0521779407-23 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:24
1550 WartsSigns & Symptoms
■Firm rough papules with tiny surface papillations, 1 mm to >1 cm
on any mucocutaneous surface
■Paring of the thick surface may show pinpoint bleeding (“seeds,”
thrombosed capillaries)
tests
■Skin biopsy: Rarely needed
■Research tools: PCR to determine HPV type
differential diagnosis
■Common warts: squamous cell carcinoma, molluscum contagio-
sum, deep fungal infection (blastomycosis), epidermal nevi, seb-
orrheic keratoses, fibroepithelial polyps
■Flat warts: acne comedones
■Plantar warts: callus, clavus/corn
■Genital warts: condyloma lata (secondary syphilis), squamous
cell carcinoma including giant condyloma of Buschke-Lowenstein,
bowenoid papulosis
management
■Avoid potentially scarring therapies when possible.
■Virtually all warts should be treated considering inhibition of func-
tion, cosmetic factors, potential for decreasing spread, and the fact
that small warts are more easily cleared.
■The natural history of warts is not favorable (only 40% of patients are
free of wart in 2 years without treatment).
specific therapy
■First-line therapies:
■Over the counters: 17% salicylic acid qd to moist skin; file with emery
board or pumice stone prior to application
■Cryotherapy: liquid nitrogen applied to wart for 2 freeze/thaw cycles
each about 15–30 seconds with a thaw time of 20–30 seconds. Repeat
every 2–3 weeks.
■Cantharidin: apply to warts, cover with occlusive tape for 24 hours,
then wash with soap and water. Repeat every 2–3 weeks.
■Cantharidin plus salicylic acid plus podophylin: Apply to warts, cover
with occlusive tape×2 hours, then wash off with soap and water.
■Imiqimod (Aldara): applied three times a week to genital warts, left
on overnight and washed off in the morning (inducer of interferon
alpha).
■Contact sensitizers: squaric acid, diphecypropenone (DCP). For
DCP: Apply test patch of 0.1% solution to flexor arm and cover for 24