Warts EXAM III

Question 1

Which type of warts are NOT appropriate to treat with OTC products?
REFER

Answer 1

-Genital warts (infectious)
-Butcher’s warts? exposure to raw meat (HPV #7)

Question 2

Which patient population is susceptible to warts?

Answer 2

-immunocompromised people (HIV, Lymphoma, CLL, Hodgkinʼs)

Question 3

Prevalence in the population

Answer 3

7-10% in children
16% in the general population

Question 4

Epidemiology

Answer 4

-Age: Peak incidence at 12-16 yoa
-Genital warts most common 18-28 yoa
-Females more frequent, earlier age

-once infected and removed -> more likely to have another episode of warts

Question 5

Which pathogen is responsible for warts?

Answer 5

Human Papilloma Virus

-often warts are due to exposure to someone who is infected
-All human warts caused by the Papillomaviridae family
-frogs and toads do NOT carry HPVs

Question 6

How are warts transmitted?

Answer 6

Skin to skin -> breaks through the epidermis
-shed skin can carry the virus
-Heat-stable protein coating allows survival
-Fomites (carrier) include towels, clothing, bath water
-1-8 months incubation time (hard to tell when and where they were exposed)
-Auto-inoculation: can be shared with someone self to different parts of the body

Question 7

What is the Koebner phenomenon?

Answer 7

Transmission of the pathogen (causing warts) through broken skin (broken due to injury, burn, etc)

Question 8

How to prevent transmission?

Answer 8

-Avoid skin-to-skin contact
-Be aware of surfaces where viruses may linger
-Bare feet in public, sharing towels, razors, nail clippers, socks, shoes,

-Prevent autoinoculation: no biting, no scratching, no picking, no cutting

Question 9

Common warts

Answer 9

-70%
-Skin-colored or brown, dome-shaped, hyperkeratotic papules with a rough surface
- Black dots (“seed warts”)

-HPV Subtypes 1,2,4,26-29

Nails, fingers, and knees
-Periungual (around nails) or subungual warts (uplift the nail plate)

Question 10

Plantar warts

Answer 10

-24% of warts
-Skin-colored, flat, callous-like papules on the feet
-may grow together into a mosaic wart
-typical endophytic (grows inwards)

-HPV Subtypes 1, 2, 4, 57 and 60

Question 11

Which type of warts are appropriate to treat with OTC products?

Answer 11

Common and Plantar warts

Question 12

Which OTC products are used for warts?

Answer 12

-salicylic acid products and cryotherapy products
-If salicylic acid is used for > 12 weeks –> an MD appointment is necessary

Question 13

MOA of Salicylic Acid

Answer 13

Keratolytic agent

Question 14

Available formulation of Salicylic Acid

Answer 14

-Plaster vehicle 12-40%

-Collodion vehicle 17% (breaks down the top layer of the skin -> more moisture to the skin -> wart peels off)
-Karaya Gum Glycol plaster vehicle 15%

Question 15

Which concentrations are used for Common vs. plantar warts?

Answer 15

-17% for common warts
-40% for plantar warts
-Duration: might take several to peel off the warts bc the wart might be dense and deep!!

Question 16

ADE of salicylic acid plaster vehicles

Answer 16

-ADE: Skin irritation, systemic effects potential

Question 17

Patient population to avoid salicylic acid plasters?

Answer 17

Patients with advanced or uncontrolled diabetes
-thin skin -> lack of awareness (less sensitive?)
-lower ability to heal

Question 18

Cryotherapy

Answer 18

Temperatures -70 Celsius
-Applied directly to the wart for up to 90 days
-Blister forms –> the layer will pill off, 10 day cycle
-Re-administer every 2-3 weeks (max 4x)

Question 19

ADE for Cryotherapy

Answer 19

Pain, blistering, scarring, pigmentation changes, tendon damage