Community Pharmacy

Pharmacy Role in the Self-Care of Warts

Pharmacists are likely to encounter patients seeking advice on the best self-care and self-treatment options for common warts and plantar warts (verrucae).

Most people will have warts at some time during their life. However, they are more common in school children and teenagers than in adults. It is estimated that 4-5% of children and adolescents will have them.

Verrucas are very common in children and teenagers – around one in three will get them. They’re actually warts on the feet, caused by the human papillomavirus, but they don’t look like normal warts because they’re pressed in.

Children tend to catch them more easily because their immune systems are not fully developed, and they’re more likely to have cuts and scratches on their skin where the virus can get in. Teenagers who play contact sports can also be particularly prone.

Warts are classified as noncancerous viral infections of the epidermis and mucous membranes that are caused by the human papilloma virus (HPV). At any given time, warts affect approximately 7% to 10% of the population.

Warts and verrucae are both caused by the Human Papilloma Virus (HPV). Certain types of HPV have an affinity for certain body locations, for example hands, face, anogenital region and feet.

Warts can look different depending on where they appear on the body and how thick the skin is. There are several different types of warts.

The more common types include:
 common warts
 plantar warts (verrucae)
 plane warts
 filiform warts
 periungual warts
 mosaic warts

The appearance of each type of wart will depend on several factors:
 where it is located on the body
 the strain (type) of HPV that is responsible for the wart
 factors such as whether the sufferers has a weakened immune system
 whether they have rubbed or knocked the wart

Warts are very contagious. The skin cells in warts release thousands of viruses, which means that close skin-to-skin contact can pass on the infection.

It is also possible for the infection to be transmitted indirectly from an object, such as a towel, or by contact with a contaminated surface, such as the surface surrounding a swimming pool. It can take weeks, or even months, for a wart or verrucae to appear after someone has caught the infection.

Verrucae
Plantar warts are found on the weight bearing areas of the sole and heel. Their appearance is different from the rest of the body owing to constant pressure imparted to the sole of the foot, causing the lesion to be pushed inwards.

Pressure of the nerve pain causes considerable pain and patients often complain of pain when walking. Tiny black dots that characterise verrucas are the thrombosed capillaries. This may not be visible until the hardened skin is shed away. They are distinguishable from corns as they have a whitened appearance and remain soft.

Corns appear as hard corns (top of toes) or soft corns (between toes). Callouses appear as flattened, yellow white thickened skin and are common on the balls of the foot. Like warts, they are 1cm in diameter and can occur singly or in crops.

Most pharmacies now have a consultation room. These should be utilised for performing examinations, allowing the patient to feel at ease, reduce embarrassment at the counter and make it more comfortable to remove clothing, if this is necessary.

Examinations can be performed in the consulting room without the need for any specialised equipment, however on occasions a magnifying glass may be useful. Distribution of warts is generally asymmetric, and lesions are often clustered or may appear in a linear configuration due to scratching.

 

Tips to Prevent Verrucas in Children
• Don’t let them go barefoot in public places
• Don’t let them use personal items that aren’t their own.
• Keep their feet dry whenever possible – the virus spreads more quickly on wet feet.
• Make sure any cuts or scratches are covered up if they’re going to any of the places mentioned above.
• Check their feet regularly.

Treatment Goals
Treatment goals for warts include effective removal that produces no scarring and prevents reoccurrence or spreading to other areas of the body or to another person. Certain patients, including those with diabetes, peripheral vascular disease, and immunodeficiency disorders, as well as those on immunosuppressive agents, should never attempt to use these products unless they have been referred to their GP.

Prior to recommending the use of products for self-treatment of warts, pharmacists should always make sure that self-treatment is appropriate. Since warts are contagious, patients should be advised to wash their hands before and after having direct contact with the wart to guard against transmission of warts to other areas of the body or to other people. In addition, patients should be reminded to use a separate towel for drying the area that contains the wart to prevent warts from spreading to other areas of the body. Patients should also be warned not to manipulate the wart in any way. If plantar warts are present on the bottom of the foot, patients should make sure the wart is covered when walking barefoot.

Pharmacists should always stress the importance of using wart treatments properly and note that they must be used for the duration indicated in their instructions in order to be completely effective. Patients should be told that perceptible results are typically observed within the first or second week of therapy and that complete wart removal typically occurs within 4 to 12 weeks of starting therapy.

Patients should be encouraged to seek medical care therapy if the wart remains after 12 weeks of therapy or if there are signs of infection, swelling, pain, or irritation.

Salicylic Acid Products
Products that can be used for self-treatment of common or plantar warts include plaster/pad vehicles that contain salicylic acid, collodion-like vehicles that contain salicylic acid and karaya gum–glycol vehicles that contain salicylic acid. Prior to recommending the use of these products, it is critical that pharmacists determine whether self-treatment is appropriate, first ruling out patients with any contraindications relevant to the use of salicylic acid. Other exclusions for self-treatment of warts include painful plantar warts, warts that occur extensively on 1 area of the body, and warts that occur on the face, fingernails, toenails, or genitalia.

Patients with these types of warts should be referred to a dermatologist for further treatment. In addition, topical
salicylic acid should not be used on irritated or infected skin.

Poor methodology is the reason why treatment sometimes fails. Compliance with treatment has also been identified as a limiting factor in the cure rate for warts and verrucae.

The affected area should be hydrated first by soaking in warm water for five minutes before application of a product containing salicylic acid.

It is very important in the management of warts and verrucae that good skin is protected. This can be achieved by applying petroleum jelly eg Vaseline on the surrounding skin followed by application of treatment on wart or verrucae.

Cryotherapy Products
These are best for warts on hands. Cryotherapy has been used for several years and it used to freeze the wart. OTC products, marketed as home cryotherapy treatments, are available for home use.

In offering guidance, patients should be advised to always adhere to the directions provided with these products, since improper use can cause damage to adjacent unaffected areas of the skin. Warts typically fall off 10 days after the application of the cryotherapy agent.

A persistent wart can only be treated 3 times using these products.

Formaldehyde is used for the treatment of verrucae. It is an irritant so is less suitable on hands. However, the thickened layer of skin on feet protects against this irritant. It is a gel formula.

Glutaraldehyde is also used for treatment of verrucae and should be used twice daily.

It is available in 5% and 10% percent strengths. It should not be used for anogenital warts only verrucae. It stains skin brown, although this is reversible.

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