Guidelines for the management of cutaneous warts (original) (raw)

Destructive therapies for cutaneous warts: A review of the evidence

Australian Journal of General Practice

COMMON WARTS (Verruca vulgaris), plantar warts (Verruca plantaris) and flat/plane warts (Verruca plana), collectively known as cutaneous warts, are benign growths of the skin caused by the human papillomavirus (HPV). In Australia, up to 24% of children and 5% of adults are affected. 1 A break in the epidermal barrier of the skin allows entry of HPV and subsequent infection of basal epithelial cells. HPV replicates alongside the natural lifecycle of epithelial cells, and is eventually released from desquamated keratinocytes on the surface of warts, potentially infecting other sites via direct contact or through fomites. 2 Cutaneous warts generally self-resolve. Up to two-thirds of immunocompetent children experience spontaneous clearance of their cutaneous warts by two years of age. 3 Adults tend to take longer. Patients might request treatment for their warts when they cause discomfort, functional impairment, social ostracism, are numerous, grow large or raise concerns regarding transmission. 4 Treatment for cutaneous warts can be painful, scar, cause pigmentary disturbances and might not be effective. 5 Therefore, clinicians should be wary of the evidence behind the efficacy of cutaneous wart treatment. This review summarises high-quality studies investigating the efficacy of chemical and physical destructive wart therapies. Methods We performed a literature review (up to June 2021) of published articles for wart management from the MEDLINE and Embase databases. No language restrictions were applied. We considered systematic reviews, randomised controlled trials (RCTs), cohort studies and case series. Case reports were excluded. For MEDLINE, we used the Boolean operation to combine MeSH terms 'warts' AND 'therapeutics'. For Embase, we used the Boolean operation to combine MeSH terms 'Verruca vulgaris' AND 'therapy'. We included studies that investigated chemical or physical destructive therapies.

Common warts revisited: a clinical study

International Journal of Research in Dermatology

Background: Common warts are cutaneous viral infections caused by various strains of human papilloma virus (HPV). Their variants include filiform, periungual and pigmented warts. At present more than 200 different HPV genotypes have been detected and a periodic clinical analysis will reveal whether any new morphological variations have occurred. Methods: Hundred and ten patients with common warts were taken up for this study. Results: The clinical characteristics of 637 common warts in 110 patients were studied over a span of 1 and a half years. The age group ranged from 18 years to 72 years. Seventy six were males and 34 were females. Majority belonged to the age group of 18-30 years. The most common occupational group involved were students followed by housewives. The initial site of onset in 44.5% of patients was on the fingers. Eleven patients had atopic diathesis. Similar complaints in friends and family were seen in 30%. The most common sites of involvement for classical common warts were on the fingers and for filiform warts were on the head. 30% had association with other warts out of which 28.1% had palmoplantar warts. Conclusions: Common warts usually present as a cosmetic concern in most patients. Our study concluded that young male students are susceptible to acquiring them. Characteristics of warts in atopics did not differ significantly from non atopics. Regions most prone to contact and susceptible to trauma are the most common sites of inoculation i.e. fingers, scalp and face.

Nongenital warts: recommended approaches to management

Prescriber, 2007

Although warts usually resolve spontaneously in time, patients often request treatment due to discomfort or their appearance. Our Drug review considers the properties and efficacy of the many treatments available, followed by sources of further information and the Datafile. V iral warts are a common dermatological problem that affects most individuals at some stage of their lives. They are caused by a DNA virus, the human papillomavirus (HPV); over 100 types have been fully identified. The virus infects epithelial cells, where it induces keratinocyte growth and replicates, resulting in the appearance of a warty papule or plaque. However, HPV may remain dormant within the epithelium without producing any visible disease. The clinical appearance of warts depends both on the site of infection as well as the type of HPV involved, with different HPV types having a predilection for different anatomical sites, eg type 1 affects hands and feet, types 2, 4, 27 and 57 usually cause common warts, and plane or flat warts, which tend to arise on the distal limbs and face, are caused by types 3 and 10. Any area of skin can be affected but the hands and feet represent the commonest sites.

Cutaneous warts clinical, histologic, and virologic correlations

clinics in Dermatology, 1985

From the Department Human-papillomavirus (HPV)-induced cutaneous lesions differ of Dermatology, Warconsiderably in their clinical morphology. This was thought to saw School of Medidepend mainly on anatomic location and other factors related to the tine, Warsaw, host and to the age of the lesions. It was long-assumed that a single Poland, and the virus was responsible for all of these lesions.' Department of Disclosure of the plurality of HPV types associated with skin Virology, Pasteur warts? raised the problem of the relation of clinical morphology to Institute, Paris, the distinct types of HPV. This was first suggested by the charac-France terization of distinct HPVs from different types of lesions: HPVl from deep plantar warts,3 HPV2 from common hand warts3 and HPV3 from plane warts and flat wart-like lesions of patients with epidermodysplasia verruciformis (EV)? At present, 39 types of HPVs are recognized, with several subtypes for many of them.'" Some HPV types are specifically associated with cutaneous warts: HPVl, 2, 3, 4, 7, 10, 26-28, and a great number of them are associated with EV.10~" The problem of specific or preferential association of distinct HPVs with warts differing in morphology and/or location is still controversial, since only a limited number of cases were studied,z-17 and no widely accepted clinical and histologic criteria are available for the differentiation between wart types.'*-21 For instance, myrmecia warts are often not distinguished from common or mosaic warts in spite of their very precise histologic and clinical description by Lye11 and Miles.22 Our aim is to present the available data on the association of different types of cutaneous warts with distinct HPVs, and to find out whether it is possible to evaluate the type of infecting HPV on the basis of clinical and histologic features. Such recognition might be important because of the differences in clinical course, contagiousness, and response to treatment of lesions associated with different HPVs. Classification The main currently recognized clinical types of warts are plantar Supported, in part, by warts (deep and superficial varieties), common warts (including the Polish National filiform warts), and plane or flat warts.zl Cancer Program PR 6 The classification appears inadequate to classify all the varieties 'Including 66 butchers.

Nongenital warts: recommended management in general practice

Prescriber, 2012

Nongenital warts are benign skin lesions caused by HPV infection and can be easily treated in primary care. Our Drug review presents the different clinical types and discusses the properties and efficacy of the available treatment options, followed by sources of further information. N ongenital warts are very common and most people at some stage of their lives will be affected. Although the exact frequency of this infection is difficult to establish, it is estimated that 3.9 to 4.9 per cent of all children and adolescents in the UK are affected. 1 Warts are caused by infection of the epidermis with the human papillomavirus (HPV). There are more than 100 different HPV genotypes identified, each associated with distinct clinical and histological features. Depending on the genotype, infection with this nonenveloped DNA virus results in proliferation of cornified stratified squamous epithelium of the skin or uncornified mucous membrane at particular anatomical sites. 2 HPV is spread by either direct or indirect contact. Broken or macerated skin facilitates infection and is therefore common in people with nail-biting habits or those who regularly use communal swimming pools. Autoinoculation is also common and results in local www.prescriber.co.uk Prescriber 19 March 2012 35 Drug review Warts

Nongenital warts: clinical features and recommended treatment

Prescriber, 2009

Viral warts are one of the most common cutaneous diseases, and treatment can be difficult and frustrating with frequent failures. In our Drug review we discuss the clinical presentations and treatment options, followed by sources of further information.

Effectiveness of individualised homoeopathic intervention in warts – A case series

Indian Journal of Research in Homoeopathy, 2023

Verruca vulgaris, also known as common warts, is benign lesions caused by the non-malignant human papillomavirus, affecting approximately 10% of the population globally. It may range from 1 mm to several cm, and are mostly seen on the extremities, followed by the face. They may be transmitted by direct or indirect contact and lead to cosmetic concerns, itching and mild to severe pain while doing activities. Conventional treatment has destructive therapies such as salicylic acid, cauterisation and cryosurgery, which induce many adverse effects from local to general. However, an individualised homoeopathic approach can be used to effectively treat these warts, without any need of applying topicals, or recurrence of the complaints. The improvement was assessed through photographic records. This case series provides an insight to individualised homoeopathic intervention in different types of warts and paves the way for pragmatic studies in the future.