Warts; Types, Causes, Symptoms, Diagnosis, Treatment

Warts; Types, Causes, Symptoms, Diagnosis, Treatment

Warts are typically small, rough, and hard growths that are similar in color to the rest of the skin. They typically do not result in symptoms except when on the bottom of the feet where they may be painful. While they usually occur on the hands and feet they can also affect other locations. One or many warts may appear. They are not cancerous

Types of Warts

A range of types of wart have been identified, varying in shape and site affected, as well as the type of human papillomavirus involved. These include

  • Common wart – (Verruca vulgaris), a raised wart with roughened surface, most common on hands, but can grow anywhere on the body. Sometimes known as a Palmer wart or Junior wart.
  • Flat wart – (Verruca plana)  a small, smooth flattened wart, flesh-coloured, which can occur in large numbers; most common on the face, neck, hands, wrists and knees.
  • Filiform or digitate wart – a thread- or finger-like wart, most common on the face, especially near the eyelids and lips.
  • Genital wart – (venereal wart, Condyloma acuminatumVerruca acuminata), a wart that occurs on the genitalia.
  • Mosaic wart  a group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet.
  • Periungual wart – a cauliflower-like cluster of warts that occurs around the nails.
  • Plantar wart – (verruca, Verruca plantaris), a hard sometimes painful lump, often with multiple black specks in the center; usually only found on pressure points on the soles of the feet.

Causes of Warts

Micrograph of a common wart (verruca vulgaris) showing the characteristic features (hyperkeratosis, acanthosis, hypergranulosis, rete ridgeelongation, and large blood vessels at the dermoepidermal junction, H&E stain)

Warts are caused by the human papilloma virus (HPV). There are about 130 known types of human papilloma viruses.HPV infects the squamous epithelium, usually of the skin or genitals, but each HPV type is typically only able to infect a few specific areas on the body. Many HPV types can produce a benign growth, often called a “wart” or “papilloma”, in the area they infect. Many of the more common HPV and wart types are listed below.

  • Common warts – HPV types 2 and 4 (most common); also types 1, 3, 26, 29, and 57 and others.
  • Cancers and genital dysplasia – “high-risk” HPV types are associated with cancers, notably cervical cancer, and can also cause some vulvar, vaginal,penile, anal and some oropharyngeal cancers. “Low-risk” types are associated with warts or other conditions
  • High-risk – 16, 18 (cause the most cervical cancer); also 31, 33, 35, 39, 45, 52, 58, 59, and others.
  • Plantar warts (myrmecia) – HPV type 1 (most common); also types 2, 3, 4, 27, 28, and 58 and others.
  • Anogenital warts (condylomata acuminata or venereal warts) – HPV types 6 and 11 (most common); also types 42, 44 and others.
  • Low-risk –  6, 11 (most common); also 13, 44, 40, 43, 42, 54, 61, 72, 81, 89, and others.
  • Flat warts – HPV types 3, 10, and 28.
  • Butcher’s warts – HPV type 7.
  • Heck’s disease (Focal epithelial hyperplasia) – HPV types 13 and 32.

Treatment of Warts

There are many treatments and procedures associated with wart removal.A review of clinical trials of various cutaneous wart treatments concluded that topical treatments containing salicylic acid were more effective than placebo.Cryotherapy appears to be as effective as salicylic acid, but there have been fewer trials.

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Medication

Two viral warts on a middle finger, being treated with a mixture of acids (like salicylic acid) to remove them. A white precipitate forms on the area where the product was applied.

This image shows throat warts (papillomas) before treatment and during the treatment process. Left to right: warts prior to treatment, warts on day of silver nitrate treatment, warts two days after treatment, warts four days after treatment, warts six days after treatment, and warts remaining nine days after treatment.

  • Salicylic acid can be prescribed by a dermatologist in a higher concentration than that found in over-the-counter products. Several over-the-counter products are readily available at pharmacies and supermarkets of roughly two types: adhesive pads treated with salicylic acid, and bottled concentrated salicylic acid solution.
  • Imiquimod is a topical cream that helps the body’s immune system fight the wart virus by encouraging interferon production. It has been approved by the U.S. Food and Drug Administration (FDA) for genital warts.
  • Cantharidin, found naturally in the bodies of many members of the beetle family Meloidae, causes dermal blistering. It is used either by itself or compounded with podophyllin. Not FDA approved, but available through Canada or select US compounding pharmacies.
  • Bleomycin is not US FDA approved and can cause necrosis of digits and Raynaud syndrome.The usual treatment is one or two injections.
  • Dinitrochlorobenzene (DNCB), like salicylic acid, is applied directly to the wart. Studies show this method is effective with a cure rate of 80%.But DNCB must be used much more cautiously than salicylic acid; the chemical is known to cause genetic mutations, so it must be administered by a physician. This drug induces an allergic immune response resulting in inflammation that wards off the wart-causing virus.
  • Cidofovir is an antiviral drug which is injected into HPV lesions within the larynx (laryngeal papillomatosis) as an experimental treatment.
  • Benzoyl peroxide (BPO) is effective in the treatment of flat warts

A 2014 study indicates that lopinavir is effective against the human papilloma virus (HPV). The study used the equivalent of one tablet twice a day applied topically to the cervices of women with high-grade and low-grade precancerous conditions. After three months of treatment, 82.6% of the women who had high-grade disease had normal cervical conditions, confirmed by smears and biopsies.

  • Freezing: In this treatment, a doctor will use liquid nitrogen to freeze a wart. A blister forms around the wart and the dead tissue falls off within about a week.
  • Cantharidin: This substance, an extract of a blister beetle and applied to the skin, forms a blister around the wart. After cantharidin is applied, the area is covered with a bandage. The blister lifts the wart off the skin.
  • Other medications: These include bleomycin, which is injected into a wart to kill a virus, and imiquimod (Aldara and Zyclara), an immunotherapy drug that stimulates your own immune system to fight off the wart virus. It comes in the form of a prescription cream. Although imiquimod is stated for genital warts, it is modestly effective on other types of warts.
  • Minor surgery: When warts cannot be removed by other therapies, surgery may be used to cut away the wart. The base of the wart will be destroyed using an electric needle or by cryosurgery (deep freezing).
  • Laser surgery: This procedure utilizes an intense beam of light (laser) to burn and destroy wart tissue.
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Studies of fat-soluble garlic extracts have shown clearing in greater than 90% of cases. The extract is applied twice daily and covered with an adhesive bandage. Improvements show within 2–4 weeks and total clearing in an average of 6–9 weeks.

Procedures

Liquid nitrogen spray tank
  • Keratolysis, of dead surface skin cells usually using salicylic acid, blistering agents, immune system modifiers (“immunomodulators”), or formaldehyde, often with mechanical paring of the wart with a pumice stone, blade etc.
  • Electrodesiccation
  • Cryosurgery or cryotherapy, which involves freezing the wart (generally with liquid nitrogen),[36] creating a blister between the wart and epidermal layer after which the wart and the surrounding dead skin fall off. An average of 3 to 4 treatments are required for warts on thin skin. Warts on calloused skin like plantar warts might take dozens or more treatments.
  • Surgical curettage of the wart
  • Laser treatment – often with a pulse dye laser or carbon dioxide (CO2) laser. Pulse dye lasers (wavelength 582 nm) work by selective absorption by blood cells (specifically hemoglobin). CO2 lasers work by selective absorption by water molecules. Pulse dye lasers are less destructive and more likely to heal without scarring. CO2 laser works by vaporizing and destroying tissue and skin. Laser treatments can be painful, expensive (though covered by many insurance plans), and not extensively scarring when used appropriately. CO2 lasers will require local anaesthetic. Pulse dye laser treatment does not need conscious sedation or local anesthetic. It takes 2 to 4 treatments but can be many more for extreme cases. Typically, 10–14 days are required between treatments. Preventative measures are important.
  • Infrared coagulator – an intense source of infrared light in a small beam like a laser. This works essentially on the same principle as laser treatment. It is less expensive. Like the laser, it can cause blistering pain and scarring.
  • Duct tape occlusion therapy – involves placing a piece of duct tape over the wart. The mechanism of action of this technique still remains unknown. Despite several clinical trials, evidence for the efficacy of duct tape therapy is inconclusive. Despite the mixed evidence for efficacy, the simplicity of the method and its limited side-effects leads some researchers to be reluctant to dismiss it.
  • inconclusive – Despite the mixed evidence for efficacy, the simplicity of the method and its limited side-effects leads some researchers to be reluctant to dismiss it.

Home Remedies

We have several wart removal tips and tricks for you to try besides Compound W, freezing, and other standard techniques. Meanwhile, work on prevention at the same time—avoid walking barefoot, don’t share personal hygiene items, and avoid touching all warts—yours and everyone else’s.

Boost your immune system

Warts are caused by a virus, so one of the best ways to get rid of them is to boost your body’s ability to fight them. In fact, many people notice that warts show up when they’re feeling tired, sick, or worn down. Make sure you’re getting enough sleep and exercising regularly, and use some potent immune boosters like astragalus, elderberry, olive leaf, vitamin C, zinc, turmeric, and cat’s claw.

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Stop the spread

Not only can warts be passed from person to person, but you can also spread them around your own body through touch. If you touch your wart, for instance, and then touch another part of your body before washing your hands, you may spread the virus, and notice new warts popping up several days later. Be conscious of this, and vigilantly wash your hands.

Use Pineapple

Apply fresh pineapple directly to the wart several times a day. The natural acids and enzymes will help.

Garlic

Mix some fresh garlic with water and apply the paste to the wart. Put a bandage on top. Re-apply every few hours and continue until the wart is gone.

Baking Powder

Mix baking powder and castor oil into a paste, apply to the wart at night, and cover with a bandage. Repeat daily. You can also try crushed, fresh basil in the same way—or even mix the two together.

Vitamins

Crush up a Vitamin C tablet and mix with water to make a thick paste. Apply to the wart and cover with a bandage. You can also try Vitamin E—break a capsule, rub on the wart, and cover.

Aspirin

Use Aspirin like the Vitamin C tablet—crush, add a little water, apply the paste to the wart, and cover overnight. Repeat for several nights until gone.

Tea Tree Oil

Apply tea tree oil directly to the wart, then cover with the bandage. Repeat daily. You can also mix with clove and/or Frankincense oils for additional power.

Bee Propolis

Some people have found success applying bee propolis directly to the wart several times a day. Or try applying at night and covering until morning.

Aloe vera

Fresh from the actual aloe vera plant is best. Break off a leaf and rub the gel onto the wart. Aloe contains malic acid. If you don’t have the plant, get the purest form of aloe gel you can find. Cover after each application.

Homeopathic medicine For Warts

To begin with, the remedies that have been used since the time of Hahnemann to cure genital warts. The specific individualized homeopathic medicine is selected based on the symptomatic pattern. Six Important Homeopathic medicine used for Treating Genital Warts are given below:-

1. Calcarea carbonica,

2. Causticum,

3. Dulcamara,

4. Natrum muriaticum,

5. Nitric acidum, and

6. Thuja occidentalis.

References

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