Warts and Verrucae

Question 1

Benign growths of the skin caused by the Human Papilloma Virus is called

Answer 1

Warts and verrucae

Question 2

Epidemiology of Warts and Verrucae

Answer 2

Mostly affect children (peak between 12-16 years old)

Warts are uncommon in infants and the elderly. Caution

Question 3

Aetiology of Warts and Verrucae

Answer 3

HPV enters the host by the epithelial defects in the epidermis
Transmitted by direct skin-to-skin contact
Once established in the epithelial cells, the virus stimulates basal cell division to produce the characteristic lesion

Question 4

Resolution of Warts and Verrucae

Answer 4

Spontaneous resolution is seen in 30% of people within 6 months and two thirds of cases within 2 years. However despite this, they are cosmetically unacceptable to many patients.

Caution should be exercised if an elderly patient presents to the pharmacy with a self-diagnosed wart.

Although contact with an infected person’s shed skin can also transmit the virus

Question 5

State the condition to eliminate when considering Warts and verrucae?

Answer 5

Corn/callus
lesions on the tops or between the toes, appear as white/yellow hyper keratinised areas of the skin. Caused usually by ill-fitting shoes

Question 6

State the signs and symptoms of warts

Answer 6

Most often occur on backs of hands, fingers and knees, either singly or in crops.
Appear raised , hyperkeratotic papule with thrombosed, black vessels often visible as black dots within the wart
Rough texture, skin coloured and usually less than 1cm in diameter.

Question 7

State the signs and symptoms of Verrucae

Answer 7

Presentation (signs & symptoms):
Found on sole of the foot, usually in weight bearing areas
Pressure on the nerves can cause considerable pain
Lesions normally reveal tiny black dots on surface
Rarely larger than 1cm in diameter
Occur singly or in crops

Question 8

State the signs and symptoms of Verrucae

Answer 8

Found on sole of the foot, usually in weight bearing areas
Pressure on the nerves can cause considerable pain
Lesions normally reveal tiny black dots on surface
Rarely larger than 1cm in diameter
Occur singly or in crops

Question 9

State why warts/verrucae and must be viewed with caution, especially in elderly patients.

Answer 9

Itching and bleeding are not associated with warts/verrucae and must be viewed with caution, especially in elderly patients.

Question 10

What patient group suffering from Warts and verrucae should be referred?

Answer 10

Diabetic patient

Question 11

Treatment of Verrucae 1

Answer 11

Majority of warts & verrucae self-resolve spontaneously so treatment is not necessarily needed.

Pharmacists should determine from the patient how much the wart/verrucae affects day-to-day life and also what social impact the lesions have on the patient .

Question 12

Treatment of Warts and Verrucae 2

Answer 12

Salicylic acid products
Keterolytic action

Counselling very important:
Daily treatment

Side effects: local irritation
but also therapeutic effect

Question 13

What to do prior to use of Salicylic acid

Answer 13

Prior to use- soak area in warm water and towel dry. Rub the surface with a pumice stone or emery board to remove any hard skin. (THIS SHOULD BE DONE AT LEAST ONCE A WEEK)
A few drops of the product then applied to the lesion, taking care with surrounded skin. DAILY TREATMENT.

If paint makes skin sore, stop treatment until discomfort has settled. Apply for minimum of 12 weeks

Question 14

Other treatments of Warts and Verrucae

Answer 14

Glutaraldehyde (Glutarol)
TWICE daily
S/E: Colours skin brown

3. Formaldehyde (Veracur)
   TWICE daily
4. Silver Nitrate (Avoca Pen)
   Moistened tip applied for 1-2 minutes

Question 15

Facts about treatment products of Warts and Verrucae

Answer 15

Glutarol: Can cause skin irritation and stains the outer layer of the skin brown

Veracur: Marketed partic. For verrucae. Not common

Avoca: Moisten the tip and apply to the verruca for 1-2 minutes. Must be repeated daily

Question 16

Facts about freezing product used to treat Warts and verrucae

Answer 16

Freezing products
Kill virus particles via temporary freeze

Dose: Up to 3 applications for warts and up to 6 applications for verrucae

Question 17

State the limitation of Freezing products

Answer 17

GPs use to use liquid nitrogen to freeze warts & verrucae but not any more – difficult to treat base layer and so the warts and verrucae return, best way to treat these is to irritate the skin sufficiently to encourage the immune system to act

Question 18

Self advice for patients suffering from W and V

Answer 18

Patients should be warned not to pick, bite, suck or scratch
Cover with waterproof plaster/sock when swimming
Wear flip-flops in communal showers
Avoid sharing shoes, socks & towels
Dock tape!

Question 19

When to refer a patient suffering from W and V

Answer 19

Anogenital warts 
Multiple & widespread warts
Diabetics/immunocompromised
Lesions to the face
Warts that have changed colour, grown, itch/bleed.