Warts Handout 2023 (PDF)

Warts Lisa Cohen, Pharm.D., CDE, CDOE, CVDOE Professor of Pharmacy  Describe symptoms related to warts. Identify signs and symptoms in which self-care is not appropriate. Recommend nonpharmacological measure to treat...

Warts Lisa Cohen, Pharm.D., CDE, CDOE, CVDOE Professor of Pharmacy  Describe symptoms related to warts. Identify signs and symptoms in which self-care is not appropriate. Recommend nonpharmacological measure to treat warts Identify potential drug-drug and drug-disease state Objectives interactions. Recommend appropriate nonprescription products depending on presenting symptoms and underlying disease states. Counsel patients effectively on pharmacotherapy chosen including administration, dosage, adverse effects, and follow up.  Pathophysiology of Warts HPVs are double stranded DNA viruses and there are about 150 related and 200 subgroups identified HPV enters in the epidermal layer and infects the basal keratinocytes Warts l Approximately 7-10% of people have warts l Caused by human papillomaviruses (HPVs) l Most common inoculation is in swimming pools l Incubation period, 1 to 24 months l Common warts, plantar warts l Defined according to location  Plantar Warts Warts Common Warts Flat Warts  Mosaic Wart Filiform Warts Warts Periungual Warts Referrals for Warts Painful or debilitating plantar warts Extensive warts at one site Warts on face or around fingernails or toenails < 4years old Warts around anus or genitalia, face, breasts, armpits, mucous membranes Patient has diabetes, poor circulation, or immunocompromised or is pregnant Lesion still exists after 12 weeks of treatment Recurrent warts Physical or mental impairments Patient is taking immunosuppressive agents or other medications contraindicating salicylic acid  Treatment for Warts Non-drug measures, prevent spreading Good hand-washing Do not cut, poke or probe wart tissue Salicylic acid 3 types; Salicylic acid 12-40% in plaster Salicylic acid 5-17% in collodion vehicle Salicylic acid 15% in karaya gum/glycol vehicle Improve in 1-2 weeks, complete in 4-12 weeks Cantharidin, podophyllum, podofilox Cryotherapy (liquid nitrogen, dimethyl ether and propane) Duct tape Alternative therapies Treatment for Warts Nonpharmacologic Treatment of Warts Avoid cutting, shaving or picking warts After treating or touching warts, wash hands Avoid sharing towels, razors, shoes, etc. Use footwear in public places (i.e. swimming pool areas) Lambswool or moleskin may provide comfort on pressure point areas from the warts Wart Products Salicylic acid 5-17% in collodion vehicle Examples (Tinamed Wart Remover, DuoFilm, Dr. Scholl's Clear Away Wart Remover Gell) Salicylic acid 12-40% plaster/pads Examples (Dr. Scholl's Clear Away Wart Remover System Plantar, Dr. Scholl's Clear Away Wart Remover One Step, Compound W Pads) Salicylic acid 15% in Karaya gum/glycol vehicle Examples (Trans-Plantar, Trans Ver Sal Cantharidin, podophyllum, podofilox, dimethyl ether, propane Examples (Wartner, Compound W Freeze Off)  Salicylic Acid – Wart Products Salicylic acid slowly destroys the virus infected cells Salicylic acid is more effective for warts on the hands than the feet Disadvantages Need to apply 1–2 times daily The potential for damage to healthy skin surrounding the wart The duration of treatment needed to achieve a therapeutic response. Warts will begin to decrease in size within a couple of weeks Cryotherapy - Warts Similar directions between the products Wash hands, then soak the area for 5 minutes, then dry area Use a file or pumice stone to abrade the surface of plantar warts Prepare the device as directed – activate the product specific instructions Apply to the wart until a halo appears 20 seconds for common warts 40 seconds for plantar warts Repeat after 2 weeks, if needed; may use up to 3 treatments (6 weeks) Alternative Therapies Garlic Cloves Vitamin A Zinc – dietary 10mg/kg/day Vitamin E bath with bandage Duct tape Others – folklore Apples, chicken gizzards Commonly Recommended Wart Removers Compound W Duofilm Dr. Scholl’s Clear Away Wartner Curad Mediplast Other