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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Warts, Viral


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Medical Codes

ICD-9-CM:
078.10 - Diseases Due to Viruses and Chlamydiae, Other; Viral Warts, Unspecified; Verruca

Related Terms

  • Common Warts
  • Epidermodysplasia Verruciformis
  • Flat Warts
  • HPV
  • Human Papillomavirus Infection
  • Plantar Warts
  • Verruca Plana
  • Verruca Plantaris
  • Verruca Vulgaris

Overview

Warts are benign (noncancerous) skin growths caused by infection with a virus called human papillomavirus (HPV). There are over 100 types of HPV (Shenefelt). The specific features of the wart depend on the type of virus present and the location of the infection. The most common types of warts are the common wart (verruca vulgaris), plantar wart (verruca plantaris), flat wart (verruca plana), and genital or venereal wart (condyloma acuminatum). Epidermodysplasia verruciformis is a very rare inherited disorder characterized by generalized warts of the skin that frequently result in carcinomas.

The vast majority of warts are painless and harmless, although some types can be painful (plantar warts), and some can increase the risk of cancer. HPV is very contagious and can be spread through direct contact from one part of the body to another. Warts can also be transmitted indirectly in moist warm environments such as locker rooms, bathroom floors, and swimming pools. The risk of transmitting flat warts (warts of the hands or feet) from one individual to another is small.

Incidence and Prevalence: Warts are one of the 10 most common dermatoses, and are estimated to affect about 7% to 12% of the population (Shenefelt).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors include broken skin, locker room use, and the use of drugs that suppress the immune system. Warts predominantly occur on children between the ages of 12 and 16 years (Shenefelt). Although warts can occur at any age, frequency declines when individuals reach adulthood. Neither race nor sex appears to be a factor in papillomavirus infections. The risk of developing warts is higher in meat handlers.

Individuals with atopic dermatitis (eczema) or those currently afflicted with a disease that weakens the immune system (such as HIV or lymphoma) are more likely to develop warts. In individuals with HIV, warts are more abundant or widespread, exuberant, and resistant to treatment; can simulate epidermodysplasia verruciformis, and frequently evolve into carcinomas.

Source: Medical Disability Advisor



Diagnosis

History: The incubation period ranges from weeks to a year. The clinical course of all varieties is chronic and unpredictable. The individual often does not have any symptoms. In general, the appearance of an unfamiliar lesion prompts the individual to seek medical attention. Some individuals, particularly those with warts on their feet, may report pain that worsens with pressure (e.g., due to walking). Warts of the eye area may present with symptoms such as a foreign body sensation, mild secondary viral inflammation of the membrane lining the eyelids (conjunctivitis), and possible corneal involvement.

Physical exam: The appearance and the anatomical location of the wart vary, depending on the type of HPV responsible and the location of the wart. Common warts (verruca vulgaris) are small, skin-colored, raised, rough, irregular masses on a broad base and are shaped like a cauliflower. The lesions may be single or multiple, isolated or confluent, and are sharply demarked. Common warts are most commonly found on the hands, especially around the nails and on the fingers. They also frequently infect the scalp, forearms, knees, and face.

Skin-colored, round, and rough, plantar warts (verruca plantaris) may be found on the feet, particularly on the soles of the feet or between the toes. On close examination, small black spots are seen. These black spots are caused by bleeding (thrombosed blood vessels) within the wart as a result of standing and walking on the wart.

Flat or juvenile warts (verruca plana) are smaller and smoother than other warts, occur in large numbers (20 to 100 at a time), are found in a linear arrangement, and are commonly found in the beard area of men and on the legs and hands of women.

Generalized skin warts (epidermodysplasia verruciformis) are found on the face (forehead), neck, shoulders, trunk, outer sides of forearms, back of hands and fingers, and lower extremities, and are bilateral, symmetrical, flat, and reddish in color.

Tests: In most cases, simple examination of the wart is sufficient for diagnosis. A magnifying glass may help the physician see the mosaic pattern. Definitive diagnosis can be obtained through electron microscopy, immunohistochemical evaluation, or nucleic acid hybridization, but these tests are more academic in nature and not necessary. Human papillomavirus cannot be cultured.

Source: Medical Disability Advisor



Treatment

No treatment is guaranteed to remove warts. Often treatment is unnecessary because warts are generally harmless and usually resolve on their own without scarring. Warts that are bothersome or painful or that multiply rapidly can be treated in several ways. Treatment varies depending on the age of the individual, the type of wart, the number of warts and their location, and symptomatic problems.

Chemical treatments such as salicylic acid, cantharidin, or podophyllotoxin may be applied to the surface of the wart and must be applied regularly over a period of up to 12 weeks in order to achieve favorable results. Some warts may be frozen off (cryotherapy). Cryotherapy is uncomfortable but not terribly painful, although it can require frequent treatments (every 1 to 3 weeks) for 3 to 4 months. Laser treatment can be used to remove warts, but this procedure is generally reserved for warts that do not respond to other treatments. Repeated treatments may be necessary, and the resulting scab may take a few weeks to heal. Very stubborn warts may be injected with an anticancer drug called bleomycin or with interferon, an agent that boosts the immune system.

Cutting away the wart is not generally recommended because this method will leave a permanent scar and is no more effective than other, nonscarring methods.

Source: Medical Disability Advisor



Prognosis

In most instances, warts resolve completely within 2 years, even without treatment (Shenefelt). Epidermodysplasia verruciformis will persist for life, and malignant transformation is common. Other warts tend to resolve on their own, although they may persist for years before disappearing. Recurrence is common.

Chemical treatments are effective in about 70% to 80% of cases if the individual is compliant with the application regimen (Shenefelt). Frequent treatments (every 1 to 3 weeks) of cryotherapy for 3 to 4 months are successful in about 50% to 80% of cases (Shenefelt).

Source: Medical Disability Advisor



Differential Diagnosis

  • Callus
  • Condyloma lata
  • Corn
  • Hyperkeratosis
  • Lichen planus
  • Mole
  • Molluscum contagiosum
  • Scar
  • Seborrheic keratosis
  • Skin tag
  • Solar keratosis
  • Squamous cell carcinoma

Source: Medical Disability Advisor



Specialists

  • Dermatologist
  • Family Physician
  • Gynecologist
  • Internal Medicine Physician
  • Orthopedic (Orthopaedic) Surgeon
  • Urologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Immune system disorders

Source: Medical Disability Advisor



Complications

Possible complications include self-reinfection (autoinoculation). This usually occurs when a wart is picked or scratched, releasing virus particles that can then infect other parts of the body. Scarring can occur if a wart is picked or treated too aggressively. Damage to fingernails can result in abnormal growth and appearance of the nail. Chronic pain may also occur, particularly with plantar warts.

Source: Medical Disability Advisor



Factors Influencing Duration

Warts generally resolve completely, with or without treatment. Duration depends on site, size, and method of treatment.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations are not associated with this condition.

Risk: Although the risk of transmission of warts on the hands or feet from one individual to another is small, in order to prevent transmission by direct or indirect contact in the workplace, individuals should avoid touching warts on others, and refrain from sharing personal items such as razors, towels, socks, or shoes. Individuals with warts should keep the lesions covered with a bandage or athletic tape.

Capacity: Capacity is typically unaffected by this diagnosis. Individuals with symptomatic plantar warts on the weight-bearing surfaces of the foot may temporarily require reassignment to more sedentary duties until the warts have resolved.

Tolerance: Tolerance is usually not a concern once healed.

Source: Medical Disability Advisor



Maximum Medical Improvement

90 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has diagnosis of warts been confirmed with a physical exam by a physician?
  • Have other conditions with similar symptoms been ruled out, such as corns, scar tissue, flat wart-like lesions of syphilis (condyloma lata), hyperkeratosis, moles, cancer, calluses, skin tags, and a skin condition called molluscum contagiosum?

Regarding treatment:

  • Did warts resolve spontaneously? If not, was treatment considered?
  • Was chemical treatment effective at eliminating the warts? If not, was individual compliant with the treatment regimen?
  • Did the warts warrant intervention with cryotherapy or laser treatments?
  • Were repeat treatments necessary?
  • Was more aggressive treatment with injections of bleomycin or interferon considered?

Regarding prognosis:

  • Was individual compliant with prescribed treatment regimen?
  • Have the warts recurred?
  • Is more aggressive therapy being considered? Has it taken longer than 1 to 2 weeks to resolve symptoms?
  • Does individual have an underlying condition (such as immune suppression) that may affect recovery?

Source: Medical Disability Advisor



References

Cited

Shenefelt, Philip. "Nongenital Warts." eMedicine. 9 Dec. 2014. Medscape. 3 Aug. 2015 <http://emedicine.medscape.com/article/1133317-overview#showall>.

Source: Medical Disability Advisor