Warts
Introduction: When a human
papilloma virus enters the superficial layer of the skin in one spot, cells multiply
and enlarge leading to a protruding lump, which we commonly term "wart".
The medical term "verrucae" means the same as "wart", but
few lay people likely would know that. I will stick to the more popular term "wart"
in this summary. Depending on location there are a number of different types of
warts. Also, as the various cell types have different cell metabolisms,
papilloma viruses adapted throughout the centuries and there are now more than
60 different papilloma virus types known that cause the various wart types. Here
is an abbreviated list of some common warts and the types of papilloma viruses
that cause them.
| Various
warts and their causes |
| Name of wart: |
Human papilloma virus type: | Comments: |
Common
warts | 1,
2, 4 and 7 | On
hands, feet and around nail folds |
Genital warts
| 6, 11, 16,
18 and 33 | Strong
association to cancer of the cervix in women and to bowenoid papulosis of genitalia
in both sexes | CIN
(=cervical intraepithelial neoplasia) of the cervix | 16,
18, 31, 33, 35 and 39
| These microscopic
CIN III lesions are irreversible and lead to cancer of the cervix in women
| Laryngeal
papillomas | 6, 11, 16
and 30 | Can become cancerous; infants
can acquire this from HPV in vaginal secretions during delivery; adults can get
it from oral-genital sex |
Flat warts | 3
and 10 | Common in children and younger
adults, often in face |
Heck's disease (=oral papillomatosis)
| 13 and 32 | Benign;
treatment with CO2 laser | Signs
and symptoms: Wart lesions are sharply demarcated skin lesions
with a cauliflower-like surface on top. Inside they are vascular and if injured
can bleed a fair bit. They tend to grow slowly, but due to the fact that they
do not hurt, might grow to a considerable size before they are detected. Here
is an wart
picture. If there is a point bleeding into the surface of
the wart there might be a black component to the otherwise grayish appearance
of the wart and the patient likely then will bring this to the attention of the
physician for fear of cancer. In the nailfold regions the warts may appear waxier,
on the body skin surface they are drier.
Plantar
warts On the sole of the foot, where the skin is thicker,
the wart stays flat in appearance, but has a growth pattern that goes into the
depth and only becomes apparent after several treatments with liquid nitrogen
or several chemical applications followed with shaving using a surgical blade.
Diagnosis: The diagnosis in clinical practice is
almost exclusively done by inspection and based on clinical experience. Here is
an plantar
wart picture. However, in certain high risk settings there are hybridization
techniques available to separate oncogenic DNA from HPV's, but this is only available
in highly specialized research facilities. If this is not available, then a reasonable
alternative is to treat warts conventionally first, and if they do not respond,
to refer the problem lesions for further testing to a dermatologist. Wart
treatment: There are many effective treatment modalities, but all
of them have a certain failure rate. Often it is not the failure of the treatment,
but failure to treat the wart completely and to not repeat the treatments until
the wart has been completely eradicated. Here are a few rules regarding wart treatment.
1. The most common therapy is to apply a salicylic acid daily onto the
wart until it melts away slowly. Several preparations are available. Popular ones
are such brand names as Duofilm and Duoforte 27 for common warts, and Duoplant
for plantar warts. 2. If this fails, the physician may want to treat the
warts with liquid nitrogen. ADVERTISEMENT
This method is used to freeze the wart, but not the surrounding skin for
several seconds up to 15 or 30 seconds depending on the size and the type of wart.
Undertreatment will not have much effect on the wart, overtreatment leads to painful
blistering. The patient should be told to return after 1 or 2 weeks for a recheck.
At the follow-up visit the physician may want to use a scalpel and peel the dead
wart tissue down to the live wart. This is visible by the small punctuate bleeding
spots from the wart vessels. At that level the wart is frozen again with liquid
nitrogen and the procedure of recheck and possible repeat treatment with liquid
nitrogen is done again. Using this method until eradication of all warts has a
high success rate. 3. In case of resistant warts to the other treatment
modalities it is useful to switch to a different treatment modality. Podofilox
(brand name: Condyline), an antimitotic agent, causes the wart to shrivel up and
fall off. It can also be combined with liquid nitrogen. Venereal warts on the
outside of the male and female genitalia can be treated with Podofilox as well. 4.
Laser surgery using a CO2 laser is useful in plantar warts and genital warts.
However, scarring can result from this as it can with electric cautery. 5.
Various anti-DNA chemicals such as topical 5-flourouracil (=5FU)has been used
with success for flat warts as a 1% or 5% cream. Flat warts might also respond
to tretinoin cream 0.05% (brand name: Retin-A 0.05% cream). If a wart problem
cannot be successfully treated by the family doctor, the patient should be referred
to a dermatologist who has more experience in the difficult to treat wart cases.
Link to another site regarding warts: http://www.telemedicine.org/stamford.htm
(when on site click on"Warts"). |
