Viral Infections

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Diagnosis

The diagnosis is most often made on the basis of clinical appearance. Diagnostic clues include black dots within the warts and/or pinpoint bleeding after paring down the thickened skin. The wart also tends to disturb the natural skin lines and creates a disrupted surface. A biopsy can be used to confirm clinical suspicion, provide proper diagnosis, and help determine if progression to skin cancer, a rare complication, has occurred.

Treatment

There is no single effective treatment for warts; management is based on the age of the individual as well as the size, number, and location of warts. Common warts, especially in children, do not necessarily need to be treated, because they exhibit a high rate of spontaneous remission. Without treatment, however, spread can occur.

Treatment involves the physical or chemical destruction of the lesion. In physical destruction, liquid nitrogen, which is extremely cold, is sprayed onto the wart or applied with a cotton-tipped swab. Because freezing is painful, this form of treatment is not tolerated well by young children. Warts can be anesthetized and then scraped (curetted), burned (desiccated), lasered off, or surgically cut out (excised).

A variety of chemicals are used to eradicate warts. Genital warts respont to a topical resin, podophyllin, applied in strong concentration at regular intervals by the doctor, or a prescription gel (Condylox®) to be used at home. Cantharin, an extract from a blistering beetle, is used alone or in combination with podophyllin to treat warts.

Over-the-counter preparations of salicylic acid are sometimes used. Imiquimod cream (Aldara®) is approved as a prescription for enhancing the immune response to warts, thus helping the body fight the human papilloma virus.

A dilution of bleomycin, a medication used in chemotherapy, can be effective when injected into warts that are resistant to other treatments.

Despite numerous treatment modalities, warts sometimes require repeated treatment because they are difficult to eradicate and commonly recur.

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