Blast that Verruca! - To Treat or not to Treat?

Between 1 in 10 Australians suffer from warts at any given time more commonly under the age of 20. Warts are lumps of skin overgrowing caused by viruses. They are not dangerous but can be a real nuisance, causing pain walking on them or interfere with fine tasks if located on fingertips. Rarely if they are wide spread and treatment resistant mean a weak immune-system which the doctor excludes from history / blood tests. Warts are not very contagious and simple precautions prevent spread to others and from one part of your body to another one.
o When swimming, cover any wart with a waterproof plaster.
o If you have a verruca, wear thongs in communal areas
o Don't share shoes, socks or towels.
o Don't scratch warts.
o Don't bite nails / suck fingers with warts.
o With verruca, change your socks daily.

Warts usually disappear without treatment but sometimes last for several years. Treatment might speed up recovery. Management with the best supporting evidence are: Salicylic acid, Freezing (Cryo-)therapy, Duct tape.
Salicylic Acid has to be applied in the form of wart paint (gels, cream…) daily for weeks at end. It is best done to the soaked wart, dead tissue has to be regularly rubbed away (emery board, pumice stone). Rest with application if the skin gets inflamed or sore. Protect healthy skin with Vaseline or putting a zinc tape with a hole the size of the wart onto the lesion. Acid can be combined with Freezing for improved success. Salicylic Acid is cheap and readily available and well tolerated unless you have blood flow problems or suffer diabetes. Your GP can freeze , freeze-taw–freeze warts , taking a mean of 5 treatments usually. Freezing is no more effective than acid treatment, but maybe faster. Acid cures warts in 75% of cases, Cryo in 52% of cases. But more aggressive Cryo has more local side effects (blistering , burning, scarring) Warts heal with placebo treatment (not chemical active treatment ) in ca 30% after 10 weeks!
One promising study just using duct tape to cover the warts for six days in a row than soaking and rubbing it down again before covering it again cleared 7 in 10 warts.
A chiropodist/podiatrist can give great comfort with simple surgical treatments.
Third line treatments like cutting or curetting the wart out can change a lump for a bump , cause scarring , or even spread the wart if unskilfully done. There are lots of treatments on the market and used in surgeries and skin clinics, which have not been fully investigated but definitely cost a lot.

Helko Schenk
12 1 2009

Sources :
- Warts and Verrucas www.patient.co.uk
- James Murtagh “practice tips”, “patienteducation”
- www.gpnotebook.co.uk
- “Bandolier” oxford journal of evidence based medicine
- “Australian Family Practice – To freeze or not to freeze”

Summer , sun and serious skin problems

The great Australian work- and lifestyle comes with a price tag, not only on outdoor toys.
800,000 Australians see their doctor yearly for a skin cancer consultation, a huge burden ultimately to the taxpayer and all of us. Thanks to public health campaigns and increasing awareness, the sun-smart Aussie is for a long time now wearing a broad-brimmed hat, a long sleeve shirt and a high protection layer of sun screen. Skin cancer is rare in childhood but sunburn or excessive exposure to the sun in childhood is thought to be the biggest risk factor for developing skin cancer as an adult. Cancer is the disorganized and uninhibited aggressive growth of modified, previously normal cells, either damaging local structures or spreading to distant organs. Look out for each other - especially for lesions on the back of arms, neck and back. Should skin-lesions persistently change or grow over weeks and months, see your Doctor. 30% of melanomas develop from pre-existing pigmented moles.
ABCD rule of skin lesions
· Asymmetry - the shape of a cancer is often uneven and asymmetrical, not round and even.
· Border / edges of a cancer are often ragged, notched or blurred and not smooth and well-defined.
· Colour - the colour (pigmentation) of a cancer is often not uniform. So there may be 2-3 shades of brown or black.
· Diameter - cancer is usually larger than a normal mole, and continues to grow.

Cancers can start as small pink or pearly lumps on the skin. The lumps are often dome-shaped and grow at different speeds. The skin lump may crust over, form a crater and bleed sometimes. Other cancers start as a small crusted or scaly area, with a red or pink base, growing into a wart like lump.
Most skin cancers in Australia are managed by GPs, the best doctors in the world at recognising skin cancer, most are now using magnifying glasses, skin microscopes and cameras. GPs know when lesions are beyond their expertise and other doctors need to be involved. There are numerous computer programs claiming to diagnose skin cancer by linking software to a scanner. They are heavily marketed to the public. Slogans such as, ‘Be scanned be sure’ are grossly misleading. The evidence is, Patients are better off seeing their own GP or dermatologist if necessary.
So ask for a special skin check consultation with your Doctor at least once a year.
Dr. Helko Schenk

Kids , Nits , Lice and School rashes

Head lice, Warts, Ringworm and molluscum are by far the commonest presentation of skin problems in otherwise healthy children. Head lice, an infestation, presents often as itch, but can be symptom free, give away are the 1-4 mm sesame seed size life lice or the dandruff like nits (eggs of the female lice) which are different to dandruff cannot be brushed off, as they are tightly glued on. Wet combing (with a special tight nit comb) is effective in about 40% of cases. The use of insecticides (malathion , permethrin) based applications cures up to 80% infestations. It might be wise to study by pack-sheets and/or to discuss use with the pharmacist, as certain conditions (asthma / pregnancy …) will be contraindications. All family members have to be treated and treatment has to be repeated 7 -10 days later to kill surviving lice offspring. Cure is best confirmed by wet combing some days after 2nd treatment. Tea tree oil sounds a promising lice treatment, as it contains terpenoids a kind of neurotoxin to insects but safety of use or repeated use has never been formally investigated.
Another common endemic skin problem - typically in the up to 15 year olds - is impetigo or school rash in its honey crust or blistered pussy presentation. It is a highly contagious infection, which is normally treated with topical antibiotic creams if mild or systemic oral antibiotics if more severe. Topical antiseptic preparations might help by loosening the scab. Bedding and towels and all clothing require frequent change and personal hygiene special attention - very much like in head lice treatment.
Tinea of the head is a ringworm fungus presenting with localized baldness or blistery crusty head rash and requires review, testing and oral treatment by your GP.
Molluscum are also often run in school endemics. They are small blistery pink coloured lesions typically with a central crater or dent and filled with cheesy fluid. They are like warts caused by viruses. Single lesions only last for 8 weeks, but the disease carries on in average for 8 months. Cutting fingernails short and covering itchy lesions with plasters to avoid self spread are a good idea. Many treatments have been tried but lesions are best left alone as treatments have limited effectiveness can cause scarring and are often painful.
Warts are usually easily recognized mole like or embedded often hornified dry lesions. The most effective treatment remains simple salicylic acid in paint, creams, gels and plasters. Again other treatments might be promising but can like cryo-therapy for instance cause pain , burns and scarring and should be the exception rather than the rule for self limiting conditions ( they can last for years though)
Children with head lice should be kept from school til treated, Impetigo can return to classes when lesions are dry and healed. All other above mentioned conditions have no recommended school leave , sorry if you were hoping for the contrary.

Sources:- British Medical Journal, Common skin infections in children 2004
- www.gpnotebook.co.uk
- John Murtagh, General Practice, McGrawHill- www.dermatology.co.uk

Geraldton Medical Group
22 6 2009