A 23-year-old-man comes to the clinic seeking treatment for a facial lesion. He has had similar lesions that resolved spontaneously. He has no associated pain, itching, or burning. The patient works as a meat packer. He would like the lesion removed as he has started dating and thinks that the "bump" on his face would hinder this process. He has no previous medical problems and takes no medications.
The lesion is shown in the photograph below:

What is the best treatment option for this patient?

Question

A 23-year-old-man comes to the clinic seeking treatment for a facial lesion.  He has had similar lesions that resolved spontaneously.  He has no associated pain, itching, or burning.  The patient works as a meat packer.  He would like the lesion removed as he has started dating and thinks that the "bump" on his face would hinder this process.  He has no previous medical problems and takes no medications.
The lesion is shown in the photograph below:

What is the best treatment option for this patient?

Quizplus · Accepted Answer

Common warts are due to human papilloma virus (HPV) infection. They are especially common in individuals who handle meat, poultry, and fish, as well as those with atopic dermatitis. Immunosuppressed individuals (eg, HIV) also commonly develop warts. Frequent sites include genital areas, plantar and palmer surfaces, and the digits. The diagnosis is established predominantly by observation. If the diagnosis is uncertain, scrapings of the lesion can be evaluated microscopically for thrombosed capillaries (so-called "seeds"). digits Observation is an option for all warts since the rate of spontaneous resolution is 60-70% over 2 years. However, warts are more easily treated when they are smaller and sooner rather than later. All treatments involve some form of tissue destruction and often must be repeated at intervals for removal without recurrence. Some treatments may take weeks or months. Over-the-counter salicylic acid or liquid nitrogen applied in a physician's office effectively removes many warts. However, liquid nitrogen use is contraindicated in patients with periungual warts due to the risk of nail bed dystrophy. (Choice C) Snip and shave excision is used primarily for filiform warts. It would not be used for the flat wart in this patient. filiform warts (Choice D) Topical corticosteroids are used to treat eczema, dermatitis, lichen planus, and other skin conditions. They are not used in the treatment of warts. (Choices A and E) The lesion in this patient does not appear to be a fungal or herpes lesion. Educational objective: Salicylic acid or liquid nitrogen application is effective for the treatment for many warts. However, liquid nitrogen use is contraindicated in patients with periungual warts due to the risk of nail bed dystrophy. __________ References: Topical treatments for cutaneous warts. (http://www.ncbi.nlm.nih.gov/pubmed/16855978)

A 23-Year-Old-Man Comes to the Clinic Seeking Treatment for a Facial