Wart Treatment by Type of Drug and Procedure

The new advance in treatment of genital warts has been imiquimod (Aldara). This encourages the patient’s autoimmune system to attack the wart. This is particularly helpful in the moist areas of the skin or mucosal surfaces.

Salicylic acid
Salicylic acid can be applied either in the form of plasters or as liquid on to the warts. This will break down the thickened skin on the surface. It is more effective if the area is covered. These are useful for warts on the hands, knees and feet. They do turn the skin white. They can be used in combination with paring of the warts. Treatment with these at nighttime and covering with duct tape can be effective although slow.

Podophyllin

Podophyllin has a long history of use. It is useful mostly in genital warts. It should be applied very carefully on the warts, trying to prevent spread on to normal skin. It should be washed off after a few hours. There is irritation usually for a few days. Repeat treatments are usually required. A more purified form of podophyllin called podophyllotoxin is available for patient use. It can be used once or twice daily for a few days in succession. This produces some irritation. It has the advantage of not being as irritating as podophyllin and can be applied by the patients themselves.

Vitamin Acid

Vitamin acid (Tretinoin) is a vitamin A preparation. It is used in the treatment of acne and photo damage. Vitamin A products tend to regulate the surface of the skin, generally trying to keep the epidermis behaving normally. It may also cause some inflammation. In some individuals it can help reduce or even eliminate warts.

Cantharone

Cantharone (cantharidin) is derived from an insect. It can be very helpful in children but the application is painful. Inflammation and
blistering usually occurs later in the day, after application. Multiple treatments may be required. There are two concentrations. The
stronger version combines Cantharone with podophyllin and salicylic acid. Very occasionally the blistering reaction can be quite severe
and associated with swelling and pain. It is often very effective even in resistant warts.

Cryotherapy

Cryotherapy is the use of liquid nitrogen. This can be applied either with a Q-Tip or it can be sprayed on to the skin. It causes destruction by freezing water inside the cells. This damages the cell causing death. It is painful to apply and there is blistering associated with this. Multiple treatments may be required. Thawing and freezing again makes this therapy more effective. It can be a problem in dark skin in that it can either increase or decrease pigmentation, which can be permanent. This treatment can be used in combination with other therapies.

Electrodesiccation

Electrodesiccation is the use of an electric needle to burn warts. It usually requires a local anesthetic. It does have a potential risk of scarring. Very large warts can sometimes be scraped off before they are cauterized.

CO2 Laser

The CO2 laser has been used for many years. It essentially vaporizes water in the skin and causes destruction. It leaves a hole in the skin which will heal. There is often scarring with this technique. Other lasers such as the pulse dye laser are easier to use. The yellow light is absorbed by blood in the vessels that feed the warts. This is a similar laser used in the treatment of red birthmarks. The pulse dye laser at a high power setting can be effective particularly if multiple pulses are used in succession.

Aldara

Aldara is an immune response modulator. It boosts the patient’s immune response to viruses. It can also encourage the production of a
lasting immune memory. It has been available in Canada since 1999. It works best in the genital area as penetration into the skin is easier. When it is used elsewhere it often has to be covered to help with penetration into the skin. It has been shown to work well particularly in women. It is applied three times weekly. There will be some inflammation associated with this. The results may be enhanced by combining this with liquid nitrogen. This drug has added a very significant tool in treating genital warts.

Wart Treatment by Type of Wart

Treatment will depend in part on the location, the age of the patient, as well as the size and immune status of the individual. The treatment choice will depend in part on previous experience of the patient and the patient’s preference. Many of the treatments can be uncomfortable and therefore difficult to use in children.

Treatments can be either destructive as in the use of liquid nitrogen or most recently there is an immunological approach to boost the patient’s own immune system.

Common Warts

Liquid nitrogen cryotherapy is most commonly used in those who can tolerate the pain. Repeat treatments are frequently required. Excising or scraping off these warts is less desirable as it will scar. The use of pulse dye laser or very occasionally the Co2 laser can be used in resistant lesions. Cantharone can be used particularly in children as it is more easily tolerated. Other treatments involve the use of immune therapy. Substances such as DNCB involve painting the substance on the warts in order to develop an allergic reaction. This immune allergic reaction will be useful for destroying the wart.

Flat Warts

Flat warts frequently occur on the face and on the legs. Care needs to be taken not to use a treatment that will have a high risk of scarring. Very light liquid nitrogen cryotherapy can be used.

It is important that shaving is done very carefully or is stopped for a while as this is known to spread these warts. Treatments such as Aldara have been used. Topical treatments such as vitamin A acids (Tretinoin) can sometimes be of benefit. Efudex cream has also been used.

Plantar Warts

Plantar warts can be stubborn. Because of their location aggressive use of liquid nitrogen cryotherapy is difficult in that it can not only be painful but swelling and soreness can prevent walking for a number of days. Often paring the warts by thinning them down can be helpful. The use of salicylic acid preparations that are applied daily and cover the affected area will eat away at the surface of the wart allowing it to be pared down. This may make it more responsive to liquid nitrogen. The use of duct tape to soften the lesions in some individuals can be in itself curative. It appears that changing the water content and making the skin mushy enhances the patient’s ability to eradicate these warts. Treatments such as surgery and scraping of these warts is discouraged as scars can sometimes be painful on the weight-bearing parts of the foot. The pulse dye laser can be used once the wart has been thinned as it does not produce scarring. Occlusion combining these therapies with Aldara cream in some individuals is helpful.

Genital Warts

Genital warts are usually sexually transmitted. It is important that woman be checked to rule out any atypical changes on the cervix. Small warts can be treated with liquid nitrogen although this is uncomfortable. Podophyllin or podophyllotoxin can be applied every few days and this can be helpful.

Identifying Skin Lesions - Warts, Moles and SebKs

By Van Le |  While freckles can add to a person’s beauty and uniqueness, other skin lesions such as large moles, skin tags, warts, and seborrheic keratoses can be unsightly and embarrassing. Most lesions are malignant (non-cancerous), however, it is important to be aware of and track any skin abnormalities on your body as a preventative measure.

Freckles

Freckles are irritating for some and embraced by others. They are pigment cells that retain within the skin to form light brown spots, and individuals with lighter complexions are more susceptible to freckles since their skin contains less melanin. Freckles, also known as ephelides, can appear on the face, arms and other sun-exposed areas. Excessive and continued exposure to harmful UV rays can cause more freckles and cause them to appear darker. While they are harmless, it is important to distinguish between freckles and symptoms of melanoma, a type of skin cancer that can grow from an existing freckle. Consult your doctor if you notice any change in freckle size, shape and color.

Skin tags

Skin tags are pieces of skin that hang from the surface of a surrounding area. Like freckles, they are benign, but can cause irritation if located on an area that is exposed to constant contact, such as the eyelids or areas where they can be snagged by jewelry or clothing. Skin tags can vary from a small pin-point size to a large grape size. While some can fall off on their own, there are several ways to medically remove skin tags, including freezing and burning. There are home remedies as well as creams available on the market to remove unwanted and embarrassing skin tags.

Seborrheic keratoses

Seborrheic keratoses, another benign skin lesion, can form anywhere on the body, but is commonly found on the chest and back. They can be distinguished from other types of lesions due to their waxy, stuck-on-the-skin appearance and often described as brown candle wax stuck on the skin. While the cause is still unknown, scientists have found that they can be hereditary and not affected by sun exposure.

Warts

Most warts are skin infections caused by viruses of the human papillomavirus (HPV) family. Basically, warts are benign tumors of the epidermis (outer layer of skin), and can occur in people of all ages, but are most commonly found on children and teenagers. There are different types, including flat and plantar warts. Flat warts are small in size but can be high in quantity, can spread to other areas of the body by shaving or scratching, and can be transferred person-to-person by physical contact. Plantar warts grow on the heel, ball or sole of the foot, and pressure from standing or walking pushes them into the deeper layers of skin.

Skin lesions like warts, seborrheic keratoses and skin tags are often harmless, but they can be embarrassing. While they can be surgically removed, there are creams and ointments available on the market to remove and reduce their appearance. If you have further questions about a particular skin lesion, consult your doctor or pharmacist for proper diagnosis and treatment.

Van Le is a staff writer for the CSU Daily Titan and writing intern for Vivoderm Laboratories in Los Angeles, California. She is currently pursuing a Journalism degree at California State University, Fullerton.

For the latest findings on skin lesions and treatments, you can also link to http://www.dermatosispapulosanigra.net

Treating Warts on Children

Many of us have had a wart somewhere on our bodies at some time. Other than being a nuisance, most warts are harmless and go away on their own.  More common in kids than in adults, warts are skin infections caused by viruses of the human papillomavirus (HPV) family. They can affect any area of the body, but tend to invade warm, moist places, like small cuts or scratches on the fingers, hands, and feet. Warts are usually painless unless they’re on the soles of the feet or another part of the body that gets bumped or touched all the time.

Kids can pick up HPV — and get warts — from touching anything someone with a wart has used, like towels and surfaces. Kids who bite their fingernails or pick at hangnails tend to get warts more often than kids who don’t because they can expose less-protected skin and create open areas for a virus to enter and cause the wart.

Types of warts include:

* common warts. 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.
* flat warts. 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.
* plantar warts. Found on the bottom of the foot, plantar warts can be very uncomfortable — like walking on a small stone.
* filiform warts. These have a finger-like shape, are usually flesh-colored, and often grow on or around the mouth, eyes, or nose.

Sometimes warts are sexually transmitted and appear in the genital area, but most warts appear on the fingers, hands, and feet.

Are Warts Contagious?

Simply touching a wart on someone doesn’t guarantee that you’ll get one, too. But the viruses that cause warts are passed from person to person by close physical contact or from a surface that a person with a wart touches, like a bathmat or a shower floor. (You can’t, however, get a wart from holding a frog or toad, as your child might have wondered!)

A tiny cut or scratch can make any area of skin more vulnerable to warts. Also, picking at a wart can spread warts to other parts of the body.
The length of time between when someone is exposed to the virus that causes warts and when a wart appears varies. Warts can grow very slowly and may take weeks or longer, in some cases, to develop.

Preventing Warts

Although there’s no way to prevent warts, it’s always a good idea to encourage kids to wash their hands and skin regularly and well. 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.

It’s also wise to 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).

Treating Warts

Warts don’t generally cause any problems, so it’s not always necessary to have them removed. Without treatment, it can take anywhere from 6 months to 2 years for a wart to go away. A doctor might decide to remove a wart if it’s painful or interferes with activities because of the discomfort.

Doctors have different ways of removing warts, including:

* using over-the-counter or prescription medications to put on the wart
* burning the wart off using a light electrical current)
* freezing the wart with liquid nitrogen (called cryosurgery)
* using laser treatment (with recalcitrant warts)

Within a few days after the doctor’s treatment, the wart may fall off, but several treatments might be necessary. Doctors don’t usually cut off a wart because it can cause scarring and the wart may return.

If an older child has a simple wart on the finger, ask the doctor about using an over-the-counter wart remedy that can help remove the wart. This treatment can take several weeks or months before you see results, but eventually the wart should crumble away from the healthy skin. Wart medicines contain strong chemicals and should be used with care because they can also damage the areas of healthy skin. Talk with your doctor before using any over-the-counter wart medicine on the face or genitals.

Also make sure that your child:

* soaks the wart in warm water and removes dead skin on the surface of the wart with an emery board (that’s never going to be used for nails) before applying the medicine. Be careful not to file into it.
* keeps the area of the wart covered while the medicine works
* knows not to rub, scratch, or pick at it to avoid spreading the virus to another part of the body or causing the wart to become infected

You might also have heard that you can use duct tape to remove a wart. Talk to your doctor about whether this type of home treatment is OK for your child.

Seborrheic Keratosis or Seborrheic Verrucas

A seborrheic keratosis (also known as “Seborrheic verruca,” “Senile keratosis,” and “Senile wart” [1,2]  is a noncancerous benign skin growth that originates in keratinocytes. Like liver spots, seborrheic keratoses are seen more often as people age.[3] In fact they are sometimes humorously referred to as the “barnacles of old age”. [1]

They appear in various colors, from light tan to black. They are round or oval, feel flat or slightly elevated (like the scab from a healing wound), and range in size from very small to more than 2.5 centimetres (1.0 in) across.[4] They can resemble warts[3], though they have no viral origins. They can also resemble melanoma skin cancer, though they are unrelated to melanoma as well.

Because only the top layers of the epidermis are involved, seborrheic keratoses are often described as having a “pasted on” appearance. Some dermatologists refer to seborrheic keratoses as “seborrheic warts”, however these lesions are usually not associated with HPV, and therefore such nomenclature should be discouraged.

* 1 Classification
* 2 Variances of Seborrheic Keratosis
o 2.1 Dermatosis Papulosis Nigra
o 2.2 Stucco Keratosis
* 3 Diagnosis
* 4 Treatment
* 5 Cause
* 6 Etymology
* 7 References
* 8 External links

Classification

Seborrheic keratoses may be divided into the following types:[1]

* Common seborrheic keratosis (Basal cell papilloma, Solid seborrheic keratosis)
* Reticulated seborrheic keratosis (Adenoid seborrheic keratosis)
* Stucco keratosis (Digitate seborrheic keratosis, Hyperkeratotic seborrheic keratosis, Serrated seborrheic keratosis, Verrucous seborrheic keratosis)
* Clonal seborrheic keratosis
* Irritated seborrheic keratosis (Basosquamous cell acanthoma, Inflamed seborrheic keratosis)
* Seborrheic keratosis with squamous atypia
* Melanoacanthoma (Pigmented seborrheic keratosis)
* Dermatosis papulosa nigra

Also see:

* The sign of Leser-Trélat
Variances of Seborrheic Keratosis or Dermatosis Papulosis Nigra

Often are small papules. Pinpoint to a few millimeters in size. More commonly found in dark-skinned persons.[5]

Stucco Keratosis

Often are light brown to off-white. Pinpoint to a few millimeters in size. Often found on the distal tibia, ankle, and foot.[6]

Diagnosis

Visual diagnosis is made by the “stuck on” appearance, horny pearls or cysts embedded in the structure. Darkly pigmented lesions can be hard to distinguish from nodular melanomas. [7] If in doubt, a skin biopsy should be performed. Thin seborrheic keratoses on facial skin can be very difficult to differentiate from lentigo maligna even with dermatoscopy. Clinically, epidermal nevi are similar to seborrheic keratoses in appearance. Epidermal nevi are usually present at or near birth. Condylomas and warts can clinically resemble seborrheic keratoses, and dermatoscopy can be helpful. On the penis and genital skin, differentiation between condylomas and seborrheic keratoses can be difficult and may require a skin biopsy.

Treatment

When correctly diagnosed, no treatment is necessary[3]. There is a small risk of localized infection caused by picking at the lesion. If a growth becomes excessively itchy or is irritated by clothing or jewelry, it can be removed by cryosurgery.  Small lesions can be treated with light electrocautery. Larger lesions can be treated with electrodessication and curettage, shave excision, or cryotherapy. When correctly performed, removal of seborrheic keratoses will not cause much visible scarring except in darkly colored persons.

Cause

The cause of seborrheic keratosis is unclear[3]. Because they are common on sun-exposed areas such as the back, arms, face, and neck, ultraviolet light may play a role, as may genetics.[8] A mutation of a gene coding for a growth factor receptor, (FGFR3), has been associated with seborrheic keratosis.[9]

Etymology
The term “seborrheic keratosis” combines the adjective form of seborrhea[10], keratinocyte (referring to the part of the epidermis that produces keratin), and the suffix -osis, meaning abnormal.[11]

References

1. ^ a b Freedberg, et. al. (2003). Fitzpatrick’s Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.
2. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews’ Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921

-0.
3. ^ a b c d Moles, Freckles, Skin Tags, Benign Lentigines, and Seborrheic Keratoses from the Cleveland Clinic website
4. ^ Seborrheic keratosis: Symptoms, from the Mayo Clinic website
5. ^ http://www.emedicine.com/derm/topic99.htm
6. ^ http://www.emedicine.com/derm/TOPIC407.HTM
7. ^ http://www.dermadoctor.com/article_Seborrheic-Keratoses_91.html
8. ^ Seborrheic keratosis: Causes, from the Mayo Clinic website
9. ^ Hafner C, Hartmann A, Vogt T (2007). “FGFR3 mutations in epidermal nevi and seborrheic keratoses: lessons from urothelium and skin”. J.

Invest. Dermatol. 127 (7): 1572–3. doi:10.1038/sj.jid.5700772. PMID 17568799.
10. ^ Seborrheic, from Merriam-Webster’s online medical dictionary
11. ^ Suffix “-osis” from the Merriam-Webster website

How are skin tags treated?

There are several effective medical ways to remove a skin tag, including removing with scissors, freezing (using liquid nitrogen), and burning (using medical electric cautery at the physician’s office).

Usually small tags may be removed easily without anesthesia while larger growths may require some local anesthesia (injected lidocaine) prior to removal. Application of a topical anesthesia cream prior to the procedure may be desirable in areas where there are a large number of tags.

Dermatologists (skin doctors), family physicians, and internal medicine physicians are the doctors who treat tags most often. Occasionally, an eye specialist (ophthalmologist) is needed to remove tags very close to the eyelid margin.

There are also home remedies and self-treatments, including tying off the small tag stalk with a piece of thread or dental floss and allowing the tag to fall off over several days.

The advantage of scissor removal is that the growth is immediately removed and there are instant results. The potential disadvantage of any kind of scissor or minor surgical procedure to remove tags is minor bleeding.

Possible risks with freezing or burning include temporary skin discoloration, need for repeat treatment(s), and failure for the tag to fall off.

There is no evidence that removing tags causes more tags to grow. Rather, there are some people that may be more prone to developing skin tags and may have new growths periodically. Some patients even require periodic removal of tags at annual or quarterly intervals.

Do skin tags need to be sent for pathology?

Most typical small skin tags may be removed without sending tissue for microscopic examination. However, there are some larger or atypical growths that may be removed and sent to a pathologist for examination under a microscope to make sure that the tissue is really a tag and nothing more. Additionally, skin bumps that have bled or rapidly changed may also need pathologic examination. While extremely rare, there are a few reports of skin cancers found in skin tags.

What else could it be?

While classic skin tags are typically very characteristic in appearance and occur in specific locations such as the underarms, necks, under breasts, eyelids and groin folds, there are tags that may occur in less obvious locations.

Other skin growths that may look similar to a skin tag but are not tags include moles (dermal nevus), nerve and fiber-type moles (neurofibromas), warts, and “barnacles” or “Rice Krispies” (seborrheic keratosis).

Warts tend to be rougher, with a “warty” irregular surface whereas skin tags are usually smooth. Warts tend to be flat whereas tags are more like bumps hanging from thin stalk. While warts are almost entirely caused by human papilloma virus (HPV), tags are only sometimes associated with HPV.

Groin and genital lesions resembling skin tags may actually be genital warts or condyloma. A biopsy would help diagnose which of these growths are not skin tags. Very rarely, a basal cell skin or squamous cancer or melanoma may mimic a skin tag, but this is very uncommon.

Is there another medical name for a skin tag?

Medical terms your physician or dermatologist may use to describe a skin tag include fibroepithelial polyp, acrochordon, cutaneous papilloma, and soft fibroma. All of these terms describe skin tags and are benign (noncancerous), painless skin growths. Some people refer to these as “skin tabs” or warts. However, a skin tag is best known as a skin tag.

Skin Tag At A Glance

• A skin tag is a common but harmless skin growth.
• Skin tags are frequently found on the eyelids, neck, chest, armpits, and groin.
• Treatments include freezing, tying off with a thread or suture, or cutting off.