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Viral Warts

Warts are common viral infections caused by the human papilloma virus (HPV). There are different strains which affect certain predominant sites
Warts can go away spontaneously in about 60 % of patients within about 2 years. However, during that time it is contagious and can spread.

How do we treat?

Over the counter

Topical salicylic acid via liquid or ointment, pads and tape

Prescription

Off label use of topical retinoids, imiquimod cream (labelled for treatment of warts in genital and perianal region from 12 years old and above), 5-fluorouracil cream to flat warts or warts on cosmetically sensitive areas

Destructive “in office” treatments

Paring and cryotherapy (or liquid nitrogen) every one to two weeks
Electrosurgery (if more superficial)
Carbon dioxide laser (if deeper, especially over thicker areas of the soles)

Molluscum are viral infections caused by a poxvirus. They cause small, flesh-coloured to pink bumps with a slightly depressed or umbilicated centre

Molluscum can go away spontaneously over months to years. However, during that time it is contagious and may be itchy. It may also become redder and more swollen when the immune system is trying to clear the infection.

How do we treat?

Prescription

Off label use of topical retinoids, to irritate the skin, and imiquimod cream can help trigger the immune system to clear the infection sooner

Destructive “in office” treatments

Curettage
– Helps to express the molluscum body

Cryotherapy

Cantharidin (derived from blistering beetles)
– Off label use
– Forms a blister within 24 to 48 hours

Pulsed dye laser 1-2
– Usually for multiple lesions
– Especially in immunocompromised patients

References

1. Hancox JG et al. Treatment of molluscum contagiosum with the pulsed dye laser over a 28-month period. Cutis 2003;71:414-416.
2. Forbat E et al. Molluscum Contagiosum: Review and Update on Management. Paediatric Dermatol. 2017;34:504-515.