Predisposed patients depressed immune system skin maceration previous wart bite

Predisposed patients depressed immune system skin

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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
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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
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