Verrucae vulgares
Last Updated: 2021-11-19
ICD11: 1E 80
Last Updated: 2021-11-19
Author(s): Anzengruber F., Navarini A.
ICD11: 1E 80
Ciuffo, 1907.
Vulgar warts.
Frequent cellular infection with human papilloma (HP) viruses.
Division according to morphology and localisation
Special manifestations
Biopsy
HPV subtyping by PCR
Palmoplantar, on the backs of the hands, periunguinal and rarely on the tip of the nose.
Severe acanthosis, papillomatosis, hyperkeratosis, hypergranulosis, vacuolated cells, koilocytes, widening of the stratum granulosum (absent in condylomata acuminata).
Standard therapy:
Exacerbation stage I:
Step 1: Keratolysis, e.g. with salicylic acid patches, change every 3 days. At each change, warm soft soap bath and mechanical keratolysis (pumice stone, file) by the patient. Therapy duration: Approx. 14 days, depending on the thickness of the hyperkeratosis. Alternative: Salicylic acid and lactic acid solution: Apply twice daily with a spatula. AI: Use on the face, genital area, moles and hairy warts. Use in children from the age of 3 years.
Step 2: Mechanical removal by the patient after warm soft soap bath every 3 days.
Step 3: Cryotherapy (NO2 spray or sticks, 3x 5-10 seconds) and mechanical ablation. Performed by the nurse at every check-up. Control interval 14 days. Caution: Joint and tendon areas, immunosuppressed persons, diabetes mellitus, dark-skinned persons
Step 4: 5-fluorouracil & salicylic acid , 2x/d on the warts by the patient, contraindications: Pregnancy
Exacerbation stage II:
Diphenylcyclopropenone (DCP) or imiquimod
DCP procedure:
Step 1: Sensitisation on warts with DCP 0.5% in Duofilm, over which occlusive dressing for 24h.
Step 2: After 1 week, apply DCP 0.05% in Duofilm to the warts, over which an occlusive dressing is applied for 24 hours. Repetition by the patient 1x/week.
Step 3: Check and apply DCP 0.05% in Duofilm in the dressing room every 4 weeks.
Contraindications: Pregnancy/breastfeeding, vitiligo, children < 8 years old, dark-skinned
Imiquimod procedure:
Application 3x per week or until inflammation is clinically visible, maintain for 8-16 weeks.
Exacerbation stage III:
Nitric acid
Step 1: Keratolysis (see step 1 of standard therapy)
Step 2: Apply nitric acid solution to warts with glass pipette and rub in. Treatment every 3 weeks in the dressing room.
Step 3: Dabbing of treatment site with 80% alcohol 2-3x/d by patient.
Caveat: Treatment area should not be larger than 2 cm in diameter
Comments on individual therapies:
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