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Home , Wart

Warts and All….

By Lisa Kimmey-Walker, MSN, RN, CPNP, a Pediatric Nurse Practitioner with the Memorial Hermann Health Centers for Schools in Houston, Texas and Laura Brey, MS, Associate Director National Assembly on School-Based Health Care

We conclude the three part series of Pediatric problems with a review of Warts and . Both are caused by and can be handled with the body’s immune system given time. However, “benign neglect” or “watchful waiting” are not the management plans of choice for parents, students or school nurses in this fast-paced instant results society. Warts may last up to 18 months and Molluscum as long as three years.

Let’s start with common and plantar warts. Human one, two, four, and seven causes common warts with HPV 1 causing plantar (bottom of feet) and palmar (palms of hands) warts also. It is spread by both direct and indirect contact (shoes) and can be promoted by local trauma (picking, rubbing in shoes). The incubation period is between one and six months from exposure to noticeable wart. Sometimes it is hard to tell if it’s a or a wart. Clinical Tip: With warts the natural lines of the skin are disrupted.

Warts are thermolabile or heat sensitive. With traditional over-the-counter or prescription wart medications, effectiveness is increased when the wart is soaked in warm water for 10 minutes before applying the medication. An emery board can be used to scrape the wart surface and facilitate penetration of the medication. Adhesive or duct tape can be applied over the wart once the medicine has dried and left on for 24 hours. Tape can also be reinforced and removed weekly dependent on the medication schedule.

Alternative therapies include hyperthermia and cimetadine. With hypothermia, the wart is immersed in hot water (113ºF) for 30-45 minutes two to three times a day for ten treatments. Cimetadine (Tagamet) has been used to stimulate the immune system’s production of killer T cells to eradicate the virus. It is dosed at 20 mg per pound of body weight three times a day with a maximum of 800 mg per dose for 4 to 6 months. using liquid nitrogen or may be needed to remove the wart’s layers.

Molluscum Contagiosum is caused by the poxvirus: humans are the source. The virus incubates from two weeks to six months. The lesions can be pearly white or flesh colored, look waxy and are umbilicated (indented in the center resembling a belly button). Depending on the number of lesions (few to hundreds), children may pick themselves to a cure. This is the same idea as using a curette in a clinical setting to remove the lesions by “popping them out” one by one. Topical medicines that can be applied to base of lesions include , trichloracetic acid (TCS) 30%, or tretinoin (Retin A) gel. If there are a few lesions at least one cm apart, cryosurgery maybe an option.

NASBHC ● 666 11th St., NW Suite 735, Washington, DC 20001 202-638-5872 ● www.nasbhc.org

Warts tend to be a recurrent problem. Both the HPV and poxvirus remain in the body after treatment. The immune system usually controls the poxvirus, preventing future outbreaks. As with any skin problem, education and support is key to a successful treatment plan. With children and adolescents in the school setting, we also have to consider the social impact of the problem and the chosen solution. Location and recurrence of the problem factor into decisions on the best treatment for each person. For example, a painful on a basketball player’s foot will need to be treated in the quickest manner to enable participation new athletic shoes maybe recommended.

Websites:U U

American Academy of Dermatology (Check out the Kids’ Connection)

www.aad.orgHU UH

University of Iowa College of Medicine Department of Dermatology (pictures)

http://tray.dermatology.uiowa.edu/DermImag.htmHU UH

Lisa Kimmey-Walker, MSN, RN, CPNP Pediatric Nurse Practitioner/Manager Memorial Hermann Health Centers for Schools-Lamar Clinic Rosenberg, Texas

NASBHC ● 666 11th St., NW Suite 735, Washington, DC 20001 202-638-5872 ● www.nasbhc.org