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Warts |
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Definition
Warts are small, usually painless growths on the skin
caused by a virus. They are generally harmless.
However, warts can be disfiguring and embarrassing,
and occasionally they itch or hurt (particularly on
the feet).
The different types of
warts include:
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Common warts:
usually appear on the hands, but can appear
anywhere.
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Flat warts:
generally found on the face and forehead. Common in
children, less so in teens, and rare in adults.
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Genital warts:
usually found on the genitals, in the pubic area,
and the area between the thighs, but can appear
inside the vagina and anal canal.
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Plantar warts:
found on the soles of the feet.
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Subungual and periungual warts:
appear under and around the fingernails or toenails
Causes
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The cause is a virus called HPV
(human papilloma virus), which infects the skin and
causes the abnormal growth. There over 100 types of HPV.
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Some genital warts are associated
with an increased incidence of cervical cancer.
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Warts that are on the cervix (the
connection between the uterus and the vagina) can be
transmitted to newborn babies delivered via the
vagina. Babies infected this way have a higher risk
of developing warts in their throat.
Symptoms
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Small, hard, flat or raised skin lesion or lump
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Abnormally dark or light skin surrounding the lesion
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Numerous small, smooth, flat (pinhead sized) lesions
on forehead, cheeks, arms, or legs
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Rough, round, or oval lesions on soles of feet
-- flat to slightly raised -- painful to pressure
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Rough
growths around or under fingernails or toenails
Screening and Diagnosis
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Diagnosis is usually made by a
doctor who recognizes the typical appearance of
warts.
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Occasionally, a biopsy (in which
a sample of the affected area of skin is removed and
examined under a microscope) is needed to confirm
the diagnosis.
Treatment
For about 65 per cent of wart infections clear up by
themselves within two years, without any medical
intervention.
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There are multiple treatments
available for warts; however, there is no guarantee
of a cure or a way to prevent recurrences.
Therefore, the goal of treatment is to keep patients
wart-free as long as possible.
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Treatments currently available:
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Removal
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Liquid nitrogen freezes the
wart, and can be slightly painful, potentially
leading to scarring, whitening of the skin, and,
rarely, local nerve problems if used incorrectly.
Liquid nitrogen is usually used for warts on the
hands, feet, and face. It can also be used for
some genital warts.
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Keratolytic agents -- these
include Occlusal-HP, Duofilm, and Trans-Ver-Sal.
For some warts on the bottom of the feet,
Mediplast may be used, but requires weeks to
months for results to show.
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Podophyllum resin -- this is
basically a liquid that is painted over the wart
every 2-3 weeks until the wart is gone. Because
it is less painful, it is often used in genital
warts and warts around the anus.
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There is also a version of
this product that you can use at home called
Podofilox. It has to be applied twice a day
for three days in a row for 4-6 weeks.
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Podophyllum should not be
used in pregnant patients.
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Many patients treated with
this medicine develop warts again after
several weeks and have to be treated all over
again.
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Less risky in pregnant
patients, but it is also more expensive than
Podophyllum. This cream seems to work better in
women with genital warts. Therefore, it is often
the first treatment used in women.
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In men, it is not as effective.
Therefore, Podophyllum is initially used in men.
If Podophyllum fails, then Imiquimod can be used.
This medicine also has a lower chance of warts
developing again compared to Podophyllum.
Plantar Warts (those on
the bottom of the foot) can be removed surgically.
After the wart is removed, a medicine (trichloroacetic
acid or Monsel's solution) or a small amount of
electricity is applied. However, since this can be
painful and may lead to scarring, it is not used
very often. In the genital area, warts can be
snipped with scissors while a small amount of
electricity is applied. This usually does cause
some scarring, but is often more effective than
liquid nitrogen. Also, with larger genital warts,
this is the preferred treatment.
Laser therapy -- the CO2 laser
can be used for some warts on the hands and feet.
However, it often leaves an open wound that may
require 4-6 weeks to heal. Pulse dye lasers can
also be used to slowly remove the warts. However,
laser therapy is usually used only after other
treatments have failed. For genital warts, lasers
have not been shown to be any more affective than
other treatments.
Bleomycin -- this medicine can be
injected into some warts on the feet and other areas
of the body. However, it should not be used on the
hands. It does have a fairly high cure rate.
Retinoids -- medicines such as
Retin-A cream or gel applied to the warts twice a
day may be effective for facial warts and warts
under beards. Also, oral use of this medicine can
occasionally decrease the number of warts throughout
the body over a period of 4-8 weeks.
Soaking warts in warm water for
10-30 minutes every day for 6 weeks can also
sometimes decrease the size of the wart.
Warts have a high chance of
recurring. Consequently, treatments may need to be
repeated several times. There are instances
recorded in which warts have disappeared
spontaneously.
It is rare for there to be no
response to any of these treatments.
Prevention
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Prevention of an infection is the
goal here. Condoms may decrease the transmission of
genital warts.
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Patients with fat warts should
try to avoid scratching them because this can also
cause the warts to spread.
Complications
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Spread of warts
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Return of warts that disappeared
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Minor
scar formation if the wart is removed
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Formation of keloids after removal
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