Wart Diagnosis and Treatments
What Are Warts?
Warts are caused by a viral infection of the cells found in the top layer of the skin. The name of this virus is the human papillomavirus (HPV). Warts are skin-colored and feel rough to the touch.
How Many Kinds of Warts Are There?
There are several different kinds of warts that can be caused by one or more members of the human papillomavirus family.
These include:
Hand Warts
Hand warts are usually found around the nails, on the fingers and on the back of the hand. They are more common where skin has been broken and in the areas where fingernails are bitten or hangnails picked.
Foot Warts
Foot warts are usually on the soles of the feet. These warts are called plantar warts. Plantar warts tend to grow in a group the size of a quarter or larger. These grouped warts are known as mosaic warts. Most plantar warts do not stick up above the surface as much as hand warts, because sometimes the pressure of the walking on them flattens them and pushes them back into the skin. Often black dots, which are the blood vessels that feed the wart, can be seen. Plantar warts can be common in people who sweat heavily and who do a lot of walking or exercising.
Flat Warts
Flat warts are much smaller and are less rough than hand or foot warts. They tend to grow in great numbers, from 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 most often found in the beard area in men and on the legs in women. Skin irritations from shaving probably account for this.
Genital Warts
Genital warts have become a more common and worrisome problem in young adults. They tend to be small flat bumps or they may be thin and tall. These are quite soft and aren’t rough or scaly on the surface like other warts. They can occur on the genitalia, within the vagina, and on the cervix in women, and around the anus and within the rectum.
How Do You Get Warts?
Warts probably are passed from person to person. The time from the first contact to the time the warts have grown large enough to be seen is generally several months. The risk of catching hand, foot, and flat warts is small. Genital warts seem to be very contagious. These warts are associated with cancer of the cervix. It is important to use precautions so as not to spread genital warts to one’s sexual partner.
Why Do Some People Get Warts and Others Don’t?
Some people get warts depending on how often they are exposed to the virus. For example, dermatologists seem to have a higher incidence of warts than do other people. Wart viruses occur 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 naturally more likely to catch the wart virus than are others. Just as some people catch colds very easily. Patients whose immune systems have been affected by certain medical conditions and some medications also are more prone to the wart virus infection.
Do Warts Need to Be Treated?
In children, warts almost always disappear without treatment over a period of several months to several years. However, since warts can spread to others and can be spread to new areas on yourself, it’s probably best to treat most children.
Warts in adults do not disappear as easily and as quickly as they do in children. There seems to be some increased possibility of skin cancer at the site of long-standing genital warts. Women with genital warts also have an increased risk of cancer of the cervix. For these reasons, all adults with genital warts should be treated and closely followed.
How Do Dermatologists Treat Warts?
Dermatologists are trained to use a variety of treatment, depending on the age of the patient and the type of warts:
Hand Warts
Hand warts in young children can be treated at home by their parents on a daily basis by painting on low strength salicylic acid. There is very little discomfort but it does take many weeks of use to obtain favorable results. Frequent “painting” with cantharidin in the dermatologist’s office may be recommended. This basically painless treatment causes a blister to form under the wart. The dead part of the wart in the blister roof can be clipped away in a week or so by the dermatologist.
For adults and older children cryotherapy (freezing) is generally preferred. This treatment is not too painful and rarely results in scarring. However, repeat treatments at one to three week intervals are often necessary. Electrosurgical destruction (burning) is another good alternative treatment since the wart or warts can generally be completely removed during a single office visit. However, there may be some scarring and pain as a result.
Plantar Warts
Plantar warts are difficult to treat because the bulk of the wart lies below the skin surface. Many dermatologists prefer the use of salicylic acid plasters, removing the wart under local anesthesia, or by applying other chemicals to the wart. The dermatologist may recommend a change in footwear to reduce pressure on the wart or methods to reduce foot sweating.
Flat Warts
Flat warts are often too numerous to treat with methods mentioned above. As a result, “peeling” methods using daily application of salicylic acid , or other surface peeling preparations are often recommended. For some adults, periodic office treatments are sometimes necessary.
Genital Warts
Genital warts are perhaps the most difficult to treat. First, all warts must be located. This may require an examination of the vagina and cervix in women and the rectum of both sexes. Then periodic office treatments with acids or by freezing are generally needed. Repeat office visits often are necessary to get rid of the warts successfully. Your dermatologist may prescribe a form of podophyllin which can be used at home.
With very stubborn or very large genital warts, surgical removal may be necessary. The patient’s sexual partner should also be examined for warts by a dermatologist.
Warts may be very difficult to cure. Occasionally multiple treatments will be needed and even then treatment success cannot be guaranteed.
What Are Some of the Newer Treatments for Warts?
There have been many new treatment advances developed recently. Laser therapy is one of the newer methods used to destroy some types of warts. But it is more expensive and may require the injection of a local anesthesia to numb the area beforehand. Another new method is immunotherapy, which attempts to build up the body’s own rejection system. Several methods of immunotherapy are being used, but the most common is one in which the patient is literally made allergic to a certain chemical. A mild allergic reaction then occurs around the treated warts. This generally results in disappearance of the warts.
Can I Treat My Own Warts Without Seeing a Doctor?
There are some wart remedies available without a prescription. However, as dermatologists, we are concerned that you might mistake another kind of skin growth for a wart. You might end up treating something more serious as though it was a wart. If you have any questions about either the diagnosis or the right way to treat a wart, you should seek your dermatologist’s advice.
What About the Problem of Recurrent Warts?
Sometimes it seems as though new warts appear as fast as old ones are treated. This could happen because of re-infection from an infected person. Most often it happens because the old warts had shed virus into the surrounding skin before they were treated.
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 virus into nearby skin.
Is There Any Research Going On About Warts?
Research is moving along very rapidly. There is great interest in new treatment and in developing a vaccine against warts. Because of this new research there is every reason to hope that the annoying problem of warts will be solved in the not too distant future.
For more information on warts, please click here.
