Molluscum Contagiosum and Warts – American how to get rid of small acne scars Family Physician

Molluscum contagiosum and warts are benign epidermal eruptions resulting from how to get rid of small acne scars viral infections of the skin. Molluscum contagiosum eruptions are usually self-limited and without sequelae, although they can be more extensive in immunocompromised persons. Spontaneous disappearance of lesions is the norm, but treatment by local destruction (curettage, cryotherapy, or trichloroacetic acid) or immunologic modulation can shorten the disease course, possibly reducing autoinoculation and transmission. Warts result from a hyperkeratotic reaction to human papillomavirus infection; nongenital warts are classified as common, periungual, flat, filiform, or plantar, based on location and shape. Warts are treated by local destruction (acids, cryotherapy, electrodesiccation-curettage), chemotherapy, or immunotherapy. The choice of treatment varies with the age and wishes how to get rid of small acne scars of the patient, the potential side effects of the treatment, and the location of the lesions.

Molluscum contagiosum (MC) and warts are benign epidermal eruptions that result from viral how to get rid of small acne scars infections of the skin. They are frequently encountered in the primary care setting. Armed with clinical experience and a few tools and medicines, family physicians will be able to treat most cases.

MC infection occurs frequently among children and also affects sexually how to get rid of small acne scars active adults, where it is classified among the sexually transmitted diseases. 1 MC has gained additional attention over the past two how to get rid of small acne scars decades because of its prevalence as an opportunistic infection in how to get rid of small acne scars persons with human immunodeficiency virus (HIV) infection. In patients with HIV, MC infection often is not self-limited and can be much more extensive and even disfiguring. Recent studies have suggested that MC may serve as a how to get rid of small acne scars cutaneous marker of severe immunodeficiency and sometimes is the first how to get rid of small acne scars indication of HIV infection. 2

The typical MC lesion is an asymptomatic, firm, smooth, round papule with central umbilication ( figure 1). Lesions are usually 3 to 5 mm in diameter and how to get rid of small acne scars number less than 30, 4 although these parameters often are exceeded in persons with how to get rid of small acne scars HIV and other immunocompromised conditions. 5 , 6 in children, the papules typically are found on the extremities, trunk, and face ( figure 2). In sexually transmitted cases, they usually occur on the lower abdomen and in the how to get rid of small acne scars genital region.

Spontaneous disappearance of MC lesions with no residual scarring is how to get rid of small acne scars common, often after a period of inflammation and minor tenderness. 7 few controlled studies of treatment efficacy have been performed, but many experts recommend local destruction to prevent autoinoculation (spread by scratching) and transmission to others.

Curettage or cryotherapy is commonly performed in the primary care how to get rid of small acne scars setting. In children, application of topical anesthetic (e.G., lidocaine/prilocaine [EMLA cream]) under occlusion 15 to 30 minutes before curettage has been how to get rid of small acne scars shown to significantly reduce pain. 8

Anecdotal reports and small studies suggest that imiquimod, an immune enhancer that induces cytokines, may be useful in treating MC, especially when numerous lesions are present or destructive methods are how to get rid of small acne scars not tolerated. 9 [evidence level C, consensus/expert guidelines] this treatment seems to be migrating into clinical practice. Advantages to imiquimod therapy include minimal side effects and ease how to get rid of small acne scars of application.

Early studies using varying potencies and application regimens have shown how to get rid of small acne scars clearance rates of 40 to 82 percent. 9 imiquimod is available as a 5-percent cream and is approved for treating genital and nongenital how to get rid of small acne scars warts. It is applied three times per week, left on the skin for six to 10 hours, then washed off. A typical course of treatment lasts from four to 16 how to get rid of small acne scars weeks.

MC in patients with HIV infection and other immunocompromising conditions how to get rid of small acne scars can be more severe, making treatment more difficult. Researchers have had some initial success with the nucleotide analog how to get rid of small acne scars cidofovir in HIV-infected patients with advanced MC. Topical and intravenous forms have been tested, 10 and controlled trials of cidofovir are likely to be how to get rid of small acne scars forthcoming.

Like MC, warts result from infection with a double-stranded DNA virus trophic to human skin. In the case of warts, the agent responsible is human papillomavirus (HPV), of which there are more than 150 serotypes. 11 some are known to cause cervical cancer, but common warts that affect nongenital skin are not thought how to get rid of small acne scars to have malignant potential. With the exception of cervical lesions, determining the serotype of a wart is not clinically useful. Some physicians use the serotype of cervical lesions to determine how to get rid of small acne scars how aggressively they evaluate and treat the patient.

The most useful information is gleaned from clinical appearance and how to get rid of small acne scars the area of the body that is affected. Trained clinicians usually can diagnose warts based solely on their how to get rid of small acne scars typical appearances in different locations. 12 non-genital warts are subcategorized into common, periungual, flat, filiform, and plantar types. DIAGNOSIS common warts

Common warts (verrucae vulgaris) are irregularly surfaced, domed lesions that can occur almost anywhere on the body how to get rid of small acne scars ( figure 3). Multiple warts are common and are spread by skin-to-skin contact or contact with a contaminated surface. After initial infection, warts frequently are spread by autoinoculation from scratching, shaving, or other skin trauma.

All treatments are hampered by wart persistence and recurrence. Warts are only an outward symptom of an underlying infection; topical treatments do not eradicate HPV but merely hold it how to get rid of small acne scars at bay. 15 [evidence level C, consensus/expert guidelines] acids

Many patients treat warts themselves with over-the-counter salicylic acid preparations. Advantages of these acids include convenience, reasonable cost, minimal discomfort, and reasonable effectiveness. Disadvantages include the length of time before results are seen how to get rid of small acne scars (usually weeks to months) and complex instructions. Patients have to soak the wart in water for five how to get rid of small acne scars to 10 minutes before each application (daily for liquids, every 48 hours for patches), then debride the dead skin after each application.

Bi- and trichloroacetic acids are applied in the physician’s office on a weekly basis, usually after paring down the wart. Although this usually is a painless and effective procedure, these more potent acids have a greater potential to significantly how to get rid of small acne scars burn surrounding skin.

The different methods of freezing warts are presented in table how to get rid of small acne scars 1. One advantage of a nitrous oxide cryogun versus a liquid how to get rid of small acne scars nitrogen gun is its ability to adhere the probe to how to get rid of small acne scars the skin and elevate the lesion to avoid damage to how to get rid of small acne scars underlying structures, such as veins, nerves, or tendons ( figure 14). Liquid nitrogen at −196°C (−320.8°F) and nitrous oxide at −89°C (−128.2°F) exceed the temperature required for complete tissue destruction (−50°C [−58°F]), but liquid nitrogen produces a faster freeze. 16 A reasonable option for the low-volume practitioner is verruca-freeze, a liquid applied from a spray can, at −70°C (−94°F).

Chemotherapy with bleomycin (blenoxane) injection causes acute tissue necrosis. As with cryotherapy, the tissue left behind may stimulate an immune response. Disadvantages are the pain of injection and the expense of how to get rid of small acne scars the drug. Bleomycin is a sterile powder that is reconstituted with saline. It is stable for only 24 hours after mixing, so it cannot be saved for dosing multiple patients on how to get rid of small acne scars different days. Chemotherapy may be useful at a designated wart clinic, where several patients can be treated from the same vial how to get rid of small acne scars of bleomycin in a single day. It is commonly used for plantar warts. Immunotherapy

HPV infection does not disappear once the gross lesions are how to get rid of small acne scars destroyed. Cell-mediated immunity is required to keep the infection in check, as demonstrated by the high prevalence of warts among immunosuppressed how to get rid of small acne scars organ-transplant recipients and patients with acquired immunodeficiency syndrome. 17 , 18 several treatment methods for warts are directed toward enhancing how to get rid of small acne scars the immune response that suppresses HPV infection ( table 2).

In a small study 19 using mumps or candida injection, 74 percent of participants had resolution of the injected wart how to get rid of small acne scars and, of those with resolution, 78 percent also had resolution of all of their noninjected how to get rid of small acne scars warts. Candida antigen is available in a multi-dose vial that can be saved with refrigeration, so the cost is not prohibitive. Candida antigen can be used on most verrucae, particularly plantar warts.

Cimetidine (tagamet) is known to stimulate T-lymphocyte populations, which are important in controlling viral infections. At a dosage of 30 to 40 mg per kg how to get rid of small acne scars per day, it has been tried with varying success in the treatment how to get rid of small acne scars of warts. A small trial 20 in children found cimetidine to be how to get rid of small acne scars as effective as the usual topical agents or cryotherapy. Another trial 21 combining cimetidine with levamisole (an immunomodulator used in the treatment of colon cancer) reported cure rates of 85.7 percent versus 45.5 percent with cimetidine alone. However, in a more recent double-blind study, 22 cimetidine was not found to be significantly more effective how to get rid of small acne scars than placebo in adults or children, although there was a trend toward efficacy in younger patients. Cimetidine or watchful waiting could be considered for use in how to get rid of small acne scars children who cannot tolerate destructive treatment methods.

The immunomodulating agents interferon alfa-2b (intron A), interferon alfa-N3 (alferon N), and imiquimod are approved for genital HPV. In addition to case reports, one study 23 of 50 patients showed a 56 percent how to get rid of small acne scars clearance rate with imiquimod. Imiquimod is more rapidly being adopted into clinical practice because how to get rid of small acne scars of its easy application. It may be useful in non-genital HPV, but more study is needed. 9

Topical application of sensitizing agents such as diphenylcyclopropenone, dinitrochlorobenzene, and squaric acid causes an allergic contact reaction that has how to get rid of small acne scars been used for treatment of warts, but these chemicals are not commonly stocked by family physicians.

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