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Defining the Future of Dermatology

Warts

  • Wart
    Warts are benign skin growths that appear on the skin when a virus infects the top layer of the skin. Viruses that cause warts are called human papillomavirus (HPV). Wart viruses are contagious. Warts can spread by contact with the wart or something that touched the wart.
  • Common Wart
    Common Warts are warts that usually appear on hands or face. They appear as small, fleshy, grainy bumps and are flesh-colored, white, pink, or tan. They are rough to the touch and can be sprinkled with black pinpoints, which are small, clotted blood vessels. These warts can spread from the hands to the face through touching.
  • Plantar Wart
    Plantar Warts are warts that grow most commonly on the surface of the feet. These warts can grow in clusters and are often flat or grow inward.
  • Wart diagram
    This graphic shows the growth of a wart.

About

Warts are very common and are caused by infection of the skin by the human papilloma virus (HPV). There are several different types of warts caused by numerous different strains of HPV. Warts most commonly appear on the hands, feet, genitalia, face, and legs but can appear on any part of the body.

There are no specific medications that directly kill HPV, but the treatments available for warts are aimed at both destroying the infected wart tissue and stimulating an immune response to help your body fight off the virus. Furthermore, the virus is able to "hide" in the most upper layers of skin to avoid your immune system. This makes the treatment of warts very difficult with multiple treatment sessions often required.

Spontaneous clinical regression of warts is thought to be due to cell-mediated immunity, and thus, many of our therapeutic modalities use a combination of destroying the virus while inciting an immunologic response to prevent recurrence.

Treatment

Treatment

Below is a summary of some of the most common therapeutic modalities used to treat warts.

  • Cryotherapy - This is the most commonly used treatment and involves freezing the wart with liquid nitrogen (-196 Celsius). It is uncomfortable, but usually tolerable to older children and adults. It often results in a blister or crusty scab that will fall off in 2 to 3 weeks. It usually requires 3 to 4 treatments every 3 to 4 weeks. Apply Vaseline or Aquaphor twice daily to any scabs that may form as a result of cryotherapy treatment.
  • Salicylic Acid - (over-the-counter Compound W, Duofilm, Occlusal HP; prescription Mediplast or Virasal). Apply this medication once daily after shower or bath. If the lesion is very scaly or crusty, you may want to file it down with an emery board prior to application to allow better penetration of this medicine. If you are not experiencing any inflammation or irritation from this medication after one week of treatment, apply the salicylic acid, wait 5 minutes for it to dry, and then apply duct tape to the lesion and leave in place for 12 hours.
  • Candida Antigen Immunotherapy - Candida antigen is developed from yeast and helps stimulate the body’s immune system to fight the wart virus. The formulation contains a killed version of the yeast and is injected directly into the site of the wart to rev up immune activity. Immunotherapy is quite successful in eliminating warts and does so without any scarring.
  • Imiquimod (Aldara) Cream - Aldara is a topical medications that activate your own immune system to help attack the cells infected with the virus. The cream works for resistant or recurrent warts that do not respond to freezing and/or salicylic acid. The cream works best when wart(s) are softened (usually with salicylic acid first or duct tape). Directions: Use a pin to prick open the small packets and Open the apply to the affected area three times weekly at night. If no irritation develops, you can increase treatment to five night weekly and/or cover the lesion with a band-aid or duct tape. The next morning, wash off the area with soap & water.
  • Squaric Acid Immunotherapy - This chemical is similar to poison ivy. You are sensitized to the chemical by applying it to the inside of the upper arm or leg, and then when the medication is applied to the warts, an immunologic response is generated and helps fight off the wart virus. It usually takes 5 to 8 treatments and is a good modality for small children as it is generally painless, but can be itchy due to the allergic contact dermatitis it incites and may cause residual hypopigmentation.
  • Cimetidine - Oral cimetidine has been shown to be effective, likely through immunologic mechanisms, at treating recalcitrant or multiple viral warts at doses of 30-40 mg/kg/day. Most patients that are going to respond to this treatment will do so within 3 weeks of initiation. Headaches, drowsiness, and diarrhea are common side effects of this medication. Since this medication is an antacid, it is important to make sure there is no cross-reactivity or interactions with any other medications.
  • Surgical Destruction - Surgical removal, electrosurgery, and laser surgery are all employed modalities for destroying warts.
  • Cantharidin (Canthacur/Cantharone) - Cantharidin is a chemical compound derived from a blister beetle. This liquid medication is applied to wart(s) in order to cause blistering, thus destroying the affected areas. At your office visit, application of cantharidin to the wart(s) is usually painless and the applied areas dry clear. Three to four hours after cantharidin is applied to the warts, you must wash off the area(s) with soap and water. Adverse reactions such as redness, tenderness, blistering, itching and burning sensations may occur within 2-3 days. It is expected to take 2-4 weeks for the treated areas to heal.
  • Bleomycin - Bleomycin is an anti-cancer drug that can be injected into resistant warts. It is painful and usually requires 3 to 4 treatments, but has a cure rate of about 98%. It is usually only used for warts that have been resistant to several other treatment modalities as side effects of this medication (particularly on the digits) include pain, possibly Raynaud’s phenomenon, tissue necrosis with subsequent scarring, and nail dystrophy (for periungual lesions). Bleomycin should not be used in pregnant women, children, and in patients with vascular compromise.

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    Imiquimod

    Prescription strength Imiquimod. Learn More

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FAQs

How Do You Get Warts?

Warts occur when the human papilloma virus comes in contact with your skin and causes an infection. Warts are more likely to develop on broken skin, such as picked hangnails or areas nicked by shaving, because the virus is able to enter the top layer of skin through scratches or cuts.

While dermatologists still don’t know why, certain people are more likely to get warts than others. Additionally, children get warts much more often than adults, because their immune systems have not yet built up their defenses against the numerous types of human papillomavirus that exist.

Are Warts Contagious?

Unfortunately, yes. You can get warts from touching a wart on someone else’s body, or by coming in contact with surfaces that touched someone’s warts, such as towels or bathmats.

Can I Spread Warts From One Part of My Body to Another?

Yes, you can. For this reason, it is important not to pick at your warts and to wash your hands promptly and thoroughly any time you touch one of your warts. If you have warts in an area where you shave, keep in mind that shaving over the wart could transfer the virus to the razor and then spread it to other areas of your body.

Why Do Some Warts Have Black Dots in Them?

If you look closely, many skin warts contain a number of black dots that resemble little seeds. These specks are visible blood vessels that are supplying the wart with nutrients and oxygen.

Can Warts Be Prevented?

Though skin warts can’t be prevented, there are a number of precautionary measures you can take to minimize your risk of acquiring warts. One of the most important things you can do is to wash your hands regularly. Also, try to keep your skin healthy, moisturized, and free of cuts. If you bite your fingernails or cuticles, do your best to stop. Biting nails creates an opening for virus to enter your skin. Be careful to use clean, fresh towels at the gym or in other public locations, and always wear rubber-soled flip-flops or sandals in public locker rooms and showers.

Will Warts Go Away On Their Own?

Some warts will go away without treatment, others will not. Even those warts that eventually go away can take months, or even years, to disappear. Also, keep in mind that any wart can be a “mother” wart that spreads to other parts of your body. Most dermatologists say it is best to treat warts, either at home or in the doctor’s office, as soon as they appear.

When Do You Need to See a Doctor About Warts?

For common skin warts, many dermatologists agree that it’s perfectly fine to try over-the-counter wart treatments for a couple of months. If your warts don’t go away during that time, or if they get worse, it may be wise to seek medical attention. Dermatologists have a variety of wart treatments and removal techniques that are stronger and may work faster than commercially available products.

Also, remember that the faster you remove the wart, the less likely it will spread and cause additional warts.

What Are Some of the Most Effective At-Home Wart Treatments?

While at-home wart treatments can take weeks or months to work, salicylic acid plasters or solutions that peel away the wart can be very effective when used correctly. Be sure to follow directions carefully. Use a dedicated pumice stone, emery board, or nail file to remove dead skin from the wart the day after each application of wart remover. Don’t use the file for any other purpose; it could spread the virus to another part of your body. And throw it away when the wart is gone.

People also use duct tape, clear nail polish, or liquid band-aid, although these treatments probably do not work any better than a placebo. However, they can decrease the risk of spreading warts. Use duct tape like you would a wart-remover patch. Put a small strip over the wart and leave it in place for about six days. At the end of the sixth day, remove the tape, soak the wart in water and then gently debride it with a pumice stone, emery board, or nail file. Repeat the process as often as it takes to remove the wart.

How Will a Doctor Treat My Warts?

It depends. Freezing the wart with liquid nitrogen is a fast and effective treatment that does not cause too much discomfort.

Doctors may also use a chemical called cantharidin on the wart, which causes a blister to form beneath the growth. When the skin on the top of the blister separates, it contains part of the wart and can be removed.

Other options include surgical removal of the wart and the injection or application of certain drugs that strengthen your immune system’s response to the wart.

*Source:

WebMD, LLC

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