Podiatry - Warts
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Warts from NZ DermNet - New Zealand Dermatological Society
- Warts are benign tumors
of the skin and other epithelial tissues.
- They appear as discrete
keratotic papules or plaques and can be classified by their location
(plantar, genital, periungual, etc.).
- They are most common in
children and young adults.
- The etiologic agents for
these infections are a class of double-stranded DNA viruses called
Initial Diagnosis and Management
- The initial diagnosis is
generally clinical based on physical exam. Location, duration and extent
should be noted. If there are lesions near a mucous membrane, these should
be examined as well. If the diagnosis is not obvious a biopsy may be
- Treatment options
- Acids - Salicylic acid
preparations on formulary are Occlusal (17%) and Mediplast (40%); with
some instructional assistance, patients can use these at home. Similar
Over-The-Counter (OTC) preparations are readily available.
- Cryotherapy - Liquid
Nitrogen applied as spray or cotton applicator, with frost lasting for
20-30 seconds. Goal is to treat visible wart plus a millimeter "halo".
After thawing, a second treatment may be applied.
- Caustics (Podophyllin) -
For genital warts (condyloma acuminata), in-office podophyllin may be
used, with or without light cryotherapy. Avoid use in occlusive (under
foreskin, ventral penis, etc.) environment. Condylox is on the formulary
and patient applies gel twice a day for 3 consecutive days a week,
repeating up to 4 weeks for external genital warts only.
- Immune modulator (Imiquimod
5% [Aldara] cream) - Is on the formulary and may be selected for patients
who fail cryotherapy and podophyllin therapy options (mention in
"comments" section of CHCS when orderinging). Apply once at bedtime, wash
off after 6-10 hours 3x/week every other day; treat for 16 weeks maximum.
- Duct tape—Shown to
actually work. Apply duct tape cut to the size of the wart and leave in
place for 5 days. Replace it if it comes off. Remove on the 5th day and
let it air out over night. Repeat for another 5 days until the wart
Ongoing Management and Objectives
- Patients may be followed
up at 2-4 week intervals. Again, it should be emphasized that although
they are often refractory to therapy, most warts eventually resolve with
- Self-treatment between
visits is important to increase the rate of success.
Indications for Specialty Care Referral
- Periungal Warts, if large
or refractory to the conservative management noted above.
- Markedly extensive warts
(may indicate underlying immunodeficiency or disease).
- Large or numerous warts
that are resistant to therapy for 6 months.
- All Retiree's, VA and dependants with foot conditions 30, 31, 01, 02,
03, 04 etc.. Respectfully need to be routed to Scholfied Barracks Podiatry or net worked out for
treatment. Tripler Podiatry unfortunately does not provide orthotics or inserts for dependants, VA or
Criteria for Return to Primary Care
Warts have resolved and/or a suitable
treatment plan has been established.