Clinical Examples: Wart Curettage

Warts are common on the hand. They are thought to be due to viral mediated intradermal hyperkeratosis. Most warts involute spontaneously over an average of a two year lifespan, and are considered chronic after two years. Many treatment options exist, including topical irritants, oral cimetidine, electrofulguration, laser cauterization, cryosurgery and surgical excision. The proliferative process is intradermal, and local treatment with curettage under local anesthesia is often effective. This is a useful option for recalcitrant warts which either involve the eponychial fold or are mutifocal and confluent and is an alternative to excision and resurfacing with a skin graft or local flap. Curettage is also appropriate treatment for pyogenic granuloma. The following cases illustrate treatment of warts with curettage.
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Case 1.
Chronic palmar wart, base of small finger. Preop:
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Curettage, deep to the lesion, but still intradermal:
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After healing:
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Case 2.
Chronic periungual wart, middle finger. Index finger affected to a lesser extent. The difficulty with topical treatment here is involvement of the inner eponychial fold adjacent to the nail plate.
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Nail plates were removed to allow full access to curette the inner eponychial fold.
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Five years postop.
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