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Pharmacy Practice IV

Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.


Warts // Page 1 of 4
Warts (Verruca)

1. Local growth. Entirely on the surface of the skin, no deep roots that penetrate deeper
2. On all parts of body especially warm, moist places, small cuts or scratches on the
fingers, hands, and feet
3. Small, skin-coloured, rough tumour, resemble a cauliflower or a solid blister. May see
tiny black dots in the wart - blood capillaries
4. Caused by human papillomavirus (HPV) infection.
There are more than 100 types of HPV viruses
5. More common in kids than in adults especially who
bite their fingernails expose less-protected skin
and create open areas for a virus to enter and cause
the wart. In men, they are usually in the beard area
6. Harmless. Only matter appearance some children
seem quite pleased with their warts
7. Usually painless unless on the soles of the feet
(plantar warts) or another part of the body that gets
bumped or touched all the time
8. Some people naturally resistant to the HPV viruses and don't get warts as easily as other
people
9. Disappear after a few months but can last for years and can reoccur. Viral infection
naturally, the body build up resistance over a period of time. If they are allowed to
disappear in this way it is less likely that a person will get any further ones as one will
then be immune to that virus

Transmission

1. Contagious by contact. A tiny cut or scratch can make any area of skin more vulnerable
to warts
2. Picking at a wart can spread warts to other parts of the body
3. Viruses passed by close physical contact or from a surface that a person with a wart
touches, like a bathmat or a shower floor. Incidence higher in people who share common
bathing areas (e.g., dormitory students, gym members esp. plantar warts)
4. Genitals warts very contagious and can be passed to another person during oral, vaginal
or anal sex
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Warts // Page 2 of 4
Types

1. Common warts (Verruca vulgaris). Usually found on fingers, hands, knees, and elbows, a
common wart is a small, hard bump that's dome-shaped and usually grayish-brown. It
has a rough surface that may look like the head of a cauliflower, with black dots inside
2. Flat warts (Verruca plana). These are about the size of a pinhead, are smoother than
other kinds of warts, and have flat tops. Flat warts may be pink, light brown, or yellow.
Most kids who get flat warts have them on their faces, but they can also grow on arms,
knees, or hands and can appear in clusters
3. Plantar warts (Verruca pedis). Found on the bottom of the foot, plantar warts can be
very uncomfortable. Usually only found on pressure points on the soles of the feet.
Mosaic warts: plantar warts spread into cluster
4. Filiform or digitate warts. These have a finger-like shape, are usually flesh-colored, and
often grow on or around the mouth, eyes, or nose
5. Genital wart (Venereal wart, Condyloma acuminatum, Verruca acuminata)

Prevention

1. Although there's no way to prevent warts, always a good idea to encourage kids to wash
their hands and skin regularly and well
2. If your child has a cut or scratch, use soap and water to clean the area because open
wounds are more susceptible to warts and other infections
3. Do not ignore growths on, or changes in, your skin
4. Avoid direct contact with warts on other persons or on other parts of the body
5. Preventing plantar warts:
a. Have kids wear waterproof sandals or flip-flops in public showers, locker rooms, and around public
pools (this can help protect against plantar warts and other infections, like athlete's foot)
b. Avoid walking barefoot whenever possible
c. Change shoes and socks daily
d. Keep feet clean and dry
e. Check children's feet periodically
f. Visit a podiatrist as part of your annual health checkup

Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Warts // Page 3 of 4
Treatment

1. Do nothing (without any treatment):
a. Go away themselves
b. 50% disappear within a month or
c. 75% gone within 2 years
2. Keratolytic (dissolves the protein keratin) like salicylic acid, dichloroacetic acid
a. 75% cure
b. Unpredictable must apply the acid every day for many weeks (up to 12 weeks)
c. Does not attack the virus, simply removes some of the warty tissue
d. Soak in warm water for 10 or 15 minutes - acid sinks in deeper and works better when it is applied to
damp skin
e. Rub away at the white, dead warty skin with the pumice stone to file away the dead surface of the
warts. Do not overdo it if you rub too hard, you may encourage spread of the virus onto nearby skin
f. Apply the wart medication to the warts, getting as little as possible onto the surrounding skin and let
dry. Protect the normal skin with Vaseline
g. If cause burning or redness, stop using it on irritated areas, and the skin returns to normal. Stop the
treatment for a few days until the skin recovers
h. Do not use salicylic acid on sensitive areas like the face or groin, where it's likely to make nearby skin
raw and uncomfortable
i. Salicylic acid not be used in diabetics or when there is poor circulation (because of concern about how
normally the skin can heal)
3. Duct tape treatment. The tape needs to be 'occlusive'; it cannot be tape that 'breathes'
like in cloth
a. One study (Archives of Pediatric and Adolescent Medicine 2002;156:9714), duct tape is as effective
as other treatments, such as freezing. 85% of the warts disappeared with this treatment and most did
so within 4 weeks
b. Irritates the wart and the skin around it, causing the body to attack it. Warts are viruses, and thus
susceptible to changes in temperature and decreased oxygen locally. The occlusive tape probably
locally increases temperature
c. Cut a piece of tape the same size as the wart and stick it on. Leave it for 6 days then remove it in the
evening. After removing the tape, soak your hand in warm
water and then gently rub the wart with an emery board.
Leave the tape off overnight and then apply a new piece for
another 6 days. If the skin under the tape becomes red and
soggy, stop using the tape for a few days. Continue this
routine for 2 months
4. Imiquimod cream (Aldara). Imiquimod, a topical cream
that helps the body's immune system fight the wart
virus by encouraging interferon production
5. Fluorouracil (Verrumal). Prescription medicine
6. Cantharidin. Chemical found naturally in many
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Warts // Page 4 of 4
members of the blister beetle family, podophyllin, podofilox, silver nitrate (caustic)
pencil, freezing aerosol, OTC cryosurgery kits

When to refer

1. Wart or surrounding skin is painful, red, bleeding, swollen and oozing pus
2. Something that looks like a wart, but which grows rapidly or does not go away with
regular treatment could be skin cancer, such as a melanoma
3. Genital warts or around anus, especially recurrent. Genital warts are more likely to come
back because there's no cure for the virus that causes them and because warts are more
difficult to control in a moist environment
4. Patient want to try other treatment types:
a. Liquid nitrogen cryotherapy. Can cause pain, soreness and blistering and usually cures 50% of warts
after one treatment. Frequent applications to cure more stubborn warts. Research says freezing is no
more effective than wart paints
b. CO2 laser. Large warts in the genital area, laser surgery may be needed for complete removal. Laser
treatment with a pulsed dye laser burns the tiny blood vessels within the wart. The wart dies and
eventually falls off. Scientific studies have given contradictory results. The main side effect is loss of
skin colour (loss of pigment) and scar
c. Loop electrosurgical excision procedure (LEEP). Cutting the wart using a sharp instrument shaped like
a loop underneath the wart
d. Interferon injections Interferon helps our immune system fight infection. May help your body's
immune system fight the virus that is causing the wart.
e. Other treatments, such as injecting the drug bleomycin or injecting candida into the wart, are
sometimes used in hospital clinics. This stimulates the body's immune system












This article is for educational purpose only. The writer welcomes any feedback, which may be sent to
ibrahim.lecturer@gmail.com