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Types Of Warts

   

Ordinary viral warts are extremely common. Most people have had, have or will have these small viral turnoUTs. Fortunately the great majority disappear spontaneously within weeks or months. Patience and reassurance should be the ingredients of treatment. If these do not suffice, a keratolytic agent containing salicylic acid or a destructive substance such as formaldeh-yde or podophyllin extract can be used. Referral of patients with these lesions is only recommended if:

  1. There are several lesions that are persistent and have resisted simple treatments.
  2. There are a vast number of lesions and it seems possible that there is a serious underlying immunological defect.
  3. There are some warts that are large, persistent and embarrassing, and lectrocautery or cryotherapy seem to be indicated.
  4. There is some doubt as to the diagnosis.

Seborrhoeic warts

Ordinary viral warts have to be distinguished from simple seborrhoeic warts which usually start to make their appearance in the fifth and sixth decades. Seborrhoeic warts are usually pigmented, the shade varying from light fawn to dark brown and black. These mostly do not need attention unless they are very large or become inflamed. Sometimes they occur in large numbers and are an embarrassment, and referral for advice as to treatment may be required.


Extensive warts affecting the back of the hand.Treatment of this number of warts is always a problem.


Multiple seborrhoeic warts. some of these lesion get in the way and catch in clothing

Solar keratoses and small skin cancers

As their name suggests, solar keratoses occur on the light-exposed sites. They are preneoplastic in the broadest sense of the term but only progress to squamous cell carcinoma extremely rarely (perhaps in 0.01 per cent of cases). Their main importance is that they signify solar damage of the kind that can result in a malignant lesion. Solar keratoses are usually found in the elderly although they may occur at an earlier age if there has been a great deal of sun exposure in the past. They are much commoner in the fair-skinned, who have little protective pigmentation. Small skin cancers (squamous cell epithelioma and Bowen's disease) may also be difficult to distinguish from other warty lesions. If there is any question, refer.

Genital warts

Warty lesions on the genitalia probably always require the opinion of a specialist. The majorities are simple viral warts, but tragedies occur if syphilitic warts or squamous cell carcinoma are not diagnosed at an early stage.

Pigmented Lesions

Whatever else the practitioner may forget of his undergraduate training in dermatology, the danger of malignant melanoma usually remains well in mind. Delay in the referral of a suspected malignant melanoma is usually either due to the patient presenting late because of fear or ignorance, or an office bungle. In few other skin disorders is early referral so vital to the well-being of the patient. If a pigmented lesion enlarges, changes in colour, ulcerates or bleeds the patient should be seen by a dermatologist at the first opportunity. Dermatologists would prefer to see a hundred patients referred to their clinics who did not have the disease than one patient with the disease in an advanced stage who has been referred late and for whom there is a bad prognosis. The danger signals of a melanoma are:

  1. History of change in colour, increase in size and surface changes including scaling, crusting and bleeding.
  2. Irregularity in colour (variegation).
  3. Irregularity of margin.
  4. A lesion more than 1 em in diameter.