Patient education sheet of wart ttt ..

Salicylic acid
Salicylic acid in various preparations is commonly used in various formulations to treat a variety of skin disorders ranging from acne to dandruff to warts. Warts are caused when a virus infects cells in the skin. Salicylic acid helps to remove warts by destroying these virus infected cells and allowing new healthy skin cells to replace them.

Remember that warts are not easy to treat. It often takes many daily treatments over weeks or even months to get rid of warts, and there is no guarantee that this method of treatment will work for you.

How to use your salicylic acid treatment

1. Any film from previous treatments must be peeled off. 2. Excess dead skin over or surrounding the wart should be scraped away. This may be done by using sandpaper, an emery board or a nail file. 3. Next, soak the area around the wart in warm water for several minutes, then pat the area dry. 4. Using an applicator, carefully apply the salicylic acid product to the wart. 5. avoiding all surrounding normal skin You may cover the wart with occlusive tape, especially in high-pressure areas such as the ball of the foot or to prevent rubbing by clothing. 6. Repeat this process every night until the wart clears or for 6 weeks. You may take 2- to 3-day holidays from treatment if the discomfort is too great. 7. Call your physician if the warts have not cleared in 6 weeks, if you have any problems with excessive pain or if you notice any signs that the wart is coming back.

Imiquimod 5% Aldara Cream (genital wart)

Imiquimod is a protein that stimulates your body to defend itself against the wart virus. Warts are difficult to treat and there is noguarantee that this method of treatment will work for you

Before treatment Wash and dry the affected areas using mild soap and water

During treatment 1. Imiquimod is to be applied in a thin layer, directly to the warts, three times a week at bedtime. 2. After 610 hours, it must be washed off with mild soap and water. 3. If you are an uncircumcised man, washing should be done a minimum of twice a day, taking special care to retract the foreskin completely. 4. Treatment should continue until there is total clearance of the warts, or for a maximum of 16 weeks. 5. A rest period of several days is permitted if an uncomfortable local skin reaction occurs.

After treatment Call your physician if you have a fever or if the local skin reactions do not improve within a day or two.

Podophyllin methodology in wart ttt

What are podophyllins?

Podophyllins are a group of lipid-soluble, anti-mitotic compounds that cause tissue death (necrosis) and keratolysis; they are commonly used in the treatment of genital warts. The necrosis causes subsequent sloughing of tissue which destroys the wart physically.

The main advantage of this particular treatment modality is that it does not involve cutting, which would leave scars, and there is a minimal amount of pain. It is important to understand that a single treatment may not cure the wart; multiple treatments may be required. The treatment approaches a 100% cure rate depending on which formula is used. There is no guarantee that this topical pharmacologic treatment will work for you. Other methods may be used if this one proves unsuccessful.

1. Prior to treatment 1. The wart and the surrounding area are evaluated 2. The physician will examine your wart 3. The area of the wart is cleaned with alcohol prep

2. During treatment 1. The doctor will apply the medicine to the warts during the surgery visit. 2. You will have a cold sensation as the solution is applied with a wooden applicator or cotton swab. 3. After the solution is dry, a gauze may be placed over the treatment site, depending on the location. 4. Tell your doctor about any side effects from the medication at the local site or other generalized symptoms.

3.After treatment 1. At the end of the 4-hour period, remove the gauze and wash the medicine off with soap and water. 2. Later in the day, you will notice that you have redness, scaly surface, or pain. 3. Call the physician if you have any problems with pain or other discomfort. 4. May need to come back to the physicians surgery for the wound to be dbrided weekly. 5. Do not be upset if the warts do not disappear completely after a single administration. As we never know how deep a wart is, multiple applications may be required, especially if the wart is located in the palms and soles. 6. Bleeding into the blister may occur, giving it a black color 7. Warts may recur or a ring may remain after treatment. Please call our physician with any signs of recurrence.

Cryotherapy
Cryosurgery is a procedure in which abnormal body tissues are destroyed by exposure to extremely cold temperatures.

How do I prepare for cryosurgery? There is no special preparation for cryosurgery. It is a simple procedure that is done in a short time in your healthcare providers surgery.

What happens during the procedure? 1. Your healthcare provider will use a probe, spray tool or cotton-tipped applicator dipped in liquid nitrogen to treat the affected areas. 2. A very cold gas, usually liquid nitrogen, is applied to freeze the wart. 3. You will feel a burning and stinging sensation while the area freezes and then thaws. 4. Although the procedure may cause some discomfort, an anesthetic is rarely needed. 5. The length of time the wart is frozen depends on the size and type of the lesion.

6. For some lesions, the procedure works best if the tissue is frozen quickly, allowed to thaw and then frozen again.

What happens after the procedure? 1. A small blister will usually form. The blister will later become a scab or a crust. Healing usually occurs over 7 10 days. 2. Warts often need to be treated more than once. Your healthcare provider will tell you how often you need to be checked for recurrence or retreatment, even if the warts appear to have cleared. 3. You will need a follow-up visit to check healing and to see if tiny amounts of abnormal tissue remain. What are the benefits of cryosurgery? Cryosurgery is very effective and is less expensive than other treatments. It can be done in your healthcare providers surgery and anesthesia is usually not necessary. What are the risks associated with cryosurgery? The risks include: 1. Discoloration of the treated area, which can be either light or dark; 2. Damaged hair and sweat glands in the treated area; 3. Minor scarring and recurrence. If warts recur, reschedule an appointment with your healthcare provider for re-treatment. When should I call the doctor? Call your doctors office if: 1. The treated area is bleeding or not healing 23 weeks after surgery 2. The lesions reappear 3. The treated area looks infected

CO2 Laser
Laser is an acronym for light amplification by stimulated emission of radiation. This means that lasers generate an intense beam of light energy. When this light is absorbed by the water in your skin, tremendous heat is generated. The skin actually boils and bubbling can be seen. The amount of heating is controlled by the doctor. This requires a local anesthetic and small injections are given under the skin surrounding the warts that will be treated. You will also be required to wear glasses or goggles when the laser is operational. Day of treatment

1. Clean warts with soap and water the morning of your treatment 2. Tell your doctor if you have any medicine allergies or seizure disorder 3. Wear comfortable clothing that can be easily removed to expose the area to be treated 4. You will see bright flashes of light during the treatment 5. Let your doctor know if you feel any pain during the treatment Post-treatment instructions 1. Apply antibiotic ointment twice daily to the treatment site 2. Cover with a non-stick dressing 3. Call your doctor if you have increasing pain, yellow drainage, expanding redness, a red streak, fever, or any other unusual symptoms

Electrosurgery
1. Injection of local anesthetics with epinephrine (adrenaline) when the location is not contraindicated. 2. Destruction of the visible wart tissue with electrodessication to produce a white color, with some charring on top. 3. Curettage to scoop out the burned tissue with a ring curette 4. Dessication can be repeated, followed by curettage, until a healthy appearing tissue is reached at the base of the wound 5. If a palm or a sole is treated, scissors are used to trim the excess hyperkeratotic tissue present at the periphery of the lesion

Surgery for condylomas

1. For vulvar and perianal condylomas, the lithotomy position is ideal but, if the physician prefers, the jackknife position can be used. 2. Injection of local anesthetics with epinephrine (adrenaline), when the location is not contraindicated. Following the injection the condylomas tend to separate. 3. With a pair of fine-toothed forceps and fine-pointed scissors, the condylomas are individually excised, preserving as much normal skin as possible in between. The excision can also be made with a sterile razor blade held in a curved shape between the first and second or third finger (shave excision). 4. There is usually little bleeding, but electrocautery may occasionally be needed 5. It is not always possible to remove all lesions in one intervention, because of the extent of the disease and the risk of postoperative strictures. In this event, a 1month interval is suggested before further treatment.

Enucleation of plantar warts

1. Superficial callus and warty tissue is pared until the sharp demarcation between the wart and normal surrounding skin is clear. 2. Local anesthesia is first administered by a Dermo-Jet (Robbins Instruments Inc., Chatham, NJ), followed by infiltration with a 25-gauge needle under the wart and then superficially on each side of the wart. 3. Using a blunt dissector instrument (see text), the wart is encircled using firm pressure and a peeling motion to separate the wart from the peripheral tissue. 4. The callused margins of the wound are trimmed with curved scissors 5. The wound is covered with a pressure dressing which is replaced with a conventional bandage 2 days after the procedure.

postoperative care after surgery of a wart

1. The wound should be washed with soap and water twice daily, followed by hydrogen peroxide cleansing 2. An antibiotic ointment or petrolatum jelly can be applied twice daily under adhesive bandage. 3. The wound will usually heal in 23 weeks and possibly leave a flat permanent white scar

Indications for wart surgery/electrosurgery

Wart resistant to conventional accessible methods Solitary warts Filiform warts Cutaneous horns Polypoid warts (such as condylomata)

Relative contraindications for surgery/electrosurgery

Warts in children Warts on the palms and soles Multiple warts, especially if they are in a spreading phase Periungual warts Warts on the vermillion border of the lip Warts in an immunosuppressed individual

HPV infection Common warts

First line

Second line

Third line Bleomycin, vascular lesion laser, contact immunotherapy, intralesional immunotherapy

Liquid nitrogen in office, Cantharidin salicylic acid at home

Genital warts

Liquid nitrogen in office, Podophyllin 2550% in Vascular lesion laser, imiquimod office, intralesional interferon, intralesional at home Podophyllotoxin at home immunotherapy

Planar warts

Imiquimod

Liquid nitrogen, retinoicVascular lesion laser, intralesional acid Immunotherapy Vascular lesion laser, intralesional immunotherapy Surgery, bleomycin

Plantar warts

Paring and liquid nitrogen (two cycles) in office, salicylic acid at home