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Human Papiloma Virus and Warts

Warts result from skin infection with human papilomavirus (HPV). Warts can be cosmetically bothersome and occasionally a source of pain.  HPV is a DNA virus, with more than 60 types identified. It is epitheliotropic and causes tumors of the epidermis. At least five types are potentially oncogenic, with two implicated in cervical carcinoma and three in squamous cell carcinoma. Warts can be transmitted by direct contact or by autoinoculation. Young people have a high frequency of warts. Healing can occur spontaneously, presumably

Clinical presentations vary according to site and viral strain involved. The common wart (verruca vulgaris) is associated with HPV-2 and HPV-4 infection and appears flesh-colored or grayish white with a papillated hyperkeratotic surface. It may be punctuated with black dots due to thrombosis of superficial capillaries, which are present in large numbers.

The plantar wart (verruca plantaris) results from HPV-1 or HPV-4 infection of the plantar surface of the foot and appears as a small skin nodule that produces grayish or yellow interruptions in the skin lines of the foot. It is

Anogenital warts (condylomata acuminata) and genital warts result from sexual transmission of HPV-6 and HPV-16 and grow

Most warts are asymptomatic; however, plantar warts may be the source of considerable foot pain, acting as a foreign body during weight bearing. Anogenital warts may become friable, bleed, and cause discomfort. Periungual lesions may become...

DIFFERENTIAL DIAGNOSIS

Verrucae vulgaris should be differentiated from squamous cell carcinoma and also from a cutaneous horn arising from an actinic keratosis. Multiple verrucae planae on the face should be differentiated from...

WORKUP

Appearance is usually sufficient for diagnosis, but early genital warts can be difficult to identify. Typically, a patient comes for evaluation because warts have been found in a sexual partner. In the male, the penis and...

PRINCIPLES OF MANAGEMENT

Warts are benign tumors that often regress spontaneously. Treatment should not be so aggressive as to produce permanent scarring. Simple and safe treatments should be employed. Location, discomfort, cosmetic effect, and therapies available influence the decision to treat. Larger warts of long duration and those involving the plantar,...

A host of measures are available; choice is based on efficacy, patient acceptability, and scarring potential of the

Common Warts.

Freezing the lesion with cotton-swab application of liquid nitrogen is convenient, well tolerated, often effective, and associated with a low risk of serious scarring. Solid freezing of the lesion is usually achieved by 5 to 10 minutes of repeated application of the liquid nitrogen from a cotton swab dipped into a Styrofoam cup containing

Plantar Warts.

Nonsurgical methods are preferred to surgical removal because scarring in this location can cause permanent discomfort. The lesion should be pared and then treated with application of 40% salicylic acid plasters , taped

Flat Warts.

Topical 5-fluorouracil cream or solution and retinoic acid cream or gel are used effectively for flat warts, especially those on the face. With both of these topical agents, patients will probably experience irritation...

Genital Warts.

A preparation of 20% to 40% podophyllin in compound tincture of benzoin is used to treat macerated genital warts . It must be applied sparingly, only to the wart, and allowed to dry thoroughly before the patient dresses... .

Refractory Warts.

Sublesional bleomycin , diluted to 10 U/mL, has a distinct role in the treatment of refractory warts, both those..

Interferon-alpha (both type 2a and type 2b) has been approved for treatment of refractory genital warts..

Immunostimulation is sometimes tried. Dinitrochlorobenzene (DNCB) sensitization followed by repeated applications of diluted DNCB has been used to treat resistant warts. This form of immunotherapy is sometimes... Autogenous wart vaccines appear...

The carbon dioxide laser has become an increasingly popular method for treating warts, although in many..

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