritation leading the host to mount an immune response against the virus
- freezes wart tissue
Advantages of cryotherapy:
- easy access
- lower cost
- one treatment might be enough
Disadvantages of cryotherapy:
- pain
- potential for healthy skin damage surrounding wart
- may not be as effective as liquid nitrogen
T/F: you can’t use cryotherapy and salicylic acid together
F
Duct tape and warts:
- leave tape for 6 days and then replace
- local irritation can cause stimulation of patient’s immune response
Warts are…
contagious and can spread to other parts
Warts can reappear…
months after initial treatment
Alleviation of the symptoms will…
not occur overnight
Wart removal can take from…
4-12 weeks
- follow up should be in 4 weeks
Refer to MD when warts persist after…
12 weeks of self-treatment
3 groups of patients who have foot problems:
- children w/ congenital malformation or deformity
- adolescents who have rapid growth
- older patients
Why does diabetes contribute to foot problems?
- poor circulation
- peripheral neuropathy
- poor foot hygiene
Why does peripheral vascular disease contribute to foot problems?
- decreased blood flow and poor circulation
- skin ulcerations
- cold
- numbness
What medical illnesses contribute to foot problems?
- diabetes
- peripheral vascular disease
- arthritis
What are corns and calluses?
excessive growths of the upper keratinized layer of the skin
- natural protective mechanism
- nothing wrong, just not nice looking
Corns specifically are…
small, raised, sharply demarcated lesions caused by pressure
- can be hard or soft
- usually on or between toes
Calluses specifically are…
diffuse thickening of skin
- forms on joints and weight beating areas (bottom of foot and hands)
Non-pharmacologic therapy for corns and calluses:
- daily soak affected area for at least 5 minutes in warm water
- dead tissue should be removed gently
- use pad to relieve pressure
- wear well-fitting, nonbinding footwear
Pharmacologic therapy for corns and calluses:
salicylic acid
- plaster/pad vehicle
- collodion like vehicle
Counseling points for corns and calluses:
- OTC products are not recommended for those with diabetes or circulatory problems
- patient progress should be checked after 2 weeks
Bunions are ____ more common in ______
10x in females than males
T/F: bunions are linked with family history
T
Treatment of bunions:
- can’t be treated by topical drugs
- refer
- routine and chronic use of analgesic is not recommended
- management of bunion is best thing
How to manage a bunion:
- avoid high heels
- use protective padding
- take oral analgesics on short-term basis
What is the most frequent cause in ingrown toenails?
incorrect trimming of nails
What is the correct method of cutting toenails?
- cut straight across
- don’t taper ends
What is the best way to prevent development of ingrown toenails?
education
