Treatment of Burns and Skin Excoriation After Genital Wart Treatment
For burns and skin excoriation following genital wart treatment, immediately neutralize any residual caustic agent with soap or sodium bicarbonate, then provide supportive wound care with gentle cleansing and topical antibiotic ointment to prevent secondary infection. 1
Immediate Management of Chemical Burns
Neutralization of Caustic Agents
If trichloroacetic acid (TCA) or bichloroacetic acid (BCA) was used and pain is intense, immediately neutralize the acid with soap or sodium bicarbonate (baking soda). 1
If an excess amount of acid was applied, the treated area should be powdered with talc, sodium bicarbonate, or liquid soap preparations to remove unreacted acid. 1
TCA solutions have low viscosity comparable to water and can spread rapidly if applied excessively, causing damage to adjacent tissues—this is why immediate neutralization is critical. 1
Wound Care for Excoriation and Burns
Clean the affected area gently with mild soap and water to remove any remaining treatment compounds and debris. 2
Apply a small amount of topical antibiotic ointment (such as bacitracin) equal to the surface area of a fingertip, 1 to 3 times daily to help prevent secondary bacterial infection. 2
The treated area may be covered with a sterile bandage to protect from further trauma and contamination. 2
Management of Treatment-Related Complications
Expected vs. Problematic Reactions
Mild to moderate pain and local irritation are common after most genital wart treatments, including cryotherapy, podophyllin, podofilox, and imiquimod. 1, 3, 4
Local skin reactions including erythema, vesicle formation, ulceration, and excoriation can occur, particularly with more frequent application of topical agents like imiquimod. 4
If severe burns, extensive ulceration, or signs of secondary infection develop (purulent drainage, expanding cellulitis, systemic symptoms), immediate medical evaluation is required. 5
When to Discontinue or Change Treatment
Treatment should be changed if the patient experiences intolerable side effects or if there is no substantial improvement after 3 provider-administered treatments or 8 weeks of patient-applied therapy. 3, 6
If warts have not completely cleared after 6 provider-administered treatments, alternative treatment modalities should be considered. 3
Prevention of Future Complications
Proper Application Techniques
For TCA/BCA applications, only a small amount should be applied directly to warts and allowed to dry until a white "frosting" develops before the patient sits or stands. 1
The total treatment area for patient-applied therapies like podofilox should not exceed 10 cm² of wart tissue, with total volume not exceeding 0.5 mL per day. 3, 6
Care must be taken during electrocautery to control the depth of treatment to prevent scarring. 1
Common Pitfalls to Avoid
Avoid applying caustic agents like TCA/BCA to large areas or allowing them to contact normal surrounding tissue—their low viscosity means they spread rapidly and can cause extensive burns. 1
Do not use cryoprobes in the vagina due to risk of perforation and fistula formation; only liquid nitrogen should be used for vaginal warts. 1, 3
Podophyllin must be thoroughly washed off 1-4 hours after application to reduce local irritation, and the treatment area must be dry before the patient sits or stands. 1
Long-Term Considerations
Treatment complications may include persistent hypopigmentation or hyperpigmentation, depressed or hypertrophic scars, and rarely, disabling chronic pain syndromes. 3, 6
All treatment modalities have high recurrence rates (approximately 25-30%), with most recurrences occurring within the first 3 months after apparent clearance. 3, 6
Treatment removes visible warts but does not eradicate HPV infection or affect its natural history. 3, 6