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WARTS
What are warts?
Warts
are non-cancerous skin growths caused by a viral infection in the top layer of
the skin or mucous membranes. Viruses that cause warts belong to a
"family" called human papillomavirus (HPV). The appearance of a wart
depends on where it is growing. Warts are usually skin-colored and feel
rough to the touch, but they can be dark, flat and smooth.
How many kinds of warts are
there?
There
are several different kinds of warts including:
Common
warts
Foot
warts
Flat
warts
Genital
warts
Common warts usually
grow around the nails, on the fingers 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.
Foot warts are
usually on the soles of the feet and are called plantar warts. When plantar
warts grow in clusters they are known as mosaic warts. Most pl antar 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. These warts often
have black dots that are the blood vessels feeding them. Plantar warts have a
bad reputation because they can be painful, feeling like a stone in the shoe.
Flat warts are
smaller and smoother than other warts. They tend to grow in great 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.
Genital warts (also
called condyloma), have become a common and worrisome problem in adults. They
tend to be small and flat but can be thin and tall. These are soft and are not
rough or scaly like other warts. They can occur on the genitalia, within the
vagina, on the cervix in women, and around the anus or within the rectum. The
HPVs that cause genital warts rarely cause warts of the hands or feet but can
cause warts in the mouth. Genital warts have been linked to cancer of the
genital area.
How do you get warts?
Warts
probably 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 and flat warts is small.
Genital warts seem to be more contagious. It is important to use precautions to
limit the spread of genital warts to one's sexual partner.
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 often disappear without treatment over a period of several
months to years. However, since warts can be spread to others and can be spread
to new areas or other people, it is reasonable to treat most children,
especially if the warts are bothersome or painful.
Warts
in adults often do not disappear as easily or as quickly as they do in
children. There is some increased possibility of skin cancer at the site of
long-standing genital warts. Women with genital warts also have an
increased risk of cancer of the cervix. For these reasons all adults with
genital warts should be treated. Women should have regular PAP tests, even
after treatment.
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 warts.
Common
warts in young children can be treated at home by their parents on a daily
basis by painting on low strength salicylic
acid. There is usually little discomfort but it can take many weeks of
treatment to obtain favorable results.
Treatment
should be stopped at least temporarilv if the wart becomes sore. Weekly
painting with cantharidin in the
dermatologist's office 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.
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, removing the wart during a single office
visit. However, scarring and pain are more likely to occur than with freezing.
Plantar 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
or methods to reduce foot sweating.
Flat warts are
often too numerous to treat with methods mentioned above. As a result,
"peeling" methods using daily applications of salicylic
acid, or other surface peeling preparations are often recommended. For some
adults, periodic office treatments are sometimes necessary.
Genital warts are
perhaps the most difficult to treat. First, all warts must be located. This may
require an examination of the vagina and cervix in women and the rectum in both
sexes. Periodic office treatments with acids or freezing may be needed to get
rid of the visible warts. The dermatologist may prescribe a form of podophyllin which
can be used at home.
With
very stubborn or very large genital warts, one of the surgical treatments is an
option. The patient's sexual partner should also be examined for warts by a
dermatologist.
Genital
warts can be very difficult to cure. Occasionally even multiple treatments will
not guarantee success.
What are some of the other
treatments for warts?
There
are at least two different lasers used for the treatment of warts. Laser
therapy is used to destroy some types of warts. But lasers are more expensive
and may 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.
Another
method of treatment is immunotherapy,
which attempts to build up the body's own rejection system. 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 right 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 where 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 had 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,
development of a vaccine against warts, and development of natural immunity to
warts. We hope there will be a solution to the annoying problem of warts in the
not too distant future.
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