warts

Etiology

• HPV virus
• can be transferred to any part of the body including mucous membranes
• genital warts, flat warts, and palmoplantar warts.
• easily transmitted by direct or indirect contact
• especially if there is the disruption of the normal epithelial barrier. B
• usually only infects the epithelial layers of skin but can be found in the basal layer
• systemic dissemination is very rare.
• Common warts are associated with HPV types 2, 4 (most common)

Epidemiology

• 10% of the population
•  school-aged children, the prevalence is as high as 10% to 20%
• more common among immunosuppressed patients and meat handlers. 
•  can occur at any age – peaks at 12 to 16 years.
• Warts are twice as common in Whites as in Blacks or Asians. 

Prognosis

• 2/3 of warts resolve spontaneously within 24 months
• do not cause residual scarring when they disappear on their own. 
• topical treatments available has the potential to cause moderate to severe scarring. 
• treatment failures are common leading to pain and severe deficits in cosmesis. 
• Malignant change is rare with common warts but rarely transform to verrucous carcinoma, which is most common on the plantar surface

Treatment / Management

• Observation
  • There is a small risk that the wart can enlarge and may even spread to other areas
• Salicylic acid
  • has cure rates of 50% to 70%
• Cryotherapy
• topical 5-fluorouracil
• Systemic treatments that have been tried include cidofovir, cimetidine, and retinoids
• Surgical treatments include
  • Cryotherapy
  • Laser
  • Electrodesiccation
  • excision.