Case report: a wart problem

I was recently consulted at our walk-in clinic about a finger lesion. Not previously reported to a physician, this 31-year-old, fair-skinned woman in good health, with no previous illnesses, no allergies and taking no medications, reported having had a finger lesion for more than six months. Suddenly, she was inspired to seek a medical opinion. She had never injured her hand—although I suspect she had been manicuring the base of her nails, pushing back the cuticles. Read: Case report: two-step TB testing The patient, assuming that the lesion at the tip of her right third finger was a wart, had very intermittently applied over-the-counter wart treatment, with no effect. She now was seeking a quick fix—freezing or burning. I confirmed that she indeed had a wart, located in a difficult and sensitive location (see picture). I was not about to undertake treatment of a wart under a finger nail. The patient would find therapy painful and would undoubtedly result in nail loss, and who knows what else afterwards. Warts are said to usually resolve in a couple of years with no treatment. I recommend—as with this patient—that regular use of topical agents (Duofilm or other fingernail polish-based products) for a prolonged time, will hasten resolution. Read: Case report: a difficult arm lesion Perhaps this just uses up time with something for the patient to do until the body naturally rejects the wart. In any case, it usually works. Warts are not often diagnostic challenges—and often respond to time, topical agents, freezing or cautery. My personal theory is that any and all destructive procedures result in release of the causative virus into the circulation, where antibodies form and destroy the wart—sort of “topical immunization.” Would anyone attempt destruction of the wart in the location presented by my patient? Suggestions for treatment would be appreciated. Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files. Read: Case report: A neck rash

Case report: a wart problem

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