WARTS

Verruca Vulgaris aka Warts

Continuing on in our series of viral infections that cause skin problems, let’s talk about warts.

What are warts?
Warts are skin growths caused by a viral infection in the top layer of the skin. Viruses that cause warts are called human papillomavirus (HPV). There are over 100 types of HPV virus each causing different kinds of warts in different locations. Warts are usually skin-colored and feel rough to the touch, but they can be dark, flat, and smooth. The appearance of a wart depends on where it is growing and what type of HPV causes it.

How many kinds of warts are there?
There are several different kinds of warts including common warts, flat warts. plantar warts and genital warts.

Common warts usually grow on the fingers, around the nails and on the backs of the hands. They are more common where the skin has been broken, for example, where fingernails have been bitten, or hangnails picked. These are often called “seed” warts because the blood vessels in the wart produce black dots that look like seeds.

Foot warts are usually on the soles (plantar area) of the feet and are called plantar warts. When plantar warts grow in clusters, they are known as mosaic warts. Most plantar warts do not stick up above the surface like common warts. Like common warts, these warts may have black dots. Plantar warts have a bad reputation because they can be painful, feeling like a stone in the shoe. 

Flat warts are smaller and smoother than other warts. They tend to grow in large numbers – 20 to 100 at any one time. They can occur anywhere, but in children, they are most common on the face. In adults, they are often found in the beard area in men and on the legs in women. Irritation from shaving probably accounts for this. 

How do you get warts?
Warts are most often passed from person to person through direct skin-to-skin contact, The virus that causes warts, HPV, is everywhere.  The time from when the first contact to the time when warts have grown large enough to be seen is often several months. The risk of catching hand, foot, or flat warts from another person is small.  However, it is very easy to spread them from one part of the body to others by biting and picking at warts.

Why do some people get warts and others don’t?
Some people get warts depending on how often they are exposed to the virus. Wart viruses invade more easily if the skin has been damaged in some way, which explains the high frequency of warts in children who bite their nails or pick at hangnails. Some people are just more likely to catch the wart virus than are others, just as some people catch colds very easily. Patients with a weakened immune system also are more prone to a wart virus infection.

Do warts need to be treated?
In children, warts can disappear without treatment over a period of several months to years. Warts resolve when the body’s immune system kicks in and fights off warts. However, warts that are bothersome, painful, or rapidly multiplying should be treated. Warts in adults often do not disappear as easily or as quickly as they do in children.

How do dermatologists treat warts?
Dermatologists are trained to use a variety of treatments, depending on the age of the patient and the type of wart.

There are hundreds of reported treatments for warts.  Many of these treatments are old wives’ tales, folk remedies, or misunderstandings of how a wart grows.  One of the most common misperceptions is the need to dig out the seed. There is no true seed, and the black dots that people perceive to be seeds are just the tips of blood vessels that supply blood and nutrients to the wart. Many of the reported treatments work by stimulating the immune system to recognize and fight off the wart. As mentioned above, almost all warts resolve spontaneously with a tincture of time (however, this time maybe 20 days or 20 years).  For this reason, every given treatment works for somebody, because the immune system happens to kick in and fight off the wart at an opportune time.  This explains the effectiveness of hypnosis, duct tape, toothpaste, and Vicks Vaporub, and many other homeopathic regimens

Can I treat my own warts without seeing a doctor?
There are some wart remedies available without a prescription. However, you might mistake another kind of skin growth for a wart, and end up treating something more serious as though it were a wart. If you have any questions about either the diagnosis or the best way to treat a wart, you should seek your dermatologist’s advice.

What about the problem of recurrent warts?
Sometimes it seems as if new warts appear as fast as old ones go away.  In reality, new “baby” warts are growing up around the original “mother” warts. The best way to limit this is to treat new warts as quickly as they develop, so they have little time to shed viruses into nearby skin. Often it takes multiple treatments to effectively destroy a wart. The wart often appears to be gone only to come back a few weeks/months later. 

Is there a vaccine for warts?  There is a vaccine for the strains of the virus that cause genital warts only.

How are warts on the skin treated?

First of all, it’s important to know that warts on the skin (such as on the fingers, feet, and knees) and warts on the genitals are removed in different ways. Don’t try any home remedies or over-the-counter drugs to remove warts on the genital area. You could¯hurt your genital area by putting certain chemicals on it. You also shouldn’t treat warts on your face without talking to your doctor first. The following are some ways to remove warts from the skin:

• Applying salicylic acid–You can treat warts on places such as the hands, feet, or knees by putting salicylic acid on warts. To get good results, you must apply the acid every day for many weeks or months. After you take a bath or shower, pat your skin dry lightly with a towel. Then put salicylic acid on your warts. The acid sinks in deeper and works better when it is applied to damp skin. Before you take a shower or a bath the next day, use an emery board or foot file to file away the dead surface of warts. Be sure to change the emery board or sanitize your foot file, so as not to re-infect yourself over and over again. Salicylic acid in many different forms is available over the counter (OTC) preparations. These can be found at drug stores as well as at department stores such as Walmart.  Liquid versions of salicylic acid paints or plasters are most commonly found in a 17% concentration.  Some impregnated bandage versions are more convenient and are most commonly found in 40% concentrations.
• Applying cantharidin Often a solution called cantharidin (Cantharone or Cantharone Plus) is used to treat warts. Cantharidin is a blister beetle extract that works by irritating a wart and forming a blister under the wart. The goal is to have the wart peel off with the blister roof. Please Note:  Cantharone is not FDA approved and is purchased from a Canadian supplier.  However, this is a common, safe, and minimally painful procedure used by dermatologists for many years.  With this treatment, the doctor “paints” the chemical onto the wart. Most people don’t feel any pain when the chemical is applied to the wart. You’ll experience some pain and blistering of the wart in about 3 to 8 hours. After treatment with cantharidin, a bandage is often put over the wart. 
• Applying liquid nitrogen Dermatologists often use liquid nitrogen to freeze the wart. This treatment is called cryotherapy. Applying liquid nitrogen to the wart is painful. Again, this works by irritating a wart and forming a blister under the wart. The goal is to have the wart œpeel off with the blister roof. To completely remove a wart, liquid nitrogen treatments may be needed every 3-4 weeks for a total of 2 to 4 times. If no improvement is noted, your doctor may recommend another type of treatment.

• Imiquimod (Aldara orZyclara)  -Imiquimod is an immune modulator topical medicine that works by encouraging your body’s immune system to fight off the wart virus. This medication works best on mucosal surfaces and as a combination agent.  It is also good at keeping a recurrent wart away.
• 5-Fluorouracil (Efudex or Carac)  This chemotherapeutic drug also works to trigger your immune system to fight off the wart virus. For large lesions on the plantar feet, this cream can be the least painful method of treatment.  This cream can be used in combination with the OTC Salicylic Acid treatments described above. 
• Bleomycin Another treatment is to inject each wart with an anti-cancer drug called bleomycin. The injections may be painful and can have other side effects. Dr. Rosenberger does not recommend this treatment except for the most treatment-resistant cases.
• Other treatments for warts on the skin–Your doctor can also remove warts on the skin by burning the wart, cutting out the wart, or removing the wart with a laser. These treatments are more aggressive than others, and they may leave a scar and a wound that takes a long time to heal. The other major risk is that the smoke from these procedures is infectious and has been proven to cause warts in the mouth and throat of medical workers who breathe these fumes.
• Duct tape treatment— Covering a wart with duct tape may also help because it irritates the wart and the skin around it, causing the body to attack it. Cover the wart with duct tape for up to a week. Then remove the tape, soak the wart in warm water and rub it gently with an emery board or a foot file. Leave the tape off overnight, then repeat treatment until the wart goes away. If this is not successful after two months, see your doctor to try another approach.

Are there any dietary changes or supplements that might help? There is no single dietary change recommended other than a healthy well-balanced diet. We will share articles about alternative therapies on social media this week.

As you can see, treatment for warts is not simple and easily achieved in a single treatment.  Please be patient as your wart resolves!

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