Internal Medicine

0521779407-23 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:24

Warts 1551

hours to sensitize. One week later, apply 0.1% to warts and cover for

6 hours.

■Podophyllin: 25–50% applied weekly to warts by physician, washed

after 6 hours. Repeat every 1–2 weeks.

■Podophyllotoxin (Condylox) can be applied at home twice daily for

3 days, then not treated for 4 days, then repeated each week until

clear. Avoid in pregnant women.

■Vascular Lesion Laser (585 nm) - 20 W, two or three pulses to each

wart. Repeat every 2–3 weeks until clear.

■Tretinoin: may be applied once a day to flat warts

■For recalcitrant warts:

■Intralesional alpha interferon: reserve for recalcitrant warts, inject

each wart 2x/week for up to 8 weeks or until clear

■Surgical excision: reserve for large warts to remove tumor burden.

HPV in clinically normal skin results in frequent recurrence.

■CO2 laser ablation: Scarring possible; recurrences likely

■Electrosurgery: best for small warts, use a smoke evacuator to avoid

inhalation of aerosolized viral particles

■Bleomycin: injected intralesionally or applied topically and instilled

with an allergy needle excoriating surface. Avoid injecting the distal

digits because of a risk of necrosis.

➣Candida antigen: into warts: Inject 0.3 ml into one of the larger

warts every 2–4 weeks until wart resolves. Discontinue if no

response after 5 treatments. Warts distant to the treatment site

often resolve as the target lesion disappears.

follow-up

■Self-exam weekly after clearing; follow up with physician with any

sign of recurrence for physician-applied therapies

■Periodically every 2 weeks to 2 months for patient-applied therapies

complications and prognosis

■“Doughnut wart”: treated wart clears but a new wart may occur encir-

cling the prior wart as viral particles within blister fluid infect the skin

at the periphery of the blister initiated by previous treatment

■Scarring: occurs more commonly with destructive therapies: elec-

trosurgery, CO2 laser, cold-steel surgery

■Side effects of treatment may include pruritus, local skin necrosis

■Prognosis is excellent when treatment is tailored to each patient and

adjusted according to response. Immune surveillance will clear warts

in some cases even without treatment.