Warts, Corns and Calluses

Question 1

How are warts caused

Answer 1

HPV infection
*caused by person-to-person contact
autoinoculation to another body part
transmission on fomites

Question 2

What are the 3 criteria for wart development

Answer 2

presence of HPV
opening in the skin
susceptible immune system

Question 3

What are some risk factors for warts

Answer 3

history of warts
immunocompromised
chronic skin condition
walking barefoot
use of public bathing/swimming areas
nail biting
working at meat-handling facility

Question 4

What is the clinical presentation of common warts

Answer 4

skin-colored or brown lesions
rough, cauliflower texture
usually painless

Question 5

What is the clinical presentation of plantar warts

Answer 5

skin-colored lesions appearing on the feet
extend deeper into the skin
may be painful
*named after bottom surface of foot

Question 6

What are the exclusions for self-treatment

Answer 6

under the age of 3 if using salicylic acid products
under the age of 4 years if using cryotherapy products
unable to follow instructions
pregnant or breastfeeding
immunocompromised status
chronic conditions like diabetes, PVD, and/or neuropathy
large and/or multiple warts concentrated in a particular area
bleeding, painful, or discolored warts
warts found on sensitive areas of the body
little to no improvement after 12 weeks of self-treatment

Question 7

What is the main focus when treating warts

Answer 7

Preventing the spread of HPV

Question 8

What are non-pharmacologic options we can take to prevent the spread of HPV

Answer 8

avoid shaving, cutting or picking at warts
avoid walking around barefoot
wash hands before and after contact with warts
use a designated towel on affected areas
avoid sharing towels, razors, socks and shoes
keep feet clean and dry
cover warts

Question 9

How long may a person self-treat warts for?

Answer 9

MAX of 12 weeks

Question 10

What is the MOA of salicylic acid

Answer 10

keratolytic agent
“exfoliant” for warts

Question 11

How long does it usually take for salicylic acid to start working

Answer 11

1-2 weeks

Question 12

Who should not use salicylic acid treatment for warts

Answer 12

those younger than 3 years old
salicylate allergy
patients on immunosuppressive agents
patients that are pregnant or lactating

Question 13

What is the dosing for salicylic acid for warts?

Answer 13

apply 1-2 times a day if using the liquid/gel
apply every 48 hours if using the pad/plaster

Question 14

Can you combine salicylic acid with any other treatment options

Answer 14

yes, can combine with cryotherapy and duct tape

Question 15

What is the MOA of cryotherapy

Answer 15

destroys warts by freezing them off with nitrous oxide or a mix of dimethyl ether and propane

Question 16

What is the dosing and usage guideline for cryotherapy

Answer 16

wash hands before and after use
before treatment, soak affected area in warm water for 5 minutes
wash and dry area thoroughly
Prepare and activate device according to the device instructions
apply to wart until a halo appears around the wart
*approx 20 secs for common wart and 40 secs for plantar wart
repeat after 2 weeks if needed
*max of 3 treatments or for up to 12 weeks

Question 17

What are some cautions with cryotherapy

Answer 17

treat only one side of finger/toe at a time
treat ONE wart at a time
apply directly to wart ONLY
protect eyes during use
do not ingect or inhale chemicals
keep away from children
avoid areas with thin skin
avoid irritated or infected skin
do NOT use for moles of birthmarks
AVOID in pregnancy or lactation(unless medically advised)
do NOT use in those under the age of 4

Question 18

What is used for occlusion therapy

Answer 18

silver duct tape

Question 19

What is the process of using duct tape for occlusion therapy

Answer 19

cut duct take to size of lesion or slightly large
apply and leave on wart for 6 days
remove on evening of sixth day
soak in warm water and debride with pumice stone
replace the next morning with a new piece of duct tape
ONLY USE SILVER DUCT TAPE

Question 20

What causes corns and calluses

Answer 20

increase of friction and pressure leads to increased growth of the basal cell skin layer

Question 21

What is the clinical presentation of corns

Answer 21

small, raised lesion with a central core and defined border appearing on bony joints
hard corns: found on tops of toes near joints
soft corns: found between toes

Question 22

What is the clinical presentation of calluses

Answer 22

thickening of skin with an indefinite border
found at the bottom/sides of the foot
usually somewhat raised and dull yellow in color

Question 23

When should you not self-treat corns and calluses

Answer 23

less than 3 years of age
chronic conditions
history of rheumatoid arthritis with prominent metatarsal bone heads or great toe deviation
fault in body weight distribution
bleeding or oozing purulent material
painful or extensive in nature
self-care ineffective

Question 24

What are some complementary and non-pharmacologic options for corns and calluses

Answer 24

soak affected area in warm water for at least 5 minutes daily and then remove dead tissue with a callus file of pumice stone
use circular foam cushioning pads or polymer gel pad to protect and relieve pressure
wear appropriately fitted shoes
wear arch supports
avoid trimming tissue
*surgical correction may be needed if severe

Question 25

What is the pharmacological treat for corns

Answer 25

Soft corns: salicylic acid in collodion vehicle 1-2 times a day for 3-6 days

Hard corns/calluses: salicylic acid 1-2 times a day OR plaster pad every 48 hours for 14 days