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.
