Tuesday, September 03, 2019

Wart in a 9 y.o. girl

The patient is a healthy 9 year-old girl.  Her pediatrician referred her for a two-year history of a wart on the right middle toe after the child could not tolerate cryosurgery.
On questioning, the child states that the wart rarely bothers her.  She can walk and run without discomfort. 

My advice was to leave it alone as it will probably regress over time.  I discussed how this occurs with the girl and her grandmother.

Would you treat this?  And if so, how?

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  1. It appears to be a multiloculated verruca. You might consider offering a course of oral cimetidine, which sometimes works. Watchful waiting is certainly another option.

  2. Robert Shapiro, Hilo Hawaii: Intralesional candida, plus LN2, plus aldara. Hit it with everything.

  3. I would use DNCB monthly till gone.
    No pain and effective.
    Need to sensitize on the first visit.

  4. If they want to treat it — which by no means is necessary— I like sal acid plasters and 5-FU. The compounding pharmacy Nucara makes a nice one, WartPeel.

  5. Bhushab Kumar, Chandigarh, INdia: " Interestingly varied comments on a common problem. Asymptomatic nature of lesions should not prevent us from prescribing treatment – because the wart(s) are going to spread and also enlarge before regressing or self healing- which may take months.

    Cimetidine alone does not seem to work, using a process to chemically sensitize the child for treatment is not devoid of risks. Intralesional candidin, bleomycin, BCG, PPD etc. are painful and not always effective.

    We use Formalin soaks (1:4 dilution of Formalin (35% w/w CH2O) of with water) for 10-15Min 3-4 times per week and additionally apply Salicylic Acid(17%) collodion flexi paint after soaking in formalin and then gently scrapping the now softer wart surface.

    It takes about 4-5wks and sometimes heals even earlier.

    More aggressive procedures like fulgration, laser therapy and surgical removal and not usually recommended.

  6. From Dato Ong Cheng Leng. Malaysia, "Thank you for a very practical problem for us to consider or reconsider our therapy.

    Natural history of common viral warts is they’re self limiting as the host immunity picks up to destroy the human papilloma virus. The only problem is we won’t know when that will happen, and parents need to be treated more than the child, as they won’t go home without anything done..

    To do anything especially cryotherapy is very unfair to our little friends. It’s very painful, especially periungal ones, and can thus result in an iatrogenic condition, the “ white coast phobia”.
    Let’s be champions of these quite defenceless little ones, and persuade their parents to leave them alone. If they request or agree, I’ll even pray for healing in the name of Lord Jesus Christ!
    To do anything else can be worse, eg surgical removal and diathermy can be more painful but not more successful and may leave behind permanent scars even if healed.

    Save our children!


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