Dermatofibroma

• Dermatofibroma - syn. histiocytoma (PCDS)

Epidermoid/Sebaceous cyst

• Epidermoid cyst - syn. epithelial cyst. Sebaceous cyst is a misnomer (PCDS)

Ganglion

• Ganglion (PCDS)

Haemangioma

• Haemangioma and other vascular tumours and malformations (PCDS)​

​Keratoacanthoma

• Keratoacanthoma (PCDS)

Lipoma

• Lipoma (PCDS)

Pilar cyst

• Pilar cyst - syn. trichilemmal cyst (PCDS)

Pyogenic Granuloma

• Pyogenic granuloma (PCDS)

Warts & Verrucas

• Common warts: mainly due to HPV2, firm papules with a rough surface

• Plantar warts / verrucas: see Foot & Ankle

• Plane warts: Tend to occur on face and backs of hands, often numerous

• Filiform warts: Most commonly found on face and neck in men. Have a filiform appearance and may have a stalk

• Anogenital warts: Usually multiple. Condylomata acuminata. May appear pearly, filiform, cauliflower, plaque-like, smooth, verrucous or lobulated. Skin coloured or pigmented. Check for other STI but not always sexually transmitted. Refer GUM clinic.

Management options

• No treatment: up to 90% of warts in young children will resolve in 2 years

• Pairing reduces discomfort: soak in warm water for 5-10 minutes. Pair away dead skin using disposable emery board / nail file. Repeat once/twice per week

• Topical salicylic acid preparations

• Duct tape

• Curettage and cautery, laser, cryotherapy (generally ineffective for plantar warts)

• Other treatments: 5% Imiquimod cream (Aldara) may help in cases of persistent facial warts (off-label); Efudix (5-FU cream); topical retinoids

A 15-year-old boy has warts on his hands. You discuss first-line treatment with his mother and she asks about success rates with such treatment. Which ONE of the following percentages would MOST LIKELY represent the proportion of simple hand warts persisting beyond six months of first-line treatment?

• 10%

• 30%

• 50%

• 70%

• 90%

Up to one-third of non-genital warts will become recalcitrant (defined as persistence at six months despite five or more cycles of first-line treatment).

Second-line treatment – if needed – includes topical therapy such as imiquimod, intralesional injection or destructive treatment.

References

• Warts and verrucas (NHS Choices) / Warts and verrucas (patient.info) / Warts (PCDS) / Warts and verrucae (CKS), Salicylic acid (BNF)

• British Association of Dermatologists’ Guidelines for the management of cutaneous warts (BJD 2014)

• Topical treatments for skin warts. (Cochrane Database of Systematic Reviews 2012)