Lawrence S. Neinstein, M.D., F.A.C.P.
Professor of Pediatrics and Medicine
USC Keck School of Medicine
Executive Director
University Park Health Center
Associate Dean of Student Affairs



Medical Problems - Dermatology - Skin Growths (B4)

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Probably the two most common skin growths in adolescents are warts and molluscum contagiousum.

plantar warts
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This lesion above is characteristic of plantar warts. These are painful lesions on the base of the feet. A couple of things to be thinking about. Obviously calluses could look something like this. However, these are plantar warts. Two things to help in differentiating these two. Calluses can have the skin lines/folds continuing into the lesions, warts do not. In addition, if you pare down the area a little of the hyperkerototic areas, you will find black dots in the lesion. These are the thrombosed capillaries characteristic of plantar warts.

Treatment: All warts including plantar warts have many types of treatments that all usually have about a 70 to 80% efficacy. About 50% or more of cure relies on the individuals own immune system. Treatment can be very simple for plantar warts and includes paring them down if they are very thick. The patient can then buy salicylic acid pads (mediplast pads) and cut them out to the size of the wart. These can be put on for about 24 hours. Several days later, the teen can debride the area with a pumice stone or metal debriding tool. This can be repeated twice a week. Usually over the course of several weeks the warts will resolve.

Below is also a common wart on an extremity. As mentioned above there are many ways to cure warts including cryotherapy with liquid nitrogen, electrodesiccation, trichloroacetic acid, podophyllin, imiquimod 5% and laser surgery.

common wart
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The two slides below demonstrate one more common growth in adolescents. This is molluscum contagiosum

molloscum contagiosum
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molloscum contagiosum
click for full-size image

Molluscum contagiosum is a skin disease caused by a member of the poxvirus group. The condition is transmitted by direct person-to-person contact, with a 30-day to several month incubation period. It can also be spread by autoinoculation. It can occur frequently in adolescents on the inner thigh secondary to transmission during sexual intercourse. It is most commonly on the face, arms, legs and chest and in sexually active adolescents on the genital and pubic areas. The lesions are firm, flesh - colored, raised, waxy, dome-shaped, globular nodules with central umbilication. There are usually less than 20 lesions that are about 3-7 mm in diameter. Inside the molluscum lesion there is an expressible cheesy material that on potassium hydroxide preparation shows intracytoplasmic inclusions (molluscum bodies)

Treatment: Unroofing of the lesion or expression of cheesy material or application of TCA or podophyllin to base is usually curative. Topically applied 1% imiquimod cream has also been shown to be effective. The teen should be rechecked in about 30 days for any new lesions that may have been incubating at the time of the initial treatment.

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Copyright (©) 2004-2013 Lawrence S. Neinstein, University of Southern California . All rights reserved. Republication or redistribution of the text, table, graphs and photos is expressly prohibited. The University of Southern California shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.