Plantar Warts
Warts on the soles of the feet tend to develop
callosities over them and become painful. These should be pared
down carefully or scraped with a pumice stone and a salicylic acid
preparation applied. Collodion flex containing salicylic acid is
suitable, as are combinations of salicylic and lactic acid (Salactol,
Compound W), or one of the proprietary salicylic acid plasters can
be used. The treated area should be covered with an occlusive plaster.
When effective the wart turns white and the area becomes slightly
tender. If this is ineffective then a podophyllin preparation can
be employed.
Podophyllin is a mixture of toxic alkaloids obtained
by extracting the root of the mandrake plant. There are podophyllin
paints and collodion flex preparations as well as proprietary ointment
preparations (Posalfilin). The latter are particularly useful for
plantar warts; the paints and flexes are more useful for genital
warts (see opposite). Treatment with formalin or glutaraldehyde
had a vogue but does not seem to have much advantage over other
treatments.
Warts around the big toe. Plantar warts can be very painful
If these measures do not work then locally destructive
treatment by freezing with liquid nitrogen or a cryoprobe, or electrocautery
and curettage, will be required. These methods of treatment are
usually available in hospital out-patient clinics but the waiting
lists for patients with warts are often so long that the warts resolve
before the appointment comes round. Even these vigorous procedures
do not always succeed and warts often recur at the treated sites.
If treatment is too vigorous, permanently painful scars can result,
for which no one is thanked.
Multiple Warts
Solitary warts on the
hands or two or three on the fingers don't often need treatment
but when there are multiple warts on the fingers and around the
nails (paronychial) active treatment should be considered. The same
treatments are available for these as for plantar warts, and they
are generally more successful for these lesions. Plane warts on
the face, neck or hands don't often need treatment, but if multiple
lesions are present then one of the liquid salicylic acid or salicylic-lactic
acid film preparations (such as Duofilm) is suitable.
Extensive plane warts affecting the neck and lower face. This young man had suffered from these from many year .There was no identified immune defect in this patient.
Genital and Perianal Warts
These always need treatment as they tend to spread
quickly to sexual partners. Tincture of podophyllin is the most
popular treatment for these and is best carried out by a specialist
department. Usually treatment starts with a single application of
a 5 per cent podophyllin solution which is washed off after four
or five hours. If this is ineffective, stronger tinctures (up to
20 per cent) are used. In recent years the active alkaloid (podophyllotoxin)
has been extracted from the resin and made available in a pure form
as a 0.5 per cent paint (Condyline). If podophyllin treatment is
successful, the warts become inflamed and painful and then drop
off.
If podophyllin is unsuccessful then more vigorous destructive
measures may be necessary, such as electrocautery. For obvious reasons
this should be administered by an expert in this technique.
Perianal
warts seem to be more common in male homosexuals, who are also prone
to harbour other venereal disorders including HIV disease. It has
become routine practice to check whether such patients have evidence
of syphilis with blood tests.
