WASHINGTON, D.C. Just because a kid has a wart does not mean it needs to be removed, according to Bernard Cohen, MD, who spoke here at a meeting of the American Academy of Dermatology.
The best treatment might be just watchful waiting and education about how to avoid autoinoculation and transmission to family members. "Why treat? That is the first question you have to address with the family. I think that in most patients pain is not an issue; it's usually the parents who perceive the pain, and the kids are not symptomatic. Certainly, it's a psychosocial disaster; that's why they're in your office," said Cohen, who is director of pediatric dermatology at Johns Hopkins Children's Center in Baltimore.
Throughout history, there have been many folk methods to cure warts. In Mark Twain's The Adventures of Tom Sawyer, Huck recommends taking a dead cat to the graveyard after someone wicked has been buried. At midnight, the person with warts should say "Devil follow corpse, cat follow devil, warts follow cat, I'm done with ye!" Huck's remedy for warts if done for three years would probably work.
Cohen named several other "remedies" that work, from hypnosis to garlic. "Garlic is extremely effective. I find if you make a necklace of garlic, it reduces the risk of spread of the other children and siblings in the household," he joked.
These remedies "work" because most warts will resolve on their own, which is why waiting and education may be all that is needed. However, concern about spreading the virus either to other parts of the body or to family members, and parental demand may tip the scales in favor of treating.
Over-the-counter treatments, such as Compound W, DuoFilm, Trans-Ver-Sal (salicylic acid compounds with or without adhesive tape) are fairly effective against common warts. However, they take awhile to work, decreasing compliance. "Keratolytics can be done at home, they are over-the-counter, which may be a downside to us. They are relatively painless, don't make scars, but they are slow, and to many patients and parents, they are not fast enough for them, so they don't follow through and they don't comply," he said.
If a parent does not want to use an OTC treatment, the pediatrician can treat common warts in his or her office using a destructive technique. The destructive techniques, such as liquid nitrogen or the CO2 laser, can be difficult to do on squirming young children. "The nice thing about destructive techniques is that you do get immediate gratification. In a single, isolated, well-defined lesion that you can freeze adequately, destroy adequately, your success rates may exceed 50%. Pain is an issue, recurrence is an issue, and scar is an issue, so in younger children it may not be a practical consideration," he explained.
Single lesions can be treated safely and easily in the pediatrician's office with cryosurgical equipment, such as Histofreezer. If a child has multiple lesions or is immunocompromised, however, he or she probably should be referred to a dermatologist.
Presented at the American Academy of Dermatology 54th annual meeting, Feb. 10-15, Washington, D.C.
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