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Warts And Lesions
Warts And Lesions
Warts And Lesions
Warts And Lesions
Warts And Lesions
Warts And Lesions
Warts And Lesions
Warts And Lesions
Warts And Lesions
Warts And Lesions
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Warts And Lesions

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  • 1. Warts and Other Lesions
  • 2. Warts • Benign neoplasms caused by keratinocytes transformed by HPV • HPV type I, II and IV associated with plantar warts – Type I causes verrucae plantaris lesions – Type II causes mosaic warts – Type IV causes seed corn lesions – Type III causes genital warts • Physical factors such as infectious location, weight-bearing pressure and moisture help determine the clinical appearance of the lesion
  • 3. Warts • Due to immune system development, warts Note pinpoint spots representing thrombosed are seen more commonly in children and capillaries less commonly in adults • Can spread through small cuts in skin • May disappear spontaneously, often within 2 years of appearance • Diagnostic signs include pain with lateral more than direct pressure and pinpoint bleeding with sharp dèbridement of the lesion
  • 4. Wart Treatments • Burning: • Tend to have the same things in common: – Chemical: 40% Salicylic acid, mono, bi and tricholoroacetic – Painful acid, cantharidin – Multiple treatments needed – Freezing: liquid nitrogen – High rate of recurrence (40- – Thermal: electrocautery, 60%) pulsed-dye laser
  • 5. Wart Treatments • Immune system modification • Surgical – H2 blocker (Cimetidine) appears – Sharp excholeation with blunt to act by suppressing dissection of lesion histamine. Histamine – Primary resection with sutured suppresses the immune system closure by activating suppressor T-cells. Low circulating levels of IgG – Intentional implantation to and IgM are associated with a other extremity (Panacos graft) higher incidence of verrucae – Bleomycin treatment (45% of immunocompromised kidney recipients develop warts) – Only Tagamet seems to have this effect – 30mg/kg (adult) 20mg/kg (child) TID for 6-8 wks
  • 6. Wart Treatments • Immune system stimulation • Others: – Vitamin A (10K IU vit A) with – Effudex cream (5-flurouracil) 15μg of zinc BID – Retin-A – Bleomycin injection (breaking – Denavir (Pencyclovir) the capsule of the wart, – Aldara cream (Imiquimod) injecting Bleomycin to arrest • Typical use is genital warts the growth of the virus and • Use 3X week with 8-10 hour allowing T cell development) application time without occlusion • Wash off completely • Use for 3 months • Dèbridement of the plantar wart is essential as this has to be absorbed through the epidermis
  • 7. Central core with no overlying bony Other Lesions prominence • Porokeratosis plantaris discretum lesions (Steinberg’s lesion) •Looks like a wart •Is a blocked eccrine sweat gland •Painful with direct pressure
  • 8. Large central core Other Lesions •Intractable plantar keratosis •Caused by pressure at the plantar metatarsal head •Usually seen in conjunction with contracted digits and loss of the plantar fat pad
  • 9. Algorithm Lesion is debrided pinpoint bleeding small central core large core at not necessarily at a weight-bearing area weight bearing area Wart PKP IPK Surgery Burn Other surgical excision elevational osteotomy (Bleomycin) (acid) (Tagamet) with chemical cautery (Panacos) (electrocautery) (Effudex) (resection) (cryotherapy) (Aldara)
  • 10. What if it returns? • Current success rate with the Bleomycin treatment is 95+% • Those who fail the Bleomycin treatment are placed upon Aldara cream with 1 failure so far in 12 cases • The person who failed on the Aldara cream had primary surgical excision with no return of lesion • 16 current cases of the Panacos graft for mosaic warts with 2 failures, who then responded to the Bleomycin treatment

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