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As all dermatologists are aware warts are a very common problem and often difficult to treat. They have also generated a large number of competing therapies, which often makes it even harder for the practicing physician to decide on the best course of action. This timely book, daws on the latest studies to present a guide to diagnosis and the evidence-based approach to management. It is an invaluable resource in any clinic or office managing skin disorders.
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Warts, which are among the most common of skin lesions, occur in patients of any age and on virtually any epithelial surface or lining. Although biologically benign, they are unsightly and often painful, and they may cause considerable functional disability, especially if they are on the plantar aspects of the feet or on the digits. Given the prevalence of warts, most physicians, regardless of specialty, attempt to treat these lesions, usually without success. This handsome, multiauthored book should be invaluable to nondermatologists who choose to deal with these lesions. Each chapter critically discusses one of the methods of therapy, which include conventional mechanical techniques (such as cryotherapy, other surgical interventions, and laser ablation), topically applied chemicals (most notably, acids, keratolytic agents, and vesicants), medications injected intralesionally (such as bleomycin, interferon, and cidofovir), topical and systemic immunotherapy, photodynamic therapy, and even unconventional approaches (such as hypnosis and homeopathy). Although the authors do not present an exhaustive review of the literature, they cite, critique, and compare the important published studies for each method and emphasize, whenever possible, design flaws that may have influenced their acceptance of the results. The authors have also attempted to use current principles of evidence-based medicine to rank their recommended treatments for each major type of wart. What I particularly like about this book is that it provides detailed protocols for most of the treatments and well-written instruction sheets for patients -- information that nondermatologists can use to incorporate many of the therapies into their own practice. Major side effects for each of the treatments are also clearly described. The only important omission that I could find was the lack of any mention that Raynaud's disease is a contraindication to cryotherapy for warts that appear on a digit. The book is handsomely illustrated with high-quality color photographs, most of which accompany clinical vignettes. There are also excellent reviews of the molecular biology of papillomaviruses and of the epidemiology of various papillomavirus infections. The only minor stylistic problem was a few references that were incorrectly numbered in the text, but this did not detract from the overall quality of the book. Even though, as a dermatologist, I have been treating warts for more than 25 years, I was pleased to find several clinical pearls. Although this book may not be essential reading for most dermatologists, I believe that it will be an excellent addition to the library of any nondermatologist who wishes to learn how to treat this overly abundant and frequently frustrating skin lesion. Jo-David Fine, M.D., M.P.H.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
'...one of the most comprehensive books on the subject squarely aimed at the clinician who wishes to offer management based on evidence. The book would be a useful addition to the bookshelf in the clinic for those treating plantar warts' - Ivan Bristow, University of Southampton
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