Pediatric emergency medicine trisk 1805 1805
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The tendency for recurrence of warts makes the treatment of this condition
frustrating. Because most warts disappear spontaneously with time, procedures
that are least traumatic for the child should be attempted first. The simple,
nontraumatic method of airtight occlusion with plain adhesive tape or duct tape
for 1 month is often successful. Topical application of 17% salicylic acid in
flexible collodion (Duofilm) or duct/occlusive tape is good for home use. Plantar
warts can be treated with 40% salicylic acid plasters applied nightly as tolerated.
When simple methods are unsuccessful, touching the warts with liquid nitrogen
or volatile cryogens such as dimethyl ether, propane, or isobutane (VerrucaFreeze) for 10 to 30 seconds or surgical removal can be attempted on a 2- to 4week schedule until the lesions clear completely. Both procedures are painful, and
are typically not performed in the emergency department.
Anogenital warts can be treated with topical preparations such as
podophyllotoxin gel (Condylox) or imiquimod cream. Podophyllotoxin gel is
applied on the condylomata three consecutive nights each week while imiquimod
is used every other night three times weekly. Both agents may be used for up to 3
months or so or until the warts clear. Topical cidofovir in 1% or 3% preparation
can also be used for warts and molluscum in refractory cases. Child abuse should
be considered in any child with genital warts but keep in mind that maternal
transmission can occur during delivery, and patients or caregivers can transfer
wart virus from the hands to genital areas.
Xanthomas
Papules, plaques, nodules, and tumors that contain lipid are called xanthomas.
These rare lesions can appear on any skin surface and are often associated with
disturbances of lipoprotein metabolism.
Insect Bites
Mosquitoes are probably the most common cause of insect bites in children,
followed by fleas ( Fig. 88.3 ) and bed bugs. Mosquito bites are generally limited
to the warm months of the year. In contrast, flea bites, which predominate from
spring to fall, can also occur during the winter months as a result of cats, dogs,
and rodents who live indoors.
