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Community Pharmacy > Warts n Corns > Flashcards

Warts n Corns Flashcards

1
Q

prevalence of warts

A

population: 7-10%
school children: 20%

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2
Q

peak incidence of warts

A

12-16yo
clears spontaneously in majority 5 years (6mth-2yr)

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3
Q

associated factor of warts

A
  1. Swimming (warm water > pH5 facilitates entry of virus int skin, abrasive surface contribute to tissue debridement)
  2. use of public shower
  3. immunocompromised indivuduals
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4
Q

criteria for warts infection

A

infection by human papilloma virus (HPV) infection
- presence of virus
- entry into skin
- susceptibility of immune system

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5
Q

spread of warts

A
  1. direct person to person contact
  2. indirect exposure to fomites
  3. autoinoculation
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6
Q

noteincubation period of warts

A

1-24mth

ave 3-4mths

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7
Q

common location and appearance of common warts (verruca vulgaris)

A

hands, fingers, face
- papules/ nodules
- single or grouped
- rough, cauliflower-like appearance
- slightly scaly

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8
Q

common location and appearance of plantar warts (verruca vulgaris)

A

sole of the feet

At weight-bearing areas:
- roughly circular diameter 0.5-3cm
- not raised
- greyish friable surface and thickened surrounding skin

At non-weight-bearing area: looks like normal warts

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9
Q

signs and symptoms of warts

A
  1. tender with pressure
  2. interrupts footprint patterns
  3. has black dots or seeds under karatinous surface (thromboses capillaries)
  4. repeated irritation causes the lesion to continue enlarging
  5. hyperkeratotic lesions associated with pressure (plantar)
  6. may cause severe discomfort and limitation of function if large or occurs at weight-bearing areas
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10
Q

when to refer for warts

A
  1. involvement of face, nails, anogenital areas
  2. extensive warts at one body site
  3. painful plantar warts
  4. presence of chronic, delimitating diseases that contradicts use of treatment products (DM, peripheral vascular disease, immunosuppression)
  5. physical/ mental impairments that make following product direction difficult
  6. no improvement after proper use of appropriate products for self treatment
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11
Q

decision and urgency of treating warts

A
  • desire for tx
  • impact of lesion
  • site and no. of warts in an area
  • potential for spread
  • potential for development of squaremous cell carcinoma
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12
Q

treatment goal for warts

A
  1. remove warts with no recurrence
  2. leave no scars
  3. prevent auto inoculation or transmission to others
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13
Q

pharmaco treatment for warts

A
  1. salicylic acid
  2. cryotherapy with DMEP
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14
Q

how does salicylic acid work (MOA)

A
  • decrease keratinocyte adhesion (keratolytic)
  • increase water binding: hydration of keratin
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15
Q

application frequency of salicylic acid

A

liquid product: 1-2x/d up to 12 weeks
pads/plaster: apply new patch every 48h, up to 12 weeks

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16
Q

note for treating warts

A
  • higher concentration of tx for bigger warts
  • take conservative method, and treat small area as salicylic acid/ DMEP can scar tissues
  • do not irritate skin that are already infected/redden by other causes
17
Q

advantages and disadvantages of using salicyclic collodion vehicle

A

+ flexible, water-repellent film
+ prevents moisture evaporation
+ less likely to run onto surrounding skin

  • extremely volatile and flammable
  • occlusive
  • abuse (solvent sniffing)
18
Q

how to apply salicylic acid solution on warts

A
  1. apply solution with the brush applicator until affected area is covered
  2. if medication touches healthy skin, wash off with soap and water immediately
  3. allow the solution to harden so that it does not run
  4. repeat 1-2x daily PRN
  5. cap container tightly after each use to prevent evaporation
  6. store product away from light
19
Q

how to apply salicylic acid patch on warts

A
  1. plaster: trim the plaster, to follow the contours of the wart
  2. pad: apply the appropriately sized disk directly on the affected area
  3. replace pad/plaster after 48h with a new one, for up to 12w
20
Q

how does diethyl ether and propane DMEP cryotherapy works for warts

A

causes irritation and tissue destruction that causes the host to mount an immune response against the causative virus
- after 10d, frozen skin and wart will fall off to reveal newly formed skin underneath

21
Q

application frequency of DEMP on warts

A

max 3x in the 10d lapse

22
Q

non pharm for warts

A
  • cover up since it is contagious
  • consult dr if it is recurrent
23
Q

prevalence of corns and calluses

A

increases w age

men: 40
women: 50

24
Q

impact of corns and calluses

A
  • decrease mobility
  • may be life threatening to DM, severe arthritis, impaired circulation
25
Q

location of corns

A

over bony prominences of 4th to 5th toe with hard corns occurring on top of toes and soft corns in toe webs

26
Q

location of calluses

A

weight-bearing areas of good
eg. ball, heel, sides

27
Q

appearance of corn

A
  • smooth, raised sharply demarcated
  • hyperkeratolytic lesions with central core
  • hard corns are shiny, soft corns are white
28
Q

appearance of calluses

A
  • smooth, raises, yellowish lesions with irregular margins and diffuse thickening of skin
  • may be broad based or have central core
  • no disruption of normal skin ridges
29
Q

size of corns

A

varies, few mm to 1cm

30
Q

size of calluses

A

few mm to several cm

31
Q

timing of onset for corn and calluses

A

variable, lesions may enlarge progressively

32
Q

causes of corn

A

friction from tight fitting shoes

33
Q

causes of calluses

A
  • friction from tight fitting shoes
  • walking barefoot
  • structural biomechanics problems
  • improper weight distribution
34
Q

modifying factors for corns and calluses

A
  • well-fitting footwear
  • salicylic acid
35
Q

when to refer corns and calluses

A
  1. extensive pain
  2. presence of chronic, delimitating diseases that contradicts use of treatment products (DM, peripheral vascular disease, immunosuppression)
  3. lesions hemorrhagic or oozing purulent materials
  4. anatomic defect or fault in body weight distribution
  5. Hx of RA, complaint of painful metatarsal heads or deviation of great toe
  6. physical/ mental impairments that make following product direction difficult
  7. proper but unsuccessful self care attempts
36
Q

treatment goals for corns and calluses

A
  1. provide symptomatic relief
  2. remove corns and calluses
  3. prevent recurrence by correcting underlying causes
37
Q

pharmacological treatment for corns and calluses

A
  1. salicyclic acid (in collodion vehicle)
    - hard corn and calluses: apply 1-2x/d; up to 14d
    - soft corns: apply 1-2x/d; up to 3-6d
  2. salicylic acids (in pads/plaster)
    - reapply every 48h as needed to 14d
38
Q

non pharm treatment for corns and calluses

A
  • daily soaking of affected areas
  • avoid using razors or sharp knife to remove
  • use cushion pads to relieve painful pressure
  • eliminate underlying predisposing factors
39
Q

how to select footwear

A
  1. proper length (go to podiatrist for help)
    - shoe should snug at the heel
    - toes should not bump into the front of the shoe
  2. proper width: should not feel cramped
  3. proper shape: match foot shape
  4. proper height: heels <1 inch, adequate arch support and depth of toe box
  5. try both shoes at the time of purchase, at the end of the day

Community Pharmacy (12 decks)

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