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 children.

We also bring you the latest in dermatology news and research:

1. Sunscreen ingredients found in bloodstream, but health impact unknown.

2. Females with acne stay on spironolactone longer than antibiotics in real-world usage study.

3. Employed physicians now outnumber independent doctors.

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 hyperkeratosis.
• There are more than 200 types of HPV, and warts have variable clinical and histologic features depending on type and location.
• The incidence of pediatric warts appears to peak in preadolescence.
• 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 mechanisms.
• Treatment options for pediatric warts generally fall into six therapeutic categories: destructive, immune stimulating, immune modulating, irritant therapy, vascular destructive, and nitric oxide releasing.
• 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 pediatrician.

Cohosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of University of Southern California, Los Angeles)

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 Mechcatie.

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