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Warts And Lesions

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Warts And Lesions

  1. 1. Warts and Other Lesions
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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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  • shahidakhan1

    Mar. 14, 2017
  • KoshuSwami

    Feb. 25, 2020


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