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Warts

more about Warts


Verrucae



  • Warts are caused by a virus that usually infects the skin in various parts of the body.  The most common complaint is a raised area of skin that can occur anywhere on the body, most often on the hands, feet, and genital areas.
  • Approximately 10% of children between ages 5-10 have warts.

  • Usually warts do not have any symptoms
  • Most often the problem is cosmetic
  • Occasionally they can be painful (e.g., in the voice box, at the bottom of the feet, i.e., plantar warts) or itchy.

  • The cause is a virus called HPV (human papillomavirus), which infects the skin and causes the abnormal growth.  There are many different varieties of the virus, which usually depends on the location of the lesion.
  • Some genital warts are associated with an increased incidence of cervical cancer.
  • 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.

  • Diagnosis is usually made by a doctor who recognizes the typical appearance of warts.
  • 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.

  • They occasionally disappear spontaneously.
  • 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.
  • Treatments currently available:
    1. Removal
    2. 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.  It can also be used for some genital warts.
    3. 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.
    4. 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.

      • 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.
      • Podophyllum should not be used in pregnant patients. 
      • Many patients treated with this medicine develop warts again after several weeks and have to be treated all over again.

    5. Imiquimod -- this is a cream, which is usually used for the treatment of genital warts.  It leads to destruction of the virus by the body's immune system.  The cream has to be applied once a day on 3 alternate days a week.  It can sometimes take 8-12 weeks for the warts to disappear.

      • 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. 
      • 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.

    6. Surgical removal -- some 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.
    7. 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. 
    8. 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. 
    9. 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.
    10. Soaking warts in warm water for 10-30 minutes every day for 6 weeks can also sometimes decrease the size of the wart. 
    11. 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. 
    12.  It is rare for there to be no response to any of these treatments.

  • Prevention of an infection is the goal here.  Condoms may decrease the transmission of genital warts.
  • Patients with fat warts should try to avoid scratching them because this can also cause the warts to spread.

  • Hypertrophic actinic keratosis
  • Squamous cell carcinoma
  • Secondary syphilis
  • Molluscum Contagiosum
  • Seborrheic keratosis
  • Plantar warts can look like corns or calluses




more about Warts


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