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A 22-year-old male college student is evaluated for a papule on his finger. The papule has been present for several months, over which time it has gradually increased in size. It causes pain when he grips a pen. He is sexually active with one female partner. They use oral contraceptives. He has never had a sexually transmitted disease.
On examination, he has a 0.5-cm verrucous-appearing papule on the lateral aspect of the second finger of his right hand, near the distal interphalangeal joint. He has another, smooth, flat, 0.25-cm papule on the palm of his hand near the thenar eminence. He has another small verrucous papule on the plantar surface of his left foot. He has no genital lesions.
Which of the following is the most appropriate next step in the management of this patient?
A. Imiquimod topical immunotherapy
B. Punch biopsy of the affected skin
C. Rapid plasmin reagin test
D. Triamcinolone ointment
E. Topical therapy with salicylic acid plaster

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c...?

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salicylic acid plaster

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CCC is the answer.

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sorry E is good for cutaneous lesions but the immune modulators are used for genital lesion so the answer has to be A. I also did some reading on this my sourece is Up to Date:www.uptodate.com

"Imiquimod (Aldara) is an immune modulator that induces local production of alpha and gamma interferon, as well as interleukin 1,6, and 8; and enhances T-cell-mediated cytolytic activity against viral targets [3,7,8]. Imiquimod is applied to external genital warts as a 5 percent cream three times a week at bedtime and the area is washed the next morning. Treatment is continued until the lesions clear or for a maximum of 16 weeks. Adverse reactions included erythema, burning sensations, itching, and erosions [4,5].

Office therapy ” Podophyllin is a mitotic poison that has been the principal mode of therapy for anogenital warts for many years. It is available as a 10 or 25 percent solution in tincture of benzoin and is usually applied directly on the wart once weekly and washed off within 12 hours of the application. Therapy is typically continued for four weeks. Podophyllin should be applied by a trained health care provider. Use of this agent appears to be decreasing [4,6]. Adverse reactions include chemical burns; neurologic, hematologic, and febrile complications; and allergic sensitization [4]. The agent is contraindicated in pregnancy.

Trichloroacetic (Bichloroacetic) acid (in a 10 to 90 percent solution) is a caustic agent available for the treatment of genital warts. The solution is applied directly to warts with a cotton tip applicator on a weekly basis for four consecutive weeks. It is most suitable for small warts and less efficacious for large lesions [5]. The agent has the advantage of low cost, but repeated therapy is not well tolerated because of pain and burning, which may result in ulceration [4,9]. A neutralizing agent (Talcum powder or bicarbonate of soda) should be used to remove residual acid following the application. Trichloroacetic acid should be applied only by trained health care providers."