Part 56

This is the common wart, occurring mostly upon the hands. It is rounded, elevated, circumscribed, hard and horny, with a broad base, and usually the size of a pea. At first it is smooth and covered with slightly thickened epidermis, but later this disappears to some extent, the hypertrophied papillæ, appearing as minute elevations, making up the growth. One, several or more may be present.

#Describe verruca plana.#

This is the so-called flat wart, and occurs commonly upon the back, especially in elderly people (verruca senilis, keratosis pigmentosa). It is, as a rule, but slightly elevated, is usually dark in color, and of the size of a pea or finger-nail.

#Describe verruca plana juvenilis.#

The warts are mostly pin-head in size, flat, but slightly elevated, rounded, irregular or square-shaped, and of a light yellowish-brown color. They bear resemblance to lichen planus papules. They are apt to be numerous, often becoming aggregated or fused, and occur usually in young children, and, as a rule, on the face and hands.

#Describe verruca filiformis.#

This is a thread-like growth about an eighth or fourth of an inch long, and occurring commonly about the face, eyelids and neck. It is usually soft to the touch and flexible.

#Describe verruca digitata.#

This is a variety of wart, which, especially about the edges, is marked by digitations, extending nearly or quite down to the base. It is commonly seen upon the scalp.

#Describe verruca acuminata.#

This variety (venereal wart, pointed wart, pointed condyloma), usually occurs about the genitalia, especially upon the mucous and muco-cutaneous surfaces. It consists of one or more groups of acuminated, pinkish or reddish, raspberry-like elevations, and, according to the region, may be dry or moist; if the latter, the secretion, which is usually yellowish and puriform, from rapid decomposition, develops an offensive and penetrating odor. The formation may be the size of a small pea, or may attain the dimensions of a fist.

#What is the cause of warts?#

The etiology is not known. They are more common in adolescent and early adult life. Irritating secretions are thought to be causative in the acuminated variety. It is highly probable that a parasitic factor will finally be demonstrated. They are doubtless mildly contagious.

#State the pathology of warts.#

A wart consists of both epidermic and papillary hypertrophy, the interior of the growth containing a vascular loop. In the acuminated variety there are marked papillary enlargement, excessive development of the mucous layer, and an abundant vascular supply.

#Give the treatment of warts.#

For ordinary warts, excision or destruction by caustics. The repeated application of a saturated alcoholic solution of salicylic acid is often curative, the upper portion being pared off from time to time. The filiform and digitate varieties may be snipped off with the scissors, and the base touched with nitrate of silver; or a ligature may be used. Curetting is a valuable operative method. The growths may also be removed by electrolysis. When warts are numerous and close together parasiticide applications can be daily made to the whole affected region. For this purpose a boric acid solution, containing five to thirty grains of resorcin to the ounce, and Vleminckx's solution, at first diluted, prove the most valuable.

Verruca acuminata is to be treated by maintaining absolute cleanliness, and the application of such astringents as liquor plumbi subacetatis, tincture of iron, powdered alum and boric acid. The salicylic acid solution may also be used. In obstinate cases, glacial acetic acid or chromic acid may be cautiously employed.

#Nævus Pigmentosus.# (Synonym: Mole.)

#Describe nævus pigmentosus.#

Nævus pigmentosus, commonly known as mole, may be defined as a circumscribed increase in the pigment of the skin, usually associated with hypertrophy of one or all of the cutaneous structures, especially of the connective tissue and hair. It occurs singly or in numbers; is usually pea-, bean-sized or larger, rounded or irregular, smooth or rough, flat or elevated, and of a color varying from a light brown to black; the hair found thereon may be either colorless or deeply pigmented, coarse and of considerable length. It is, as a rule, a permanent formation.

#Name the several varieties of nævus pigmentosus met with.#

Nævus spilus, nævus pilosus, nævus verrucosus, and nævus lipomatodes. So-called linear nævus might also be considered as belonging in this group.

#What is nævus spilus?#

A smooth and flat nævus, consisting essentially of augmented pigmentation alone.

#What is nævus pilosus?#

A nævus upon which there is an abnormal growth of hair, slight or excessive.

#What is nævus verrucosus?#