Simple Wart note

definition...
warts are acommon benign proliferation of skin and mucosa due to viral infection.
Causative organisms...
human papilloma virus[ there are more than 150 types of HPV], children and young adults are most commnly affected.

Types of warts....
1-common wart:found mainly in the hand[palm or around the nails ] , treated mainly with salicylic acid [but liquid nitrogen is contraindicated for a fear of defomity]
2-plane wart:found manily in the back of the hands ,face and limbs, treated mainly with liquid nitrogen or retonic acid .
3-plantar wart:found in pressure exposed areas of foot more common in females , treated mainly by electro cautry- salicylic acid-liquid nitrogen-podphylin.
4-ano genital wart=inversus wart=condyloma accuminata:
treated mainly with podophylin or cryotherapy.
Other types[filiform wart-epidermodysplasia]


Clinical description to the common lesions:
1)common wart:disecrte fleshy coloured papule multiple or single.
2)plane wart:well defined flat topped surface papules.
3)plantar wart:disecete red or black raised papules.


Diffrential diagnosis of wart:
1- malignant melanoma[sharp scalpel to remove the tumor which will reveal vascular tissue in melanoma but, in wart it's thickned epidermis underlying.
2-condyloma latum( serological test for confirmation).


General treatment:
a-topical agents
1]salicylic acid: is a1st line treatment,acting by removing surface keratin[keratolytic agents]...(a combination of salicylic acid 16.7%+ actic acid 16.7%=salactol).
2]trichloroactic acid is a caustic compound that causes immediate superficial tissue necrosis, it may require weekly applications.
3]Podophylin is a plant that contains cytotoxic compounds it has a powerful irritant effect,contraindicated in a pregnant women.
b-systemic agents( 2 agents are used)
1]cimitidine 2]retinoids
c-surgical care
1]cryosurgery:liquid nitrogen is contraindicated in case of
common wart because its very painful & also can cause
deformity to the nail. otherwise it can be used in any type.
2]laser:carbon dioxide lasers have successfully treated
resistant warts.
3]electrodesiccation and curettage
4]surgical excision:avoid using surgical excision in most circumstances because of the risks of scarring and recurrence .