Warts

What are warts?

Warts are rough-textured growths on the surface of the skin. They are the result of a viral infection in this top layer of skin.

Causes:

As mentioned above, viruses are the cause of warts. In particular, the human papilloma virus (HPV) family is now known to be the predominant virus contributing to wart formation. There are more than 60 or more types of HPV. Because warts are due to viruses, they are potentially contagious. Common warts (known as verruca vulgaris) refer to warts on your hands, elbows, and knees.

HPV also causes warts in other places, such as on the soles of the feet (plantar warts), the genitals (genital warts) or the face (usually flat warts).

Touching a person where a wart is present or touching an object where someone with warts has just used this object can transmit the virus to you and may result in warts. Walking on wet or moist surfaces, such as at the pool, gym, sauna, etc also easily transmits certain warts. On a lighter note, you cannot get warts by kissing a frog because the viruses that cause warts only infect humans.

Symptoms:

Many people present with one or more skin lesions that may cause pain or discomfort. Locations typical for common warts include:

* Hands/fingers
* Legs

Other types of non-genital skin warts, called plantar and flat warts, can occur in the following locations:

* Feet (especially the sole)-called plantar warts
* Face-usually these are flat warts


Warts may present in isolation or in clusters. Many types of warts cause little black dots to form on the skin's surface. These black dots are tiny clotted blood vessels. Warts may present in many colors, most commonly skin color, light brown or tan. Plantar warts seen on the sole of feet are thickened and are often confuse for corns or calluses. Flat warts are flatter and smoother appearing and are often seen on the face of women. Warts do not bleed. If any skin lesion ever bleeds, consult a physician immediately for further evaluation and management. Risk Factors for common skin warts:

Age is the most common risk factor. Warts are estimated to occur in up to 10% of children and young adults. Warts occur with greater frequency in girls than boys. Peak occurrence is age 13 for girls and 14 for boys. Other risk factors for developing warts include:
- Any chronic disease
- Immunosuppression (cancer, HIV, AIDS, transplant patients)
- Poor nutrition
- Poor hygiene

Teaching Point: Warts are more common in teenagers and in those with immune compromise.

Diagnosis:

Medical providers can easily recognize warts based on your presenting symptoms and warts’ typical appearance. Sometimes a wart or warts mimic other common skin lesions, such as moles, keratoses, even cancer. For this reason, primary care providers and dermatologists may choose to excise the wart and submit the specimen to the lab for microscopic analysis. Please make sure that you show any suspicious skin lesion to your doctor.


Teaching Point: Warts are often easy to recognize and diagnose, but sometimes a doctor will surgically remove the wart to confirm its nature.

Treatments:

Treatment is mainly geared toward physically destroying the wart(s) on the surface of the skin and creating an inflammatory response that signals the body’s immune system to kick into high gear, thus clearing the residual virus from the skin. Your doctor will decide which treatment is best for you.

Common modalities include:

1. Cryotherapy. This involves applying an extremely cold substance (liquid nitrogen) to the wart-covered surface of the skin. Many different application techniques and devices exist. Best results occur when the wart or warts are treated early and repeatedly every other week for up to 3 months, as needed.
2. Laser therapy. This involves a specific laser that is applied in pulsed doses, heating up the surface of the wart or warts, causing the wart to lose its blood supply and results in the wart falling off. Less treatment sessions are required, but there is more risk for scarring.
3. Topical cream. Prescription cream (imiquimod) is available for those who prefer self-treating their warts. Treatment success varies and can take up to 16 weeks for full resolution. This cream is best used for warts in the anorectal and genital regions.
4. Injections. A medical provider can inject specific agents, bleomycin, interferon or candida, into the wart area. This injection is presumed to stimulate the body’s immune system and/or inhibit the virus from reproducing. This therapy is only used when warts that fail to respond to other treatment plans, and is rarely used for the treatment of warts.
5. Excision (REMOVAL) of the warts when they mimic more ominous-looking skin lesions.
6. Over the counter topical agents: These usually dry up and dissolve infected skin tissue. These products tend to contain different strengths of the compound known as salicylic acid and require soaking of the area in warm water followed by daily application for best results.
7. Recent studies demonstrate that covering warts in duct tape may be as effective as cryotherapy in getting rid of warts. The treatment involves covering the infected area(s) for 6 days, then soaking and scrubbing the skin with a pumice stone. Repeat as needed for best results.
8. When all else fails, try the “tincture of time” treatment. In reality, most warts eventually go away on their own. Average time for disappearance is between 6-18 months. Patience can be a virtue.

Teaching Point: Liquid nitrogen therapy, laser therapy and topical creams are the most commonly used treatments to get rid of warts. Use of other techniques, such as applying duct tape or injections, may also be beneficial.

Prevention:

Simple ways to prevent warts are:

- Don appropriate shoe wear at the local gym, pool or other related facilities
- Eat and drink healthfully to maximize your body’s natural immune defenses
- Learn how to cope and manage your stress as stress can weaken your immune system, predisposing to warts


Teaching Point: Best way to avoid catching warts is to wear flip-flops or shoe wear at the local gym or pool, eat healthy, and reduce your stress.

Complications:

Complications related to common warts are usually not dangerous and include:

- Recurrence in the same or similar areas
- Discomfort, itching or burning sensation
- Cosmetic inconvenience

Teaching Point: Warts can linger and cause discomfort without treatment.

The final word:

Common warts are a common medical condition. Fortunately, they are more a nuisance than a true illness. Treatment is available. Please consult your family doctor for further information.

References:

1. Bacelieri, R; Marchese, S. Cutaneous Warts: An Evidence-Based Approach to Therapy. American Family Physician. 2005. 72(4)
2. Kodner, CM; Nasraty, S. Management of Genital Warts. American Family Physician. 2004. 70(12).
3. Warts. Information from your Family Doctor. American Family Physician. 2003. 67(6).
4. www.aad.org/public/Publicatons/pamphlets/Warts.htm - accessed 02/02/2007.
5. http://familydoctor.org/209.xml - accessed 02/-2/2007


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