August 18, 2016

Warts and Verrucas

Common warts are also called verruca vulgaris. Other names used in the literature are plane juvenile warts; periungual warts; subungual warts; plantar warts; verruca; verrucae planae juveniles; filiform warts. These are benign (non-cancerous) painless growths which can appear on the skin or mucosa. The appearance of the wart is rough and can be flat or elevated out growth from the skin or mucosa. Common locations are the mucocutaneous surface of hands, face, neck, chest, feet, genitals and around the anus. The hands are particularly susceptible to being infected. Most of the warts resolve spontaneously but for those that persist there are a range of treatments available. Warts are more common among children and adolescents but can affect older persons.

Types

Warts are named and classified based on where they appear. Some types of warts are spread through direct contact with the HPV on infected surfaces, skin contact with the wart or during sexual intercourse.

Types of warts include the following:

  • Common warts

These are frequently seen on the hands as a single wart or clusters of warts. Elsewhere the warts tend to be flat and are generally found on the face and forehead.

  • Genito-anal warts (condyloma)

Warts in the genital and pubic area are called genital warts. The warts can also occur on the inner thighs, in the area between the thighs, inside the vagina, anal canal as well as around the anus. These are sexually transmitted.

 

  • Plantar warts

These warts which occur on the soles of the feet are more common in adolescents and can be very painful resulting in difficulty walking and running. Communal areas such as locker rooms are notorious for spreading the viral verruca infection.

  • Subungual and periungual warts

Warts under the nail are subungual. When they appear around the fingernails or toenails they are called periungual warts.

The health care provider can examine your skin to diagnose warts. In some instances it may be necessary to do a skin biopsy to confirm the diagnosis of a wart. The biopsy can also differentiate common warts from skin cancer. Plantar warts can have the appearance similar to corns and calluses.

Causes

Warts are caused mainly by viral infections. Many of the viruses are part of the papovavirus group. Of this group the human papillomavirus HPV is responsible for the common localized skin wart infection. HPV can cause cancerous growths.

Symptoms

An infection can occur if an uninfected person is exposed to a surface such as the floor of a communal shower or locker room where the virus exists. Through an abrasion or cut on the skin or mucosa, the virus enters at the site resulting in the skin changes over time. It can take weeks or even months for a wart or verruca to appear after the initial infection. Symptoms include:

  • A change in the skin or mucosa which has a  rough surfaced nodule that may be either lighter or darker than the surrounding skin
  • Itching of the wart
  • Pain in the area especially those on the sole of the feet

Certain warts have an increased risk of cancer (cervical, penis mouth and throat etc.) and hence the importance of visiting the doctor who is able to determine this.

Treatments

Many patients will consult with the doctor or podiatrist (chiropodist) about the wart because they find it unsightly. Also with the increased public awareness of skin cancer there is anxiety to have the growth examined by the health professional. Some common warts will resolve spontaneously. It is important for patients to be cautioned not to attempt to remove the wart by burning, cutting, tearing or picking at it. This could result in a spreading of the infection and a worsening of the problem.

Treatment Options

Medicines

  • Over the Counter OTC medicine. Salicylic acid is a popular wart removal medicine. These should however not be used on the face or genital areas except being applied by a health professional.
  • Prescription strength wart  remover
  • Application of a blistering solution
  • Topical skin medicine called imiquimod used mainly on anogenital warts

Minor surgical procedures

  • Cryotherapy (freezing the wart) to remove it
  • Electrocautery (burning the wart ) to remove it
  • Laser treatment to remove stubborn warts
  • Immunotherapy is injected in the growth to reduce and remove the wart. One promising medicine is called interferon

Supportive Therapy

  • Here are some useful tips to promote the treatment for warts or verruca removal:
  • Insert foot cushions in footwear to ease the discomfort and pain of plantar warts. You can buy these at pharmacies. Wearing socks helps to cushion the plantar warts from pressure.
  • Wear comfortable shoes to lessen pressure on plantar verrucas.
  • Visit the podiatrist or health care provider who can trim away thick skin or calluses that tend to form over warts on your foot or around nails.
  • After applying the wart removal medicine use a nail file or emery board when your skin is damp to remove dead tissue. Discard emery board after each use.
  • Put the medicine on the wart every day for several weeks or months. Follow the instructions on the label.
  • Keep wart covered with a bandage after applying the medicine to prevent the infection from spreading.

Treatment of genital and anal warts

  • Genital and anal warts require a different treatment from that used for common warts.
  • An effective wart removal medicine veregen or podophyllin is applied to anogenital warts
  • File the wart with a nail file or emery board when your skin is damp (for example, after a shower or bath). This helps remove dead tissue. Do not use the same emery board on your nails.
  • Apply the medicine on the wart every daily until the wart disappears. This may take weeks or months.
  • To prevent infecting other parts of the skin it is advised to cover the treated are with a bamdage.

Prevention

  • Avoid direct contact with a wart whether it is on your body or another person’s skin. The HPV is highly infectious. Always wash hands carefully after touching a wart.
  • In public showers and locker rooms wear protective footwear to avoid getting plantar warts infection.
  • There is a risk of spreading the virus to other parts of your body. Any instrument used to file, remove excessive growth over and around the verrucas/warts must be sterilized after use.
  • The HPV vaccine is given to prevent many types of HPV infections. It may be helpful to prevent anogenital warts.

A Word of Caution

Call your health care provider if:

  • The wart appears infected or bleeds on contact
  • There is a noticeable change in the appearance of the wart
  • The wart is growing rapidly in size
  • The wart has not responded to OTC treatment and you want to have it removed.
  • The wart is painful and interferes with regular activity.
  • You have anal or genital warts.
  • You have diabetes or a weakened immune system (for example, from HIV) and have developed warts.
  • There is any change in the color or appearance of the wart.

There are persons who will try home remedies and homeopathic solutions. Do  not delay to have a health professional examine and treat appropriately the warts especially the anogenital types.

References

1.                   Warts, herpes simplex, and other viral infections. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, PA: Elsevier Mosby; 2009:chap 12.

2.                  Kirnbauer R, Lenz P. Human papilloma viruse. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds. Dermatology. 3rd ed. Philadelphia

3.                  [HTML]Self-administered topical 5% imiquimod cream for external anogenital warts, L Edwards, A Ferenczy, L Eron… – Archives of …, 1998

4.                  Natural history of genital warts., JD Oriel – British Journal of Venereal Diseases, 1971 – ncbi.nlm.nih.gov

5.                  Immunological events in regressing genital warts, N Coleman, HDL Birley, AM Renton… – American journal of …, 1994 – ajcp.oxfordjournals.org

6.                  Latent papillomavirus and recurring genital warts, A Ferenczy, M Mitao, N Nagai… – … England Journal of …, 1985 – Mass Medical Soc

7.                  Communal showers and the risk of plantar warts, LW Johnson – Journal of family practice, 1995 – go.galegroup.com

8.                  The treatment of palmar and plantar warts using natural alpha interferon and a needleless injector, RT Brodell, DL Bredle – Dermatologic surgery, 1995 –                       Wiley Online Library

 

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