DermHelpCentral

Close to Half of American Adults Infected With HPV

A recent report from the CDC shows that more than 42 percent of Americans between the ages of 18 and 59 are infected with genital human papillomavirus.

FULL NY TIMES ARTICLE

The CDC report on Prevalence of HPV Infections in the U.S. (published April 2017) is an important resource that covers our present state of knowledge.

Two vaccines are effective in preventing sexually transmitted HPV infection, and researchers said the new data lend urgency to the drive to have adolescents vaccinated. [This will be used by the companies that produce the vaccines as a potent advertising tool]

HPV usually is spread through direct contact with infected genital skin or mucuous membranes during intercourse or oral sex. Over 90 percent of HPV infections are cleared by the body within two years.

Testing: There is no HPV test for men at all. A test for women is sometimes used in conjunction with a Pap screen for cervical cancer.

This is important information and the CDC report is the best information we have.  At least the CDC is not in the business of marketing vaccines or treatments.  The best we can do, at this time, is to immunize children.  Not all of the public will be able to afford the vaccine and in some areas it is not a covered benefit for men.  This may change.

A potential fall-out from the report is that it will foster health anxiety and promote cyberchondria.  It may cause a spike in "venereophobia."  Time will tell.

Candida Antigen for Warts

There’s a lot of experience out there now to suggest that Candida truly does work, but you’ve got to be aware of side effects," said Dr. Friedlander, professor of clinical pediatrics and medicine at the University of California, San Diego.

Articles in the medical literature suggest injecting up to 0.3 cc of Candida antigen directly into the substance of the largest wart. "Who are they kidding?" she scoffed. The wart would have to be a giant one to hold that much. "Get what you can directly into the wart," she suggested.

FULL ARTICLE.

See: Candin for ordering.

 

 

Liquid Nitrogen Treatment

Prepared by Rhianna Flanagan, Massachusetts College of Pharmacy

Liquid nitrogen (LN₂), sometimes called cryotherapy, a cold, liquefied gas with a temperature of 196° below Celsius (-321°F),  is used primarily to freeze and destroy superficial skin lesions such as warts and  keratoses.  It causes stinging and mild pain as the growth is being frozen and then thaws.  The discomfort usually lasts a few minutes when keratosis are being treated, but considerably longer when it is warts, since warts need to be frozen for longer than keratosis.

After LN₂ treatment your skin will become swollen and red; it may even blister. Then a scab (crust) will form. It will fall off by itself in 1 - 3 weeks. The skin growth will come off with the scab, leaving healthy new skin.

No special care is needed after the liquid nitrogen treatment. Just ignore it. You may wash as usual and use makeup and other cosmetics. If your clothing irritates the area, cover it with a small bandage..

Sometimes the cryotherapy treatment fails. If the growth is not cured by LN₂ , please make a return appointment.

See handouts on warts and actinic keratosis.

HPV Vaccine: Relevant Facts

Dr. Mike Evans and the Campaign to Control Cancer are very proud to launch a new video explaining the relevant facts and ideas behind the HPV vaccination.

“There is a lot of conflicting information out there, we want to present the facts in a simple way allowing people to make their own decision.”

This video is valuable viewing for persons considering being vaccinated or having their kids vaccinated:  Should You Get the HPV Vaccine?

Other health videos by Mike Evans.

Dr. Hansen's "Ouchless Wart Treatment

Warts can be difficult and painful to treat to treat, especially in young children.  Some years ago, I saw a piece about a technique devised by Dr. Ronald C. Hansen, of the University of Arizona in a throwaway journal describing a painless wart therapy.  It explained office treatment, but can be modified for home therapy.

Please print out the document   or you can read it here: Download Ouchless

If the pain associated with wart cryosurgery (liquid nitrogen) or electrosurgery has made you or your child shy away from all forms of wart therapy, Dr. Hansen’s "Ouchless" alternative may be a great thing to try. The treatment is a 40% salicylic acid plaster that can remove even the largest of commons warts, he said.  "This is a terrific treatment for isolated warts on the fingers and toes," he said.  It is also one of the few skin treatments that call for multicolored duct tape. 

The 40% salicylic acid plasters are available over-the-counter.  Mediplast, Dr. Scholl’s Clear Away, and Salicylic Acid Wart Remover are commonly available brands.  Dr. Hansen had little success using the manufacturer's directions, andhe suggested you throw them out and follow his instructions:

• Soak the wart in warm water for a timed 15-20 minutes. 
• Using a 3-mm disposable curette, trim off close to two-thirds of the wart and the surrounding callus.  This procedure will be painless for the patient. 
• Cut the salicylic acid plaster to the size of the wart plus 2-3 mm.  Remove the backing, and stick it to the wart.  Without fail, the adhesive on the plaster will not be strong. 
• To counteract this, you can apply benzoin or athletic adhesive (Mastisol is what Dr. Hansen uses) to the adjacent area, and wrap the area in common duct tape.  Although some children like the classic silver duct tape, it is also available in a variety of colors that may appeal more to children. 
• Because you want the salicylic acid to digest the wart, leave the plaster on for 5-7 days before you apply a new one.  If the compress gets dirty, tell them to apply more duct tape to cover the dirt.  If it gets wet – no problem; maceration assists the action of the salicylic acid.  After three or four treatments, the wart will be asymptomatic at least and probably cured. 

Mediplast for Plantar Warts

(Taken from the University of Wisconsin Dermatology Web Site)

Here's a pdf:  Download Mediplast for Plantar Warts This is a great treatment since it is not painful. It is at least as effective as other treatments; but takes a bit longer.

The doctor would like you to use Mediplast® for your child’s warts.  Mediplast® is a plaster that is soaked with 40% salicylic acid.  When wearing the plaster, the acid slowly and painlessly leaches out onto the skin below.  This kills the skin cells that harbor the wart virus.  This is a very good way of getting rid of warts.  Even if another treatment is being used (for instance, the pulsed dye laser), using this plaster speeds the process of thinning the wart and any callus that has formed around it.

Where do I get it?
Mediplast® does not need to be prescribed.  You can find it at any local drugstore.  Often, you will need to ask the pharmacist for the product.  It may be kept behind the counter instead of on the shelves.  If they do not have any Mediplast, ask them to order it for you.  You may wish to call ahead to see if it is in stock.

How do I use it?
Mediplast® comes as a sheet, wrapped in paper.  When you remove the sheet from the wrapper, you will notice that one side is fuzzy and the other is paper.  Cut a circle just slightly bigger than your child’s wart, remove the paper backing, and place the sticky side down on the skin.  If there are a group of warts, cover the entire area with a larger piece of Mediplast®.  You should then take a sturdy, water-resistant tape, such as duct tape, and wrap around the toe, foot, finger, etc.  You can also use black electrician’s tape if the warts are on the toes or fingers.  This tape is thinner and slight stretchy.  Trainer or athletic tape is ok to use as well, but it tends to get soggy after showers.

Apply the Mediplast® and tape on Monday morning and leave it in place until Friday afternoon or night.  It is okay to shower, etc.  If the tape falls off, it is okay to keep using the original Mediplast® piece and just replace the tape.  Although the package says to change the Mediplast® daily, we’ve found that it works best if left in place for 4 to 5 days. You may shorten the treatment to 3 days if it causes too much irritation.  When you remove the plaster, the skin below will be very white and soft.  File the area of white, soft skin with a nail file or a pumice stone.  These can be bought in the nail care aisle at the drug or grocery store.  File the area until all the white, dead skin is removed or until it is painful. Sometime over the weekend, soak the wart in warm water for 5-10  minutes and repeat the same filing process as described above.

Monday morning, re-apply a new piece of Mediplast® covered with tape.  Repeat the process for the next week.  Do this weekly until your next visit, or until the wart is gone.  Follow up with your dermatologist  in 4 weeks or as instructed to check your progress.

Zinc Sulfate for Resistant Warts

A recent study in a major journal has shown the efficacy of zinc supplementation for recalcitrant warts. After a 2-month course of treatment with zinc sulfate, a response rate of 78.1% (25/32 patients) was achieved. The mean serum zinc level in patients who responded to treatment increased to 199.7 ± 19.9 μg/100 mL, while in the remainder, the mean serum zinc level was 73.5 ± 9.2 μg/100 mL After 6 months of follow-up in those who received oral zinc therapy and responded to the treatment, no instance of recurrence was noticed.

The study is from Iran and needs to be repeated, however, this is a safe therapy with little risk.  An Iranian colleague told me that low serum zinc is not unusual in his country.  On the skeptical side, we remember similar optimism twenty years ago with reports of the effectiveness of oral cimetadine.  It never panned out.

Full article starts at the bottom right hand corner of first page of pdf: Download Zinc and Warts

Duct Tape for Warts

Here is a PDF on Duct Tape for warts.
Download DuctTape.pdf

Update: February 3, 2012:  Recent MedScape Post on Duct Tape and Warts.

 

Molluscum

It's a common scenario.  A mother brings in a young child with a number of (usually) asymptomatic bumps on the torso, extremities, or face.  Often, they know the diagnosis, sometimes not.  These are molluscum contagiosa, a common, benign, self-limited viral infection of children.  For a brief overview, go to DermNet

It is our feeling that these lesions are vastly over-treated.  The disease poses no threat to the child, the therapies can be painful or can take weeks to months, and the disorder runs its course over time.  It is likely that if one lets nature take her course life-long immunity ensues.  Aggressive therapy may prevent this and set the scenario for molluscum to recur when a child becomes sexually active.  At that time, molluscum are more psychologically troublesome.

For an indepth discussion, Prodigy Guidance is super.

You may feel differently and want your child treated.  This is your decision and you should discuss your goals with your pediatrician or dermatologist. 

Warts

WARTS AND ALL

Warts are benign growths on the skin which are the result of a specific viral infection. Although they may occur at any age, they are most common in the 10-20 year-old age group. It is estimated that 10% of teenagers have warts. Almost everyone will get one or more warts in their lifetime. As with other infections, warts may be transmitted from one individual to another. They may also be contracted from inanimate objects (for example, the cements around a swimming pool).

Warts may occur on any location of the skin. In different locations, they have different appearances. This accounts for the many confusing names given to warts. For instance, the plantar warts are merely warts found on the soles (plantar area) of the feet.

"The strangest thing about warts is that they tend to go away. Fully grown, nothing in the body has so much the look of toughness or permanence as the wart, and yet, inexplicably and often very abruptly, they come to the end of their lives and disappear." *Warts resolve because the body's immune response destroys them as it does with other infections. Thereafter, an immunity to the wart virus develops. Because warts vanish without treatment in most cases, the routine treatment of every wart is unnecessary and undesirable.

In general, the therapy of warts is nonspecific, destructive, and often painful. For these reasons, it is often wise to proceed slowly and with gentle methods at first, especially in children. Some of the methods we use are the destructive chemicals (Duofilm, Canthardin, and for genital warts, Podophyllin). Liquid nitrogen, an electric needle, and Zonas tape occlusion. Some people believe suggestion or hypnosis may cure warts. No matter what treatment, 1 in 3 treated warts will recur. However, in most cases, after a few treatment sessions, the patient will be free of warts.

*From : "On Warts : Lewis Thomas, The Medusa and the Snail