Predisposed patients: depressed immune system, skin maceration, previous wart, bite fingernails, or walk barefoot, 12-16
years old, benign!
Appearance: skin color or brown, slightly scaly, rough papules or nodules, domed appearance with irregular shape,
repeated irritation can cause enlargement
Plantar: associated with pressure and callous-like, painful in weight-bearing areas, severe discomfort and limited function,
deeply penetrating with sloping sides
Several may coalesce into mosaic wart
Treatment goals: eliminate S/S of wart, remove wart without scarring, prevent autoinoculation or transmission, prevent
reoccurrence
Prolonged treatment increases autoinoculation risk
Exclusions: warts on breasts, face, armpits, toenails, fingernails, anus, mucus membranes, and/or genitalia, painful plantar
warts, large or multiple warts in one area of the body, chronic, debilitating disease affecting sensitivity or circulation of
hands or feet, physical or mental impairments making it hard to follow instructions, immunocompromised,
immunosuppressive meds, < 4 years old, pregnant or breast-feeding
Pharmacologic:
Salicylic acid is preferred and best for warts on hands
o
Higher concentrations needed for plantar warts
o
Completed within 6-12 weeks
o
Soak in warm water for 5 minutes prior to application
o
Apply up to BID or change pad every 48 hours
Cryotherapy (dimethyl ether and propane [DMEP])
o
20 seconds for common warts and 40 seconds for planter
o
After 10 days, falls off and reveals new skin
o
Reapply every 2 weeks for max of 3-4 treatments
o
AEs: pain, aching, stinging, blister, hyper or hypopigmentation
o
May cause burns and permanent scars
o
Use applicator ONCE
Duct tape
o
More studies needed
o
Local irritation to stimulate immune response
o
Effective in small children or used in combo

Nonpharmacologic:
Wash hands before/after
Cover wart
Do not cut, shave, or pick wart
Use lambs’ wool/moleskin over pressure points of plantar wart to minimize discomfort
Never share personal items or walk barefoot
Calluses and corns
Caused by friction and pressure – reversed when these are relieved
Callus – relatively even thickening of the skin, varying size, indefinite border
Symptomatic or protective against friction
Discrete-nucleated = most common, painful, small with central, keratin plug
Diffuse-shearing = larger surface area, no core, not painful
Corns – small, raised sharply demarcated lesion with hard central core
Caused by pressure on nerve ending; severe, sharp pain or dull discomfort
Hard = most common, dry
Soft = painful, soft appearance from perspiration
Exclusions: diabetes, peripheral circulatory disease, or conditions that contraindicate use of foot care products, lesions
hemorrhaging or oozing, anatomical defect or fault in weight distribution, extensive, painful, or debilitating corns or
calluses, proper but unsuccessful self care attempt, history of RA
Pharmacologic:
Salicylic acid is therapy of choice
o
12-40% plastic vehicle – apply directly and cover with pad
