2017 HCHB_digital

Warts
Warts are benign (non-cancerous) growths of skin caused by the human
papillomavirus (HPV). More than 100 different subtypes of the HPV virus are
known. The HPV virus causes the top layer of skin to grow rapidly forming a wart.
The HPV virus is transmitted by direct skin-to-skin contact with other people
with warts. Warts can also be spread to other parts of the body if they are picked
or scratched and the viral particles are able to gain entry through a break in the
skin barrier – this is called autoinoculation. Warts have a long incubation period
and it may take up to 12 months after infection for the first wart to appear.
Common warts typically occur on the backs of fingers or toes, less commonly
on the elbows and knees. They may occur singly or in crops and are usually
painless. Warts located around the nail bed may also distort nail growth. Some
take on a cauliflower-like appearance with tiny black dots visible within the wart
(these are thrombosed capillary blood vessels); these are known as butcher's
warts. Plane warts tend to have a flat surface and may appear in a line since they
are commonly inoculated by shaving or scratching. Filiform warts have a long
stalk and more commonly occur on the face. Warts can also affect the oral cavity,
particularly the tongue, inside surface of the cheeks, and lips. These are called oral
squamous cell papillomas and are typically caused by virus types HPV-6 and HPV-
11. These subtypes are not usually cancerous but may be surgically removed for
cosmetic reasons. Refer all customers presenting with oral cavity or anogenital
warts to a doctor or dermatologist. For information on verrucae (warts on the
soles of the feet – also called plantar warts) see Foot Care.
Warts are common in children, with a peak incidence occurring in adolescents
aged 12–16 years. Fifty per cent of cutaneous warts in children dissappear by
themselves within six months without any treatment. More than 90% are gone
in two years. Warts in adults tend to be more persistent, although most clear up
eventually. People with Human Immunodeficiency virus (HIV) infection, or who
take the immunosuppressant medicines azathioprine and cyclosporin are more
likely to suffer from numerous warts that are difficult to treat.
Initial assessment
In a private area of the pharmacy, put on gloves and inspect the wart if it is on
an exposed part of the body. If there are multiple warts, are they in a defined
area or widespread? Refer the customer to a pharmacist if the lesion does not
look typically wart-like, the patient appears to have a poor overall general health,
or if they answer "yes" to any Refer to
Pharmacist questions.
Treatment
Many people seek treatment either
because the wart is painful or
for cosmetic reasons if the
wart is unsightly.
Treatment options
include chemical treatments
containing salicylic acid or
similar compounds which
remove the dead surface skin
cells and are effective in around
70% of cases although they may
take up to 12 weeks to work. Even
if the wart doesn’t go completely,
products usually make the wart smaller and
less uncomfortable. Podophyllotoxin is a cytotoxic
TREATMENT OPTIONS
Category Examples Comments
Salicyclic/lactic acid
Volatile hydrocarbons (home
cryotherapy)
Other products
Natural / herbal products /
supplements
[PHARMACY ONLY]
eg, Duofilm Wart Remover, Scholl Wart Remover
system (fabric/washproof)
[GENERAL SALE]
eg, Wartie Wart Remover*, Warteze, Wartner
Wart Remover, Scholl Freeze Verruca & Wart
Remover
[GENERAL SALE]
eg, Wartfree Wart Remover Pen
Homeopathic Thuja wart paint, Naturo Pharm
Wartoff Paint/Tablets/Spray
Garlic, green tea extract
Products with an asterisk have a detailed listing in the Warts section of OTC Products, starting on page 267.
Soak affected area in warm water and towel dry before applying product. Effectiveness may
be improved by rubbing the surface with pumice stone or emery board to remove any hard
skin. Daily treatment is necessary except for fabric-based systems which are changed every
48 hours.
Contain ingredients that freeze the wart, such as dimethyl ether and propane. Usually just a
one-off application of 20 seconds is needed; however, it may be repeated after 15 days. May
be uncomfortable for a few minutes and may result in blistering. May take several repeat
attempts over several months to completely get rid of the wart. There is no evidence to
suggest this treatment is any more beneficial than other wart treatments; however, it may be
more convenient.
Typically contain corrosive ingredients that induce peeling of the surface of the wart.
Homeopathic remedies aim to stimulate the immune system to attack the virus responsible
for warts. Topical garlic has some effectiveness for warts. Effectiveness for a green tea extract
ointment against genital and perianal warts has been reported.
Page 166 HEALTHCARE HANDBOOK 2017-2018 Common Disorders