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Warts

Diagnosis and Treatment


Rick Lin, DO MPH
First Year Dermatology Resident
Texas Division of KCOM
Dermatology Residency Program

Background Information
Warts

are small harmless lesions of the skin


caused by a virus: the human papilloma virus.
The appearance of warts can differ based on the
type of wart and where it is located on the body.
Warts are common in children. Most cases
occur between ages 12-16 years.
Up to 30% of warts disappear by themselves
within 6 months. Most will disappear without any
treatment within 3 years.

Background Information
Warts

are caused by the DNA-containing human


papillomavirus (HPV). There are at least 63
genetically different types of HPVs.
The virus enters the skin after direct contact with
recently shed viruses kept alive in warm, moist
environments such as a locker room, or by direct
contact with an infected person.
The entry site is often an area of recent injury. The
incubation timefrom when the virus is contracted
until a wart appearscan be 1-8 months.

Background Information
Contrary

to popular mythology, touching


a frog will not give you warts.

Types of warts
Common

warts (verrucae vulgaris):


These common warts typically develop
on the hand, especially around the nail.
They are gray to flesh colored, raised
from the skin surface, and covered with
rough, hornlike projections.

Types of warts
Plantar

warts (verrucae plantaris):


Plantar warts, by definition, occur on the plantar
surface, or bottom, of the foot.
They usually occur in high pressure areas such
as the heel and the metatarsal heads (just
behind the toes).
They usually grow into the skin, not outward
like common warts.
This growing into the skin makes them more
difficult to treat.

Types of warts
Flat

warts (verrucae plana): Flat warts


are most commonly seen on the face,
the back of the hands, and lower legs.
They usually appear as small individual
bumps about 1/4 inch across.
Flat warts may spread rapidly on the
face and lower legs from the activities
involved in shaving.

Histopathology
Verruca

vulgaris (common wart) is caused by


varous strains of human papilloma virus (HPV
1, 2, 4, 7, 26-29).
Macroscopically verruca vulgaris may present
as hard, rough surfaced papule
2 20 mm (solitary or multiple).
Microscopically, this is an exophytic,
symmetric, papillomatous lesion with large
keratohyaline granules and characteristic
inturning of the rete ridges.

Histopathology
Parakeratotic

columnar tiers of stratum


corneum overlie the papillomatous surface.

Small

amounts of hemorrhage may be


present within the columns of parakeratosis.

Other

characteristic features include


koilocytosis, hypergranulosis and presence
of multinucleated cells.

Treatment
Home

care is effective in making the


wart or warts go away. No matter what
technique you use, warts will disappear
60-70% of the time.
Techniques may be done with and
without medication.

Treatment
The

ultimate goal of the medical


therapies (not the surgical treatments)
is to get your body to recognize the wart
as something foreign and to destroy it,
much like the body destroys a cold
virus.

Adhesive tape therapy


Place

several layers of waterproof


adhesive tape over the wart region
(even duct tape).
Do not remove the tape for 6-1/2 days.
Then take off the tape and open the
area to the air for 12 hours.
Reapply tape for another 6-1/2 days.

Adhesive tape therapy


The

tape works best in the region


around the fingernail.
Tape works because the air-tight, moist
environment under the tape does not
allow the virus to grow and reproduce

Salicylic acid therapy


Salicylic

acid is available by many different


trade names at the drug store.
Dual Film
Wart-Off
Dr. Scholls Wart Medication
Medi-Plast

It

comes either as a liquid to paint on the wart


or as a plaster to be cut out and placed on
the wart tissue.

Salicylic acid therapy


The

area with the wart should be


soaked in warm water for 5-10 minutes.
The wart should then be pared down
with a razor. A simple razor works fine
for this, then throw it away.
Do not shave far enough to make the
wart bleed.

Salicylic acid therapy


Apply

the salicylic acid preparation to


the wart tissue.
Do not apply it to other skin because of
salicylic acid's potential to injure normal
tissue.
Follow directions on the package for
how long to apply the acid.

Cryosurgery
Liquid

nitrogen or cryotherapy is used to deep


freeze the wart tissue.
With liquid nitrogen applied to the wart, the
water in the cells expands, thus exploding the
infected tissue.
The exploded cells can no longer hide the
human papillomavirus from the body's immune
system.
The immune system then works to destroy the
virus particles.

Cryosurgery
Periungual

area may scar if cryotherapy


with liquid nitrogen is used improperly.

Scarring

could lead to permanent nail


disfiguration.

Laser Therapy
Laser

therapy: Lasers are simply very


intense light sources.

This

light has an enormous amount of


energy that heats the tissue enough
that it vaporizes.

Shave Removal
Shave

removal and electrodessication


of the base may be necessary when
other treatment methods fail.

This

would involve numbing the region


around the wart and shaving the wart
flat with the surface and light
electrodessication of the base.

Prognosis:
Most

warts will disappear without


treatment anywhere from 6 months to 3
years.
Warts may recur after treatment and
require additional treatments.

Prevention:
Avoid

touching warts on others or touching


them on yourself (refrain from rubbing a warty
finger across your face).
Children needs to avoid biting or chewing
warts.
Wear shower shoes in the gym locker room to
lower your risk of picking up the virus that
causes plantar warts from the moist
environment.

When to Refer
If

you feel uncomfortable treating warts.

Warts

that are resistant to your


treatment

Unsure

of diagnosis

Questions and Answers