ORAL REVALIDA e-REVIEW: DERMATOLOGY

SKIN COLORED PAPULES

Patricia Duque-Ang, MD
May 23, 2020

I. VERRUCA

VERRUCA PLANA VERRUCA VULGARIS VERRUCA PLANTARIS

PHOTO

CHIEF COMPLAINT Skin colored papule from previous wound.
HISTORY
Multiple, 2-4mm, flat-topped papules that are
slightly erythematous or brown on pale skin
PHYSICAL EXAM and hyperpigmented on dark skin
(Description of lesion) Grouped commonly on the face (forehead,
cheeks nose, around the mouth), neck, dorsa of
the hands, wrist, elbows or knees
A papule that is uncomfortable or bleeds
Multiple, flesh colored,elevated round
papules,with a rough grayish surface (hence,
verrucous), averaging about 5mm
On the surface of the wart, tiny black dots may be
visible, representing thrombosed, dilated capillaries
more prominent
Firm plaque on the plantar pressure points.
May be grouped or several contiguous warts fuse
so that they appear as one= "Mosaic wart"
The soft, pulpy cores are surrounded by a
firm, horny ring.
Over the surface of the plantar wart, most clearly
if the top is shaved off, multiple small, black

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 BACTERIAL & VIRAL INFECTIONS

Koebnerization (forming linear, slightly raised Usually located on the hands, favoring the fingers points may be seen that represent dilated
papular lesions) and palms capillary loops within elongated dermal papillae
Periungual warts are common in nail biters and Myrmecia type: Smooth-surfaced, deep, often
maybe confluent, involving the proximal and lateral inflamed and tender papules or plaques, mostly
nailfolds on the palms or soles, but also beside or beneath
Digitate of filiform warts tend to occur on the the nails, or less often on the pulp of the digits.
face and scalp, present as single or multiple spikes Ridged wart: Persistence of the dermatoglyphics
stuck on the surface of the skin across the surface of the lesion. Typically, the
warts are slightly elevated, skin-colored, 3–5 mm
papules. They occur on non-weight-bearing areas
and lack the typical features of plantar warts.
Plantar verrucous cysts:1.5–2 cm, epithelium-
lined cysts on the plantar surface. These cysts
tend to occur on weight-bearing areas,
suggesting that HPV-infected epidermis is
implanted into the dermis, forming the cyst. It is
common to see ridged warts near plantar
verrucous cysts.
DEFINITION Flat warts Common warts Plantar warts
Common among ages 5 and 20 and only 15%
Children and young adults are primarily occur after age 35;
EPIDEMIOLOGY affected Meat handlers (50%), Children and young adults
common in swimmers Fish handlers,
Abattoir workers
HPV type 3,10, 28 and 41; HPV Types 1,2,4,27,57, and 63; Human papillomaviruses 1, 2, 27, and 57
Sun exposure increases risk; Frequent immersion of hands in water; HPV1- Myrmecia type
Autoinoculation from shaving of beard and Public exposures in swimming pools, Human papillomaviruses 60- Ridged wart and
ETIOLOGY & RISK
legs Public showers and going barefoot verrucous cysts
FACTORS
Transmission: Transmission: Transmission:
• Direct skin to skin contact • Direct skin to skin contact • Direct skin to skin contact
• Indirect contact with fomites • Indirect contact with fomites • Indirect contact with fomites
Incubation period of 1 to 20 months
Human papillomavirus can survive months to years on surfaces.
Infection of a host requires direct contact with viral particles either direct contact via a wart or indirect contact via fomites, such as flooring, socks, shoes,
towels, and sports equipment. There is no systemic dissemination or viremic phase to HPV infection.
Preexistent microtrauma of the epidermal barrier (esp plantar aspect of the foot) allows entry of the virus on contact.
Once in contact with a host, HPV gains entry to the basal epithelial layer, where actively dividing stem cells are located.
PATHOGENESIS
Infection of keratinocytes (the predominant cell type in the epidermis) by human papillomavirus (HPV) causes development of epidermal thickening and
hyperkeratinization occurs following infection at the basal layer and clonal proliferation, which eventually results in a visible wart, weeks or even months
later.
The infectious viral particles can then be released in high numbers from desquamated keratinocytes on the surface of the plantar wart to infect other sites
or hosts. Viral particles are released and may be transmitted to surfaces where the virus will lie until picked up by a new host or spread to adjacent sites
(autoinoculation).
Grouped commonly on the face (forehead, Hands, favoring the fingers and palms Pressure points on the ball of the foot,
SITES OF cheeks, nose, around the mouth), neck, dorsa of Nail biters: Periungual warts, lips and tongue, especially over the midmetatarsal area, but may
PREDILECTION the hands, wrist, elbows or knees Other areas: elbows, knees, plantar surfaces, be anywhere on the sole.
anogenital areas Frequently, several lesions develop on one foot.
Clinical diagnosis.
Confirmation: Biopsy enhanced by IP staining for HPV capsid antigen.
DIAGNOSTICS
Cytologic atypia and extension into the dermis suggest the diagnosis of an HPV-induced squamous cell carcinoma. There is a correlation between HPV
type and the histologic features of the wart, allowing identification of the HPV types that cause specific lesions.

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Quality of evidence regarding the efficacy of
therapies for common and plantar warts is very
low. Studies have not used standard treatment
protocols and until recently, HPV type has not
been evaluated with treatment response. This
hinders the development of evidence-based
guidelines.
• Spontaneous remission of lesion
o Therapy should be as mild as possible
o Avoid potentially scarring therapies
• Light Cryotherapy
o For few lesions
• Topical Salycilic products
• Topical tretinoin
o Once or twice daily in highest
concentration
o Effective for over several months
MANAGEMENT
o Watch out: produces erythema of warts
without frank dermatitis
• Tazarotene cream or gel
• Imiquimod 5% cream
o Apply once daily
o Add: Tretinoin if warts do not react to
Imiquimod
• 5-FU cream 5% (apply BID)
• Anthralin
o May cause staining but has useful irritant
effect
• Laser therapy
o For refractory lesions
o Reduces risk of scarring
• Oral Isotretinoin therapy 30mg/tab, OD
o For failed topical medications
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BACTERIAL & VIRAL INFECTIONS
2 basic approaches
• Destruction of wart (usually considered as
the initial treatment): Remove warts, minimize
scarring, induce lifelong immunity
• Induction of local immune reactions
Factors:
• Type of wart
• Age of patient
• Previous outcome of treatment
• 2-3 months of sustained treatment
List of treatment approaches
• Cryotherapy
• Topical products containing salicylic acid
• Bleomycin
• Surgery
Immunotherapy (topical / intralesional)
• Mainstay of wart therapy
More refractory to any form of treatment
• Reduces immune reaction responsible for except HPV-1– induced plantar warts in children
wart growth under 12 years, which have a high response rate
• Initially sensitized at distant sites (inner upper (>50%).
arm) with topical agents Initial treatment
• Or directly applied on the wart o Side effects • Daily application of salicylic acid in liquid,
= local pruritus / local pain / mild eczematous film, or plaster after soaking.
dermatitis • In failures, cryotherapy or cantharidin
• Topical DNCB, Squaric Acid dibutyl Ester, application may be attempted.
Diphencyprone, Intralesional candida /
• A second freeze-thaw cycle is beneficial
mumps antigen when treating plantar warts with cryotherapy
Cryotherapy
• In refractory cases, Bleomycin injections,
• Wart is frozen adequately to produce a blister laser therapy, or immunotherapy.
• It can lead to blisters that are painful for • For failures with nonscarring techniques,
several days surgical destruction with cautery or blunt
• Effective for periungal since the proximal dissection (plantar scar may be persistently
nailfold is seldomly affected, thus preventing painful)
matrix damage • CO2 laser may also result in plantar scars.
• Complications = hypopigmented / scarring / • PDT may be effective in some cases.
digital nerve damage
Catharon (0.7% cantharidin)
• Produces painful blisters similar to
cryotherapy
• Tendency to produce doughnut warts (central
clear zone of wart)
Bleomycin
• For warts unresponsive to treatment
• Injected immediately beneath wart until it
blanches
Surgical Ablation
• Reserved for warts that are refractory to more
conservative approaches
Electrocautery
• Common method in the Philippines
• Complete removal of wart
• Give xylocaine prior to procedure
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 BACTERIAL & VIRAL INFECTIONS

With spontaneous resolution; clearance rates in

children are 23% at 2 months, 30% at 3 months,
With highest rate of spontaneous remission
PROGNOSIS 50% at 1 year, 65-78% at 2 years, 90% over 5 May regress in 2 years.
among HPV infections
years

Do not touch lesion of others with lesions

Wear slippers in communal bathing areas
Do not share towels, shoes or socks
PREVENTION
If already have it, prevent spread.
Wear socks or gloves or patch over the affected areas
Do not touch or pick on the affected areas

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 BACTERIAL & VIRAL INFECTIONS

II. MOLLUSCUM CONTAGIOSUM, SYRINGOMA

MOLLUSCUM CONTAGIOSUM SYRINGOMA

PHOTO

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 BACTERIAL & VIRAL INFECTIONS

Skin colored papule on the eyelids.

CHIEF COMPLAINT Skin colored papule
May be insidious and not resolve with medications. Rarely may be sudden.
Often causes cosmetic concerns.
Syringomas develop slowly and persist indefinitely without symptoms. Acral
HISTORY Usually asymptomatic, may be painful or itchy.
lesions are often present. Usually bilateral and symmetrical
Ask for exposure to others with the same type of lesions.
Smooth-surfaced, skin-colored (usually cream white or pinkish in color)
firm, dome-shaped, pearly papules, averaging 3-5mm in diameter They present as small papules 1-3mm in diameter and may be yellow,
with central umbilication brown, or pink. They are virtually always multiple and most frequently occur
Giant lesions: May reach up to several cm in diameter on the eyelids and upper cheeks.
PHYSICAL EXAM
Irritated lesions: May become crusted and pustular, simulating secondary Other sites of involvement: axillae, abdomen, forehead, penis, and vulva.
(Description of lesion)
bacterial infection and may precede spontaneous resolution Genital syringomas may cause genital pruritus and may be mistaken for
Lesions that rupture into the dermis: Marked suppurative inflammatory genital warts.
reaction that resembles an abscess
*Make sure to check every part of the patient's body.
Also known as water warts.
DEFINITION Common neoplasms demonstrating sweat duct differentiation.
Benign infection of the skin caused by poxvirus.
Appear in <1% of the population
Appear during adolescence, more lesions may appear later
F>M
Three groups most often affected: Family history
Down's syndrome: Syringomas occur in 18% of adults with Down syndrome,
• Young children 1-4 years old
EPIDEMIOLOGY particularly females. This is approximately 30 times the frequency seen in
• Sexually active adults 20-29 years old
patients with other syndromes.
• Immunosuppressed persons- HIV infected Diabetes Mellitus (clear cell type)

Eruptive syringoma: Asian or dark-skinned and Afrcan-American

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 BACTERIAL & VIRAL INFECTIONS

Caused by Poxvirus (MCV-1 to MCV-4)

MCV-1 - most common worldwide
Transmission:
• Direct skin-to-skin contact, especially if skin is wet
• Indirect by towels, underclothes, toys, razor, tattoo supplies
Adolescent
• Autoinoculation to normal skin after mollusca scraping by
ETIOLOGY & RISK Females
patients
FACTORS African American and Asian
• Can be transmitted from mother’s skin during vaginal delivery
Down's Syndrome
(Suspect if with presentation in the first few months of life)
Risk Factors:
• Bathing with affected siblings and swimming pools
• Sexually active
• Immunocompromised
The incubation period ranges from two weeks to six months.
Molluscum contagiosum virus infects only keratinocytes, and skin lesions
are limited to the epidermis and do not have systemic dissemination
Many types including classical, eruptive, generalized, alopecia-associated,
Initial infection occurs in the basal layer.. Molluscum contagiosum virus
clear cell and others.
produces proteins inhibiting human antiviral immunity, thus preventing
Syringoma: benign neoplasm that differentiates along eccrine lines
the development of innate immunity response, and contributing to the
Eruptive syringoma: Type that appear suddenly as numerous lesions on the
PATHOGENESIS persistence of skin lesions Following infection, cellular proliferation
neck, chest, axillae, upper arms, and periumbilically, usually in young
produces lobulated epidermal growths that compress epidermal papillae,
persons. Some have suggested that eruptive syringomas represent a
while fibrous septa between the lobules produce pear-shaped clumps
proliferative process of inflamed normal eccrine glands, analogous to
with the apex upwards. The basal layer remains intact.Cells at the core of
traumatic neuroma being a proliferation of normal peripheral nerve.
the lesion show the greatest distortion and are ultimately destroyed,
resulting in large hyaline bodies (ie, molluscum bodies, Henderson-
Paterson bodies) containing cytoplasmic masses of virus material
Young children
• Generalized lesions, number from few to more than 100
• Face, trunk, extremities
• Genital lesions occur in 10%
• If lesions are restricted to the genital area, sexual abuse must Most common sites: Eyelids and upper cheeks.
be considered. However, may happen if with autoinoculation so Other sites of involvement: axillae, abdomen, forehead, penis, and vulva.
not necessarily abuse. Genital syringomas may cause genital pruritus and may be mistaken for
SITES OF PREDILECTION
Sexually active adults genital warts.
• Fewer than 20 lesions Eruptive syringoma: Neck, chest, axillae, upper arms, and periumbilically
• Lower abdomen, upper thighs, penile shaft in men
Immunosuppressed (i.e. HIV, sarcoidosis, malignancy)
• HIV-infected patients with molluscum contagiosum already
have an AIDS diagnosis and a helper T-cell count <100.
• Giant lesions may be seen
Clinical diagnosis: Based on observation of distinctive central
umbilication of the dome-shaped lesion Clinical diagnosis.
Light Cryotherapy: The lesions may be enhanced with light cryotherapy For definitive diagnosis, biopsy may be performed. Histological examination
which leaves the umbilication appearing clear against a white reveal dilated cystic spaces lined by two layers of cuboidal cells and
DIAGNOSTICS background. epithelial strands of similar cells. Some of the cysts have small, commalike
To confirm: The pasty core of the lesion may be expressed, squashed tails, which produce a distinctive picture, resembling tadpoles or the pattern
between two microscope slides and stained with Wright, Giemsa or Gram of a paisley tie. There is a dense fibrous stroma.
which would reveal Henderson-Paterson bodies (Numerous small
eosinophilic and later basophilic inclusion bodies are formed)
Young immunocompetent children: Treatment is difficult.
MANAGEMENT • Most practical: Do not treat and await resolution (may take Very light electrodessication or shave removal often effective
12-24 months) OR use topical tretinoin only Surgical removal: Larger lesions

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 BACTERIAL & VIRAL INFECTIONS

• Topical cantharidin applied for 4-6h is effective CO2 laser treatment by the pinhole method or by fractional thermolysis has
• Aggressive treatment: Can be emotionally traumatic and cause been reported as effective.
physical scarring
Adults with genital molluscum
• Removal with Cryotherapy or Curettage
• Sexual partners should be examined
• Screening for other coexistent STDs is mandatory
In patients with atopic dermatitis:
• Application of EMLA followed by curettage or cryotherapy
• Caustic chemicals should not be used on atopic skin
• Topical steroid application to the area (reduced to the minimum
strength possible)
• A brief course of antibiotic therapy should be considered after
initial treatment since dermatitic skin is frequently colonized with
S. aureus
In Immunosuppressed patients, especially those with AIDS
• Management of molluscum can be very difficult
• Aggressive treatment of the HIV infection with HAART
o Elevation of Th count predictably associated with a
dramatic resolution of the lesions
• If lesions are few, curettage or core removal with a blade and
comedo extractor is most effective
• Others: EMLA, Cantharone, 100% Trichloroacetic acid,
cryotherapy etc.
Usually benign and self-limiting disease that resolve without
scarring.
• Scratching the lesion, or using scraping and scooping to remove the
lesion, can cause scarring. (Physically removing the lesion is not
often recommended in otherwise healthy individuals)
Most common complication: Secondary infection caused by bacteria.
PROGNOSIS Secondary infections may be a significant problem in Benign and with treatment it leaves minimal scarring and no recurrences.
immunocompromised patients, such as those with HIV/AIDS or those
taking immunosuppressing drug therapies. This may lead to abscess,
cellulitis.
May recur in 1/3 of patients

(CDC)
Hand hygiene
Do not pick or scratch molluscum lesions,
PREVENTION Keep molluscum lesions covered with garment or band aid.
Do not share towels, undergaments and such
Safe sexual practices

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 BACTERIAL & VIRAL INFECTIONS

III. MILIA, SEBACEOUS CYST, ACROCHORDON

MILIA SEBACEOUS CYST ACROCHORDON

PHOTO

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CHIEF COMPLAINT Small white bumps
Asymptomatic
In children and adults, usually around the eyes
HISTORY
Eruptive milia have rapid onset (within a few
weeks)
Usually present as papules, however are actually
PHYSICAL EXAM keratinizing cysts (1-4mm in diameter)
(Description of Milia are superficial, pearly white domed lesions 1-
lesion)
2 mm in diameter
Cysts
Comedones
DIFFERENTIALS Xanthelasma
Syringoma
Seborrheic keratosis
Primary: Appear spontaneously
• Multiple eruptive milia- lesions that
occur spontaneously in too large a
number to be considered benign
primary milia of children and adults
• Milia en plaque- rare disorder;
erythematous plaque containing
numerous milia
• Usually on the head and neck (esp.
periauricular or periorbital regions)
• Most common in middle-age females
Secondary: Caused by trauma, skin disease, or
medication
DEFINITION
• Trauma: dermabrasion, chemical peel,
ablative laser therapy, skin grafts, and
radiotherapy
• Blistering skin diseases: epidermolysis
bullosa, pemphigus, bullous
pemphigoid, herpes zoster, lupus
erythematosus, Stevens-Johnson
syndrome, contact dermatitis, etc.
• Medications: Long-term topical
corticosteroid therapy and use of
occlusive moisturizers may cause milia
• Cyclosporine and 5-FU have been
associated with milia
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Mass/ nodule or “bukol” Multiple small growths
Usually asymptomatic with cheese-like material
Can become inflamed or infected resulting to pain Asymptomatic
and tenderness Painful or tender when inflamed or irritated by
In malignancy, there can be rapidg rowth, friability jewelry or clothing
and bleeding
Compressible, but not fluctuant, cystic mass from 0.5
to several centimeters in diameter Small, flesh-colored to dark-brown
dermal or subcutaneous mobile nodules with a (hyperpigmented), pinhead-sized, sessile and
pedunculated papillomas or papules with stalks that
central punctum with or without foul smelling cheesy
hang through the base
debris
Pilar cyst (trichilemmal cyst, wen): different Warts- filiform warts resemble skin tags, distribution
pattern of keratinization differentiate them from acrochordon
Usually found on the scalp (hair follicles Neufibroma- benign soft pedunculated growth
Nevus- small pedunculated, resemble skin tag
affected)
Seborrheic keratosis- dermatosis papulosis nigra
Lipoma (DPN) overlapy clinically with acrochordons on the
Branchial cleft cyst face
Sebaceous cyst (other names: follicular cyst,keratin
cyst, epidermal cyst, epidermal inclusion cyst, or Also known as fibroepithelial papilloma, or skin
an epithelial cyst) tag
• is a keratin-filled epithelial-lined cyst • Skin tags often increase in number when
• one of the most common benign skin patient is gaining weight or during
pregnancy and may be related to growth
tumors
hormone-like activity of insulin (associated
• result from plugging of follicular orifice often with DM)
associated with acne vulgaris As result of twisting of pedicle, one may become
• The term sebaceous cyst is a misnomer, as tender, inflamed and gangrenous
these cysts do not involve sebaceous
glands, nor do they contain sebum
• Have pasty contents of the cysts formed
mostly of: macerated keratin (which has a
cheesy consistency and pungent odor)
• The surface of the overlying skin is usually
smooth and shiny from upward pressure
• freely movable over underlying tissue and
are attached to the normal skin above them
by a comedolike central infundibular
structure or punctum
• Cysts are usually slow growing and
asymptomatic
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Primary Milia occur congenitally (shortly after birth)
EPIDEMIOLOGY in up tp 50% newborns
Multiple eruptive and milia en plaque are rare.
• Primary milia- common in newborns, over
face, trunk and limbs, most commonly over
ETIOLOGY & RISK malar and eyelid regions
FACTORS • Secondary milia- May be secondary to skin
trauma, skin inflamations, skin disease, or
topical medications
• Primary milia: small epidermoid cysts,
derived from the infundibulum of the vellus
hair
• Secondary milia: derived from eccrine ducts
PATHOGENESIS
or hair follicles as they attempt to re-
epithelialize eroded epidermis. Often transient
and spontaneously disappear.
• Primary (congenital): Favor skin of the face,
especially the nose, scalp, upper trunk, and
proximal extremities
SITES OF • Primary (adults/children): Cheeks, eyelids,
PREDILECTION forehead, and genitalia
• Primary (infants): Milia localized to the areola
may be seen
DIAGNOSTICS • Diagnosed clinically
• Primary milia that are congenital usually
resolve spontaneously,
• those seen in adults and children tend to
MANAGEMENT persist
Topical tretinoin (Retin-A): 0.025-0.05% topical
cream, once daily for 1-2 months for milia en
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BACTERIAL & VIRAL INFECTIONS
Epidermoid cysts rarely appear before puberty, and
earlier onset should suggest an alternative diagnosis
Male = Female; almost 60% of individuals acquiring
(e.g., pilomatricoma, dermoid cyst, Gardner
acrochordons by age 69.
syndrome).
• Occur in 3rd-4th decade of life • Associated with diabetes mellitus
• Male:female (2:1) • Appear to be more prevalent in those with
• Past surgery which can deform the sebaceous colonic polyps, however association has not
gland (check if surgical site)
been proven for the general population.
• Genetic conditions: Gardner’s syndrome (familial
• Frequently seen on obese patients
adenomatous polyposis), Gorlin syndrome (Basal
cell nevus syndrome)
• most commonly the result of plugged
pilosebaceous units
• Often associated with small seborrheic
• may also occur by epidermal implantation.
keratoses
• Deep penetrating injuries, such as with a sewing
• May be related to the growth hormone–like
machine needle or stapler, or even with nail
activity of insulin
biting, may result in epidermoid cysts growing
• Often increased in number when the patient is
within bone
gaining weight or during pregnancy
• In persons with dark pigment, the lining of the
epidermoid cyst and its contents may be
pigmented.
• most often on the face, neck, and trunk but may
be found in almost any location.
• may rupture and induce a vigorous foreign body
• Frequently on the neck, axillae and on eyelids
inflammatory response, after which they are
• less often on trunk and groins, where the soft,
firmly adherent to surrounding structures and
pedunculated growths often hang on thin
are more difficult to remove.
stalks
• Rupture is associated with the sudden onset of
redness, pain, swelling, and local heat,
simulating an abscess
• Biopsy: performed on acrochordons in
• Incision and drainage will confirm the diagnosis
children because the lesions are uncommon
of inflamed cyst, when the smelly, cheesy
in this age group and may be the presenting
material is evacuated
sign of Nevoid basal cell carcinoma
This will also lead to rapid resolution of symptoms.
syndrome (NBCCS)
• Small lesions can be clipped off at the base with
• Surgical excision:
little or no anesthesia
curative, complete cyst and any associated
Larger lesions: anesthesia and snip excision are
“daughter” cysts must be removed
preferred
• Biopsy Punch/laser
Aluminum chloride may be applied for hemostasis
Enucleation of the cyst through a small incision or a
if needed
hole made with a 4-mm biopsy punch or a laser may
Light electrodesiccation can also be effective
be attempted.
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 BACTERIAL & VIRAL INFECTIONS

plaque and more generalized forms of milia
involving the face
Minocycline 100 mg/tab once a day for 1 month if
no improvement with topical tretinoin for milia en
plaque
Milia in infancy usually resolve spontaneously
Secondary milia can be permanent hence attempt
PROGNOSIS to squeeze or scrape them off can cause
permanent scarring
No systemic compications have been reported.
• Avoid excessive exposure to sun
PREVENTION • Avoid thick facial cream and ointments
• Proper exfoliation of skin
A curette may be used to scrape out and snag all the
fragments of the cyst wall.
• Cautery
The lining of the cyst can be eradicated by
cauterizing it with 20% trichloroacetic acid.
Inflamed cysts may also be treated in this way, but
the inflammation makes complete removal of the cyst
more difficult.
NOTE: If any fragment of the cyst wall is left behind,
the cyst may recur.
Epidermal inclusion cysts recognized as benign cysts Generally benign; occasionally, as a result of twisting
but malignancy can occur of the pedicle, one will become inflamed, tender, and
Squamous cell carcinoma (70%) most common even gangrenous
malignancy followed by basal cell carcinoma
• Following surgical incision, avoid contact sports,
strenuous activity
• Main factor is to reduce friction where tags tend
• Sutures removed 7-10 days
to develop
• Instruct patient surgical scar takes 8 weeks for
• Friction-reducing powder or powder deodorants
80% skin strength
can help reduce irritation
• There is chance of recurrence if the cyst wall is
not removed

References:

Badri T, Gandhi GR. Molluscum Contagiosum. [Updated 2019 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK441898/
CDC
Witchy, DJ. et al (2018). Plantar Warts: Epidemiology, Pathophysiology, and Clinical Management. The Journal of the American Osteopathic Association
Wu, Q. (2019). Andrews diseases of the skin: Clinical dermatology, 13th edition. Journal of the American Academy of Dermatology, 81(6). doi: 10.1016/j.jaad.2019.08.041
(n.d.). Diseases & Conditions - Medscape Reference. Retrieved from https://emedicine.medscape.com/

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