How to Treat Persistent Warts Under the Nail Bed in Children?

Q: How to Treat Persistent Warts Under the Nail Bed in Children?

Hello： Warts located next to the nail are the most difficult to treat, especially in children. <br>Cryotherapy can be painful, and children often have a low pain tolerance, which makes many doctors and parents hesitant to pursue more invasive treatments. <br>Of course, topical wa

What should I do if the warts in the nail folds won't go away?

Dear Dr.
Chang,
I have an eight-year-old boy whose right index finger has developed a wart in the gap between the fingers.
After a failed cryotherapy treatment by a dermatologist, the application of wart treatment solution has not been effective either.
I would like to ask:
1.
The wart tissue has already spread under the nail, making it impossible for the medication to reach it.
How should this be managed? Should we continue with cryotherapy?
2.
Are there any injectable treatments that can be administered under the nail?
3.
Should we continue treatment at a clinic or go to a larger hospital?
It has been a struggle for the child for over six months just to treat this small wart, and his nail is almost deformed.
We are truly at a loss for what other methods are available.
Thank you for your guidance.

elly, 0~9 year old female. Ask Date: 2008/12/11

Dr. Zhang Zhibo reply Dermatology

Hello: Warts located next to the nail are the most difficult to treat, especially in children.
Cryotherapy can be painful, and children often have a low pain tolerance, which makes many doctors and parents hesitant to pursue more invasive treatments.
Of course, topical wart treatments are another option that is less painful, but they typically require a treatment duration of at least 3-4 months.
Currently, there are new topical medications available, such as Aldara (Imiquimod cream), which is an immunomodulator that stimulates the body's immune cells to target and destroy cells infected by the HPV virus; this treatment also requires 3-4 months.
Some individuals use Bleomycin injections (a chemotherapy agent) directly into the lesions, which can be effective but is quite painful and carries a risk of skin ulceration.
Others have found success using black duct tape, applied daily to soften the wart and promote natural necrosis.
If multiple fingers are affected, oral Cimetidine (a medication for stomach issues) has been reported to have immune-modulating effects and may also be effective.
In summary, there are many methods available, but none can guarantee a specific number of treatments for success; one must be prepared for a long-term battle.
If a method shows no progress after 4 months, it may be time to consider alternative approaches!

Reply Date: 2008/12/11

More Info

Warts, particularly those that develop under the nail bed, can be quite challenging to treat, especially in children. The persistence of warts despite previous treatments, such as cryotherapy and topical treatments, can be frustrating for both the child and the parents. Here’s a comprehensive approach to managing this condition based on your questions.

1. Understanding Warts: Warts are benign growths caused by the human papillomavirus (HPV). They can appear anywhere on the body, including under the nails, and can be particularly stubborn in this location due to the difficulty in applying topical treatments effectively.

2. Treatment Options:
- Cryotherapy: While you mentioned that cryotherapy (freezing treatment) was unsuccessful, it is often one of the first-line treatments for warts. If the wart has spread under the nail, it may require multiple sessions or a different approach. Cryotherapy can sometimes be repeated, but it’s essential to monitor the response closely.

- Topical Treatments: If the wart is not responding to topical treatments, it may be necessary to consider stronger options. Treatments like salicylic acid can be effective, but they may not penetrate deeply enough if the wart is under the nail.

- Intralesional Injection: There are treatments that involve injecting medications directly into the wart. This can include immunotherapy agents like Candida antigen or other substances that stimulate the immune response against the virus. This method can be effective for warts that are resistant to other treatments.

- Surgical Removal: In cases where the wart is extensive and has caused significant nail deformity, surgical excision may be warranted. This involves removing the wart and any affected tissue, which can provide a more definitive solution.

3. Choosing the Right Facility: Given the complexity of the case and the persistence of the wart, it may be beneficial to seek treatment at a specialized dermatology clinic or a pediatric dermatology unit in a larger hospital. These facilities often have access to a wider range of treatment options and specialists who can provide more tailored care.

4. Monitoring and Follow-Up: Regardless of the treatment chosen, close follow-up is essential. Warts can recur, and ongoing monitoring will help catch any new growths early. It’s also important to ensure that the child is not experiencing any pain or discomfort from the wart, as this can affect their quality of life.

5. Psychological Impact: It’s crucial to consider the emotional and psychological impact of having a persistent wart, especially in a child. Encourage your child to express their feelings about the wart and provide reassurance. Engaging them in discussions about treatment options can also empower them and reduce anxiety.

6. Preventive Measures: While treating the wart, it’s also important to discuss preventive measures to avoid spreading the virus. This includes avoiding sharing personal items like towels or nail clippers and keeping the affected area clean and dry.

In conclusion, managing persistent warts under the nail bed in children can be a multi-faceted approach involving various treatment modalities. It’s essential to work closely with a healthcare provider to determine the best course of action tailored to your child’s specific situation. If the current treatments are not yielding results, do not hesitate to seek a second opinion or explore more specialized care options.

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