Warts

What are warts?

Warts are common growths that can occur on the hands, face and genital areas of the skin. They often begin as pinhead sized lesions which are initially smooth and shiny. With time, they can enlarge  to appear as flesh colored or "dirty brown" like growths. Warts can become fissured, inflamed or tender when manipulated. Patients sometimes complain of discomfort when warts are bumped or scratched, noting that they bleed with minimal trauma.

Warts-difficult to eradicate and characterized by flesh colored papules on the hands

Fig. 1  Common warts on the hands

"Response to wart treatment depends, to a great degree, on a patient's immune system. Sometimes it is necessary to boost the immune system with oral medications before a wart treatment can be carried out successfully"  
                                                                                                                  Dr. Harvey and Dr. Hardy 

How many kinds of warts are there?
 
There are several types of warts which can occur on the body. These include:

- Common Warts
- Plantar Warts (Foot warts)
- Flat warts
- Genital Warts

Fig. 2  Flat Warts on the Hand

Common warts occur on the hands, nail regions, or fingers. These areas are prone  to  trauma, for example where fingernails are bitten or hangnails picked.

Plantar warts or warts of the feet usually grow in clusters. These are referred to as "mosaic warts" because of their intricate architecture. Plantar warts do not rise above the skin because the pressure of walking usually flattens them out and pushes them into the skin. Plantar warts often have "black dots" within their border which represent small blood vessels. Plantar warts have a reputation for being painful and persistent. Some patients refer to their discomfort as if they "have a stone within their shoe".

Fig. 3 Flat Warts on the face

Flat warts or Verruca Plana are smaller and tend to grow in great numbers approximately 20 to 100 at a time. Flat warts can occur anywhere. In children , they are  commonly seen on the face. In adults, they are often found in the beard area (in men) and legs (in women). Irritation from shaving techniques, in part, account for these areas being susceptible to flat wart formation.

Genital Warts (referred to Condyloma) have become a frequent occurrence in the adult population. Warts in these areas are usually small and flat,  but they can also be thin and tall. Genital warts are softer and not a rough or scaly as other types of warts. They usually occur in the vagina, cervix, penile or rectal areas. Viruses that cause genital warts rarely cause warts to form in other regions but they can be a source of  virus spread to the mouth area.

What causes warts to form?
 
Warts develop when a virus particle infects traumatized skin. The virus that causes warts to form belongs to a family of viruses called human papilloma virus or HPV. Certain professions, e.g. meat handlers are more prone to develop warts because of their exposure to infected meat. Viruses can also be passed on from person to person. After initial contact with the virus, it can take several months for a wart lesion to  appear.

Can warts predispose a patient to cancer?  What areas of the body can be affected?
 
Some wart viruses can induce cancer of the cervix to develop. This can be a concern for adult women , especially if genital transmission is suspected. Warts can also cancer to develop in the fingernail or oral cavity areas. Growths can occur in the mouth, hands, face, trunk legs or feet regions. Warts over the fingers and toes are some of the hardest types to eradicate and may require oral medications or  aggressive surgical treatments.

"Warts are benign lesions that develop when a virus particle enters the skin. They can appear flesh colored or resemble dirty brown like growths".
                                                                                                                   Dr. Harvey and Dr. Hardy 
 

Why do some people get warts and others don't?
 
Some people are more prone to develop warts because they are exposed more often to the wart virus. Warts occur more easily if the skin has been damaged in some way. That is why Dr. Harvey and Dr. Hardy stresses that biting or picking at warts be minimized. Some people are inherently more likely to develop warts due to a weak immune system. Patients with allergies, diabetes, or cancer are more likely to form warts. That is why Dr.. Harvey may recommend oral medications to boost your immune system before treating your warts.

What are some of the available treatments for warts?

There are multiple treatment options for warts. It is important to note that in children, warts usually  resolve without treatment  in 80% of cases. Most of these warts will disappear within two years. Other warts are more resilient.. Factors such as age, immune status and size determine how difficult a wart will be to treat. Management also depends on wart location, number and previous treatment responses. Specific therapies available to treat warts include Podophyllin resins, Salicylic Acids, Liquid Nitrogen Sprays, Retin  A Cream^™ ,  Canthacur PS^™  Solution,  Squaric Acid, or Imiquimod Cream. Carbon Dioxide Laser Treatments or intra-lesional chemotherapies have also been utilized but  require more time for patients to heal. Oral medications such as Tagamet^™  or Beta Carotene can assist with wart disappearance , especially in refractory cases. Dr. Harvey and Dr. Hardy can advise you of the treatment which best suits your particular needs.

Can I treat my own warts without seeing a physician?
 
There are some wart remedies available without a prescription. However, one can sometimes mistake another type of skin growth for a wart and end up treating something more serious as though it were a wart.

"Warts can resolve spontaneously or can be hard to eradicate. The variability in wart type and location can make treatment choices difficult to consider"

Dr. Harvey and Dr. Hardy may recommend:

• Tagamet^™ as directed for warts at a dosing of 40mg/kg body weight. Topical treatment may be carried out after being on this medication for 4 weeks.

• Beta Carotene^™ as directed by Dr. Harvey and Dr. Hardy

• Canthacur PS^™- Treat the affected area and wash off in 4 to 6 hours. Repeat every 2  to 4 weeks.

• Avoid manipulating (e.g. biting or picking) your wart in order to minimize the risk of spreading the wart virus.

• Aldara^™  Cream-Apply as directed every other day to the wart

• Use a dilute bleaching solution when shaving, e.g. 1 teaspoon of bleach to 1 cup of water- then dip razor into solution and  under water before each shaving stroke 

• Surgical destruction with the carbon dioxide laser

• Bleomycin injections

• Podophyllin Resin Treatment 

• Retin A Cream^™  or Tazarac Gel^™  Applications

• Avoid aspirin or Advil^™  for one week before and 3 days after your scheduled treatment for warts

• Mediplast^™  sheeting

• Squaric Acid Immunotherapy 

• Call our office if fever, chills or persistent pain develops after wart treatment

• Tylenol^™  or other analgesics as prescribed by Dr. Harvey and Dr. Hardy

• Regular follow up every two to four weeks to optimize your chances for wart eradication

    If you have any questions, or wish to schedule a consultation, please call Ponte Vedra      
    Dermatology & Aesthetic Surgery at (904) 285-7546 or email consultation@pvderm.com.