Viral Warts & Molluscumcontagiosum

What to consider in Primary Care before referring:

General Comments

Viral Warts and Verrucae

• These two viral induced lesions are common, especially in children, and are self-limiting.

• There are no easy or guaranteed treatments or magic cures and lesions are best left to resolve spontaneously.

• Greater than 60% of hand and facial warts clear within two years.

• Plantar warts tend to be most persistent.

Molluscum Contagiosum

• 90% of mollusca clear spontaneously within one year

Treatment in primary care

Viral Warts and Verrucae

• Use a high concentration salicylic acid preparation such as
  Occlusal
  Verrugon
  Salatac

• Instruct the patient that this should be applied daily after bathing and rubbing down the softened skin with pumice stone or sandpaper. This may need to be continued for many months.

Cryotherapy

• Best performed at one to three weekly intervals with two freeze thaw cycles, (hands 70% cure rate after four treatments, plantar warts 40%).

• If there is no sign of improvement after six –ten treatments then it is unlikely to be effective and should be discontinued.

• Do not treat small children under 10 years with cryotherapy.

• Higher cure rates with combined cryotherapy and topical agents.

Molluscum Contagiosum

• Treat associated eczema or impetiginisation with:
  Emollients
  Mild topical steroids +/– antibiotic therapy
  Crystacide

• Affected children should have their own towels to reduce the risk of transmission to siblings

• Individual lesions will resolve if the central core is damaged by any modality including cryotherapy but this is not recommended in young children, as it is too painful.

Referral Threshold

In general patients with viral warts/verrucae and molluscum should not be referred.

• Patients may be referred if:
  Severe disabling warts despite six months of topical salicylic acid treatment +/– cryotherapy.
  Significant warts or mollusca in immunocompromised patients.
  Facial Warts