May 9, 2019
In this episode, Vincent
DeLeo, MD, talks to Nanette
B. Silverberg, MD, about the successful management of
warts in the pediatric population. Warts are superficial viral
infections of the skin that are extremely common in children and
account for a large proportion of pediatric dermatology office
visits. Although over-the-counter treatments for warts are widely
available to patients, they are not universally effective. Dr.
Silverberg outlines a detailed treatment paradigm for managing
pediatric warts and reviews a variety of new and established
treatment options in six therapeutic categories. She also reviews
the latest human papillomavirus (HPV) vaccine recommendations for
We also bring you the latest in dermatology news and
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Things you will learn in this episode:
- Warts are benign epidermal lesions caused by infection with
HPV, which replicates in skin cells to induce a state of
- There are more than 200 types of HPV, and warts have variable
clinical and histologic features depending on type and
- The incidence of pediatric warts appears to peak in
- Children with atopic dermatitis may be at higher risk for
developing warts and other extracutaneous infections. Warts in the
setting of AD may indicate that a child is prone to other
dermatologic or allergic conditions.
- Most warts in children are transmitted in close household,
classroom, or sports settings. Evaluation for signs of sexual abuse
always is warranted in children presenting with condyloma.
- Dermatologists should be aware of respiratory complications
associated with HPV infection in children.
- The majority of warts likely will spontaneously resolve, but
those that spread or do not resolve following observation or
traditional therapies may require alternative treatment
- Treatment options for pediatric warts generally fall into six
therapeutic categories: destructive, immune stimulating, immune
modulating, irritant therapy, vascular destructive, and nitric
- The therapeutic ladder for warts in children consists of seven
rungs, beginning with diagnosis. If the clinical presentation is
not clear, suspected warts should be biopsied prior to treatment to
avoid unnecessary procedures or exacerbation of the condition.
Avoid painful procedures in children.
- The most recent HPV vaccine offers broad protection and should
be offered to both girls and boys before they become sexually
active. The dosing schedule should be reviewed with the
Cohosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD
(Keck School of Medicine of University of Southern California, Los
Guest: Nanette B. Silverberg, MD (Icahn School of Medicine at
Mount Sinai, New York, New York)
Show notes by Alicia Sonners, Melissa Sears, and Elizabeth
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