Moles Wart Remover

• Benign neoplasm caused by infection of the epidermal cells with papillomaviruses
• Thickening of the epidermis with scaling and upward extension of the dermal papillae containing prominent capillaries giving them a “warty” or verrucous appearance.
• This vascularity ? blood supply allowing for rapid and large growths.
• Common wart known as verruca vulgaris.
• Occur in healthy children and young adults. Maybe congenital due to STD.
• Genital human papillomavirus (HPV) infection may be the m/c STD.
• Estimated that 1% of sexually active adults have genital warts and additional 10-20% have latent infection, and 43% of sexually active college women have this.
• 5-10% of patients seen by dermatologists are seen for warts.
• Immunosuppressed are prone to development and occurrence of multiple warts.
• Butchers, meat cutters, sexual activity, and child abuse, have an increased incidence of warts.
• Anogenital warts (condyloma accuminata) affect sexually active individuals and their occurrence in children should increase suspicions of sexual abuse
• Described as a flesh colored firm papule or nodule that has a corrugated or hyperkeratotic surface
• Interrupts normal skin lines and is studded with black puncta.
• Well-marginated, very abrupt between good and bad skin, almost a gap between the 2 as if the bad skin rose up through a hole in good skin.
• Warts occur individually, in groups or linear (from autoinoculation/self inoculation – i.e. virus under finger nail and you scratch over an open wound).
• Hands and fingers are usual sites, under nails.
• Renal transplant patients (m/c type of transplant) take immune suppressed drugs to ? risk of transplant rejection, are at higher risk.

4 MAIN Categories:

1. Plantar warts often confused w/ corns.

• A single, painful papule on plantar aspect of foot.
• Paring down the surface with scalpel demonstrates interruption of skin lines and black puncta characteristic of plantar warts.
• Multiple warts may coalesce in a mosaic configuration or form a mother-daughter relationship (a central large wart surrounded by smaller warts).

2. Flat wart

• Flesh-colored or reddish-brown. May resemble a wheal.
• Slightly raised, flat, 2-5 mm, well-marginated papule.
• Commonly affect the hands or face.

3. Common wart/verrucous vulgaris

• Flesh-colored, firm papule or nodule, w/ a corrugated or hyperkeratotic surface.
• Studded w/ black puncta.
• Occurs m/o on the hands and fingers, individually, in a group, or linear formation.
• A filiform variant occurs on the head and neck.

4. Condyloma acuminatum (venereal wart)

• Involves external genitalia, rectum, perianal and inguinal regions, and seldom the urethra and vagina.
• A soft moist papule and plaque that maybe sessile or pedunculated.
• A cauliflower-like surface.
• Soaking lesions w/ 3-5% acetic acid turns warts white (acetowhitening), allowing for better visualization. This is not specific for HPV lesions.

Treatment

• Cryotherapy with liquid nitrogen
• Topical acids: salicylic and trichloroacetic acids.
• And a variety of others. Most of these treatment options are recommended for treatment in office.

Resolution

• Estimated that 35 to 65% of warts spontaneously resolve within 2 years
• Treatment results in cure rates as high as 80%
• Of concern is relationship between papillomavirus and carcinoma. Watchful waiting is ok, however if lesion changes color, size, or spreads, refer out it may have turned cancerous.
• Epidemiological evidence for an assoc. b/w papillomavirus and cervical cancer appears overwhelming.
• Papillomavirus is double stranded DNA virus that infects and replicates in keratinizing cells of epidermis.

By: Tri 8 Dermatology – Dr. Kuhn

- wart remover

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