Warts
What are warts?
Warts are non-cancerous skin growths caused by a viral infection in the top
layer of the skin. Viruses that cause warts are called human papillomavirus (HPV).
Warts are usually skin-colored and feel rough to the touch, but they can be
dark, flat and smooth. The appearance of a wart depends on where it is growing.
How many kinds of warts are there?
There are several different kinds of warts including:
Common warts - usually grow on the
fingers, around the nails and on the backs of the hands. They are more common
where skin has been broken, for example where fingernails are bitten or
hangnails picked. These are often called "seed" warts because the blood vessels
to the wart produce black dots that look like seeds.
Foot warts - are usually on the soles (plantar area) of the feet and are
called plantar warts. When plantar warts grow in clusters they are known as
mosaic warts. Most plantar warts do not stick up above the surface like common
warts because the pressure of walking flattens them and pushes them back into
the skin. Like common warts, these warts may have black dots. Plantar warts have
a bad reputation because they can be painful, feeling like a stone in the shoe.
Plantar warts
Flat warts - are smaller and smoother than other warts. They tend to grow
in large numbers - 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 often found in the
beard area in men and on the legs in women. Irritation from shaving probably
accounts for this.
How do you get warts?
Warts are passed from person to person, sometimes indirectly. The time from the
first contact to the time the warts have grown large enough to be seen is often
several months. The risk of catching hand, foot, or flat warts from another
person is small.
Why do some people get warts and others don't?
Some people get warts depending on how often they are exposed to the virus. 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 just more likely to catch the wart virus than are
others, just as some people catch colds very easily. Patients with a weakened
immune system also are more prone to a wart virus infection.
Do warts need to be treated?
In children, warts can disappear without treatment over a period of several
months to years. However, warts that are bothersome, painful, or rapidly
multiplying should be treated. Warts in adults often do not disappear as easily
or as quickly as they do in children.
How do dermatologists treat warts?
Dermatologists are trained to use a variety of treatments, depending on the age
of the patient and the type of wart.
Common warts - in young children can be treated at home by their parents
on a daily basis by applying salicylic acid gel, solution or plaster. There is
usually little discomfort but it can take many weeks of treatment to obtain
favorable results. Treatment should be stopped at least temporarily if the wart
becomes sore. Warts may also be treated by "painting" with cantharidin in the
dermatologist's office. Cantharidin causes a blister to form under the wart. The
dermatologist can then clip away the dead part of the wart in the blister roof
in a week or so.
Common warts
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.
Electrosurgery (burning) is another good alternative treatment. Laser treatment
can also be used for resistant warts that have not responded to other therapies.
Foot warts - are difficult to treat because the bulk of the wart lies
below the skin surface. Treatments include the use of salicylic acid plasters,
applying other chemicals to the wart, or one of the surgical treatments
including laser surgery, electrosurgery, or cutting. The dermatologist may
recommend a change in footwear to reduce pressure on the wart and ways to keep
the foot dry since moisture tends to allow warts to spread.
Flat warts - are often too numerous to treat with methods mentioned
above. As a result, "peeling" methods using daily applications of salicylic
acid, tretinoin, glycolic acid or other surface peeling preparations are often
recommended. For some adults, periodic office treatments for surgical treatments
are sometimes necessary.
What are some of the other treatments for warts?
There are several different lasers used for the treatment of warts. Laser
therapy is used to destroy some types of warts. Lasers are more expensive and
require the injection of a local anesthesia to numb the area treated.
Another treatment is to inject each wart with an anti-cancer drug called
bleomycin. The injections may be painful and can have other side effects.
Immunotherapy, which attempts to use the body's own rejection system is another
method of treatment. Several methods of immunotherapy are being used. With one
method the patient is made allergic to a certain chemical which is then painted
on the wart. A mild allergic reaction occurs around the treated warts, and may
result in the disappearance of the warts.
Warts may also be injected with interferon, a treatment to boost the immune
reaction and cause rejection of the wart.
Can I treat my own warts without seeing a doctor?
There are some wart remedies available without a prescription. However, you
might mistake another kind of skin growth for a wart, and end up treating
something more serious as though it were a wart. If you have any questions about
either the diagnosis or the best way to treat a wart, you should seek your
dermatologist's advice.
What about the use of hypnosis or "folk" remedies?
Many people, patients and doctors alike, believe folk remedies and hypnosis are
effective. Since warts, especially in children, may disappear without treatment,
it's hard to know whether it was a folk remedy or just the passage of time that
led to the cure. Since warts are generally harmless, there may be times when
these treatments are appropriate. Medical treatments can always be used if
necessary.
What about the problem of recurrent warts?
Sometimes it seems as if new warts appear as fast as old ones go away. This may
happen because the old warts have 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.
A check by your dermatologist can help assure the treated wart has resolved
completely.
Is there any research going on about warts?
Research is moving along very rapidly. There is great interest in new
treatments, as well as the development of a vaccine against warts. We hope there
will be a solution to the annoying problem of warts in the not too distant
future.
