Sunday, January 08, 2006

Suggestions for Wart Removal?

Dear Anak VGRD Members,

I am a G.P. trainee and have been having a hard time with a wart removal on a 3 year old's fifth toe. The difficulty is getting him to let anyone near it. I've seen him once, late in the day, and my preceptor asked that the child return for freezing with the help of sedation. We are now working on what to use. I prefer to avoid having to sedate the child, and have suggested duct tape in the interim (six days on, one day off with soaking). What suggestions or tricks would you have for treating a wart in this location in a three year-old? Thank you, Tammy Grimely, Hobart, Tasmania

4 comments:

  1. Thanks for posting. Not sure what has been tried so far. I would start with painless over-the-counter methods first, such as salicilic acid preparations & duct tape. Depending on availability, some people use topical immunotherapy in kids.

    Regards,
    Anatoli Freiman, MD

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  2. I would try 40% salicylic acid in petrolatum ungt nightly under duct tape. Would also consider topical tazorac, or oral cimetidine. There is no need to inflict pain on a child for a harmless self-resolving viral infection.

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  3. Dear Tammy,

    With any child (less than 10 years old) I take a very conservative approach. I explain to the parent that 85% of warts left alone will disappear within three years. If the lesions are not painful to the child they should probably not be treated. I see adults every week who tell me about the painful experiences they had as children with the burning and freezing of warts.

    It is said that pediatricians don't know that the warts will spontaneously disappear and dermatologists do know but pretend that they don't. The sad reality is that the CPT codes are much higher for procedures. So, a 1 minute procedure reimburses better than a 10 - 15 minute talk. This is insidious.

    If the child or parent insists on treatment. Then one can start with duct tape with occlusion. In young kids (from 4 - 10) suggestion and prayer may work. Hypnosis and biofeedback may work in older persons.

    The chief reason to treat a plantar wart is pain. Not just because a wart is there.

    In addition to duct tape, Mediplast with occlusion is a benign modality that is not painful.

    If you follow this approach, your billings will be lower, but your practice will be inflicting less pain on kids.
    General anesthesia to facilitate destruction of warts is a bit excessive. I can recall only one patient who we planned to use this for and her warts disappeared between the scheduling and the date of the procedure (suggestion!)

    I hope this is helpful.

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  4. I agree with colleageus that warts in kids often disappear spontaneously over time but warts could be cosmetically bad or painful or even infectious for other members of family.So treatment might be arranged like topical acids in different concentrations or 25%podophyllin in benzoin co.All these could be very helpful in short time.Still,in refractory cases,what ever you do, no responce.In these conditions,we might leave warts for selfrecovery.
    Oral zinc sulfate coud be used alone or with other therapies as immunomodulator as has been proved by many studies.
    khalifa sharquie Baghdad

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