There are many different types of warts, all of which have one thing in common… they are embarrassing, unpleasant, cosmetically unattractive, unwanted, annoying and sometimes painful protrusions that appear on the skin almost anywhere. They have always been considered ugly and in folklore over the years… witches have usually modelled a whole host of various ‘warty’ protrusions on various parts of their anatomy. In fact the larger the wart… the more evil the witch! The princess never had warts… the wicked stepmother had them though! The ‘goodies’ never sported a fashionable wart but the baddies were regularly seen displaying one or more particularly heinous ones.
What are warts and why do we get them?
They are completely benign epidermal tumors or growths on the skin and most of them are highly contagious. They originate from the human papilloma virus (HPV) which causes the infection and more than 100 HPV subtypes are known.
Warts are particularly common in childhood and are spread by direct contact or by touching itching and spreading through touch. If a wart is scratched, the viral particles may be spread to another area of skin. It can take as long as twelve months for the wart to first appear and they can just as easily spontaneously disappear temporarily or even permanently. The majority of them have a hard surface and a tiny black dot in the middle or each warty mark can often be seen. This is a capillary blood vessel seen through the skin. Warts can develop individually or in clusters and can spontaneously disappear. Hygiene must be of the highest importance to avoid cross infection and if not treated they may spread.
In children, even without treatment, some warts disappear within 6 months and up to 90% are gone in 2 years. They are more persistent than this in adults but they can sometimes disappear of their own accord.
Warts are particularly numerous and troublesome in patients that are immuno-suppressed.
There are many types of warts:
1. Common warts arise most often on the backs of fingers or toes, palms of hands and on the knees.
2. Plantar warts (verrucas) are seen on the foot – mainly on the sole of the foot.
3. Mosaic warts are also seen on the sole of the foot and appear in clusters over an area often proliferating to several centimeters in diameter. Many little dots from capillaries underneath the surface of the skin can be seen throughout mosaic warts.
4. Plane, or flat, warts are often seen on the face or limbs and under the arms and can be very numerous.
5. Periungual warts grow at the sides or under the nails and can distort nail growth if left. Treatment can be difficult because of the sensitivity of the area and the risk of damaging the nail bed.
6. Filiform warts are on a long stalk and these can appear quite often on the face where they are a most upsetting and cosmetically unattractive addition. They often have a multi faceted top like finger like projections which are very dry and crusty.
7. Oral warts can affect the lips and even inside the cheeks. They include Squamous Cell Papillomas (not to be confused with Squamous Cell Carcinomas), are small benign (non-cancerous) growth that begin in squamous cells (thin, flat cells) that are found in the tissue that forms the surface of the skin (epidermis), the passages of the respiratory and digestive tract and in the lining of hollow organs of the body.
8. Genital warts are very common. There are at least 100 different types of HPV and at least 40 can infect the genital area they are often transmitted sexually and predispose to cervical, penile and vulval cancers.
Warts are not a serious health condition and many people will not bother to treat them as often the treatment is uncomfortable and requires considerable effort. To get rid of them, the body’s own immune system has to be stimulated to attack the wart virus. Persistence with the treatment and patience is essential!
There are several options of treatment, some more successful than others.
Electrolysis has been around for over 130 years for hair removal but is fairly new to wart treatment but is proving high successful and illustrating excellent results. It is a very precise form of treatment not unlike Electrosurgery (curettage and cautery) but is gentler and less invasive. Treatment techniques depend upon the type of wart but with a common wart the tiny electrolysis needle (about the size of a eyelash) is used to cauterise the surface of the skin over the affected area. This is then inserted into the centre of the wart where a high frequency, radio frequency current is expelled. Following treatment the surface of the wart will scab over, which will, after a week or so, slough away leaving perfect skin behind. More than one treatment may be required with verrucas in particular being very resilient and definitely needing more than one treatment.
Other methods of treatment include:
Occlusion. By covering the wart 24 hours of the day may result in it clearing. Duct tape is often used.
Chemical treatment. Chemical treatment includes wart paints containing salicylic acid which remove the dead surface skin cells. Perseverance is essential as it can take 12 weeks to go or more likely to reduce in size.
Cryotherapy. The wart is repeatedly frozen with liquid nitrogen resulting in blistering, swelling and sometimes permanent white scarring following treatment.
Electrosurgery (curettage & cautery) is used for particularly large and annoying warts. Under local anaesthetic, the growth is pared away and the base burned by diathermy or cautery. The wound heals in about two weeks.
Other treatments. There are numerous treatments for warts and none offer a guarantee of cure. They include: Topical creams, oral medication, vaporisation, pulse dye laser destruction of feeding blood vessels and even duck tape and banana skin are home care options.