Warts and Molluscum

We get calls about warts on a fairly regular basis. Warts are usually caused by a virus. These tricky little skin growths have evolved over time so that they have the ability to invade the body without triggering the immune system.

Dr. Grogan, a terrific local podiatrist tells his patients to imagine that their body is a castle that has guards, but somehow the wart has sneaked through the defense system and is already at the castle walls.

Plan A for getting rid of them is to gently remind the body that there is a wart and we want it gone. Make the body pay attention to this unwelcome guest by causing a bit of irritation to the area. Think of this process as an “Intruder Alert” signal to the body.

Warts have an easier time getting onto skin that is not intact. If your child has eczema or is a nail biter, they are more prone to warts. A person whose immune system has been going through a tough time, one illness after another, may also be a bit more prone to getting warts.

A wart is on the bottom of the foot is referred to as a Plantar wart. Because there is so much pressure from walking on it, those warts tend to be deeper and probably will do better with help from the specialists. Dr Grogan's office uses something call cantharidin (fun fact, this is a substance secreted by blister beetles.) It may take 4 or 5 applications; most kids tolerate the treatments pretty well.

For warts on other parts of the body, Dr. Cheung my ‘go to” dermatologist, prefers the 40% salicylic acid patches (Mediplast.) These are used for any age. Cut the patch to the size of the wart and cover the area with duct tape.

Do the application after a shower or bath. Even if you skip a daily bath,the patch should be changed every 24 hours or so. When you remove the patch, it is quite normal for part of the wart to peel off. You can also use an emery board to gently debride the area in between patch changes.

Go ahead and make an appointment for the dermatologist to take a look at things and evaluate treatment options, but it is fully possible that if you make an appointment a month in advance, the home treatment will take care of it and then you can just cancel the appointment (of course give a 48 hour warning.)
Dr Schwanke is also happy to see a wart here in the office to help with a treatment plan.

If you do end up at the dermatologist, they will base the treatment on the age of the patient. For older kids, Dr. Cheung finds that freezing them off with cryotherapy is the most effective treatment. Most warts require multiple visits, spaced about a month or two apart.

If you are seeing clusters of warts, another possibility is a fairly common wart related skin disease called Molluscum (muh-luhs-kum) contagiosum (kən-tā-jē-ō-səm). Just like common warts, this is caused by a virus and can easily spread from person to person.

People can get molluscum by sharing towels and clothing. Wrestlers and gymnasts may get it from touching infected mats. Skin-to-skin contact also spreads the virus. Often the only sign of molluscum is pink or flesh-colored bumps on the skin. These bumps can appear anywhere on the skin.(usually not on the palms of the hands or the soles of the feet.) Most people get about 10 to 20 bumps on their skin. If a person has a weakened immune system, they may have way more than that.

Bumps on the skin can be the only sign that a person has molluscum contagiosum. These bumps often appear about 7 weeks after being exposed to the virus that causes molluscum. Sometimes, the bumps do not appear for many months. When the bumps appear on the skin, they often:

• Begin as small, firm, dome-shaped growths.
• Have a surface that feels smooth, waxy, or pearly.
• Are flesh-colored or pink.
• Have a dimple in the center. The dimple may be filled with a thick, white substance that is cheesy or waxy.
• Are painless, but some bumps itch.
• Turn red as the person’s immune system fights the virus.
• Appear on other areas of the body after a person scratches or picks the bumps. Scratching or picking can spread the virus.

This condition usually goes away by itself within a year, but I would probably give the same advice as I do for warts; go ahead and make that non-urgent dermatology appointment. If it isn’t clearing up on it’s own within a month or two, it is worth seeing what treatment options are available to you. Unfortunately folks can get this more than once. Having a prior case does not seem to give immunity.There are lots of internet 'cures' for this including coating the body with silver....., but they are likely a waste of time and money.

Warts are viral - shoes, socks and anyplace where bare feet have been in contact with should get sprayed or wiped down with Lysol. It is best not to share baths with siblings if they have warts or molluscum. Swimming in a pool is fine because of the chemicals.

There are loads of other the counter suggestions out there. Most are harmless but probably ineffective. Keep in mind that the goal is to irritate the wart enough that the body’s immune system is stimulated to come in and help get the job done. I will equate the natural remedies such as tea tree oil to using a watering can to fight a fire. The OTC wart patches are your fire extinguishers. The dermatologists and podiatrists have the fully equipped fire trucks!

Any lesion, wart or otherwise, on the body that isn’t gone within a month or two is worth an evaluation by a specialist. Dr. Cheung cautions that although it is very rare, some warts can turn into skin cancers, so get them checked out. Early intervention can make all the difference.

Urgent Care Options 2018

PLEASE SEE UPDATED POST MARCH 2025 Urgent care/emergency options 2018

Murphy's Law generally seems to make certain that the fever spikes or the vomiting starts right at 5:01 pm when the average doctor's office turns their phones off. It is important to be familiar with your after hours/urgent care options. Some of the common calls that folks need help with after hours are dosage questions. Here is the link to a post with that info: https://nursejudynvp.blogspot.com/2014/12/tylenol-vs-advil-dosage-charts.html Waiting until you or your child is ill is not the best time to start learning about what choices exist in your area. Does your insurance plan have a preferred option that won’t cost as much? Are there after hours advice nurses available? Where is the closest emergency room? Is it staffed with pediatricians? If you are traveling, plan ahead and figure out local options for care before the trip. For Noe Valley Pediatrics patients who need help after hours, we ask you to start with the pediatric after hours clinic/triage nurse line:415-387-9293 If the nurse is NOT able to help, you will be directed to our answering service where the Noe Valley Pediatrics physician who is on call that night will be paged. The answering service number is415-753-4697 Here in the San Francisco Bay Area we are lucky to have very good options for after hours care. The UCSF Benioff Children’s Physicians Pediatric After HoursClinics and Advice Service In San Francisco 3490 California Street, Suite 200                         415-387-9293 In Berkeley 3000 Colby St Suite 301 (New Location 7/2017) 510-486-8344   Patients are seen by appointment: Monday through Friday 6:00 pm - 9:30 pm, (phones open at 5:00for appointments) Saturday, Sunday and holidays 8:30 am -9:30 pm (Phones open at7:30 am) Weeknight pediatricians are made up of participating private pediatricians, including several of our doctors who work an occasional shift in the clinic there. Weekend doctors are fully trained and board certified pediatricians. On weekdays the phone lines turn on at 5 pm. The advice nurse triage team is available through the night, even after the clinic is closed. The availability of the triage nurse makes this our number one choice. The Pediatrics After Hours Care at St Luke’s Hospital is affiliated with Sutter/ CPMC and is located at 1580 Valencia Street, 7th Floor #701 This clinic has been open for about two years now. Pediatrics After Care at St. Luke's It is now open 7 days a week. Monday-Friday 5:00pm-10:00pm Saturday-Sunday 8:30am-10:00pm Phone: 866-961-8588 This service does not currently have an advice nurse team, but the person answering the phone can help do some basic triage when making the appointment and help redirect you to an emergency room if that seems necessary. This clinic has some advantages besides the convenient location. They start the scheduling process as early as 2 pm, which may make it easier to make a plan if we are already solidly booked here in our office and can’t get you in to see us that same day. They also offer weekend weight and bilirubin checks for our newborns. As a bonus, there is a special waiting area so that the healthy newborns aren’t exposed to the other sick kids. The two options listed above are the only urgent care facilities with which our office has a close relationship. When things are going as they should, both of the above after hours options send a report to the primary doctor's office. In our office, the nurse team reviews the reports and follows up to see how you are doing to maintain a sense of continuity. Most of the insurance plans that we are in network with are accepted, but not 100%. Do yourself a favor and know your best covered options before your child gets ill!! No one will be able to get you accurate coverage information outside of business hours, which is when you might be needing it. I am listing the others below as a convenience. If you are not in San Francisco, on the Peninsula you have several good options. http://www.afterhourpeds.net/ is a pediatric urgent care facility. There is no appointment needed. 210 Baldwin Ave in San Mateo. Telephone 650-579-6581 The Palo Alto Medical Foundation has several pediatric urgent care options: Palo Alto Medical Foundation They have a choice of appointment or drop in. The website gives info about the various locations and current wait times. In Marin Greenbrae Pediatric After hours clinic 1260 S Eliseo Drive Floor 2 Greenbrae CA 415-464-1350 Hours: 6:30 pm-9:30 pm Monday through Friday 9:00 am-9:00 pm Weekends and Holidays There are plenty of general urgent care places popping up all over the place as well. Keep in mind that with most urgent cares, there is no such thing as an appointment and folks just show up and get seen in the order that they come in. There is risk for a much longer wait. They are also not usually staffed with pediatricians. For a teen, this is usually not much of an issue, but for my younger kids, I would try to stick with one of the pediatric after hours clinics. If you do end up at another urgent care, please ask them to send over a report so that we stay in the loop. Emergency Rooms In a true emergency of course call 911. If it is less urgent, but you are certain that you child needs immediate medical attention we are lucky to have excellent options here in SF. When given the choice I will generally opt for one of the true pediatric emergency rooms. You are not competing for care with the elderly heart attack and stroke victims that may be populating the waiting room and getting ranked higher on the triage scale. You will also be assured of seeing a pediatrician and having appropriate pediatric equipment. If an admission is needed, my preference would be either CPMC California campus or UCSF Mission Bay, so there also won’t be any transport needed if you are already at one of those ERs. I think it is worth the extra ten minute drive across town and may save you time in the long run. The UCSF Pediatric ER in Mission Bay is located at 1975 Fourth Street: UCSF Pediatric ER This emergency room has scored very high in a nationwide ranking for getting patients seen in a timely manner. CPMC pediatric emergency room is located at 3700 California Street/ at Cherry: CPMC Pediatric Emergency Room This ER generally gets high marks from our patients. BE AWARE THAT THE CALIFORNIA ST ER WILL MOVE TO VAN NESS ON MARCH 3, 2019!! DAYTIME URGENT CARE While we strongly prefer to have our youngest patients be seen by a pediatrician, there are ‘those days’ when our office is completely booked up early. If there is something going on that is not worthy of an emergency room visit and you don’t want to wait until the pediatric urgent care offices open, here are some options. With any urgent care, make sure they send a report to your primary doctor’s office. If you were not seen by a pediatrician, it is always a good idea to touch base with your own doctor the next day to review the diagnosis, treatment plan and follow up needs. Care Practice http://carepractice.com/ This place is not terribly far from our office on 14th and Guerrero. They are a fee for service practice. They will see all ages. Visits are appointment only. They are currently open 4 days a week. They do not have X-ray or Ultrasound capabilities Golden Gate Urgent care https://www.goldengateurgentcare.com/location/ca/san-francisco/west-portal-94127 There are several locations. These folks do take some insurance They do see pediatrics for basic issues. They also do x rays. You can drop in, but it makes sense to book an appointment online to minimize the wait time. If you get labwork or Xrays done at an urgent care, please realize that you will need to follow up with them for the results.