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Related to warts: plantar wart, HPV
Warts are small, benign growths caused by a viral infection of the skin or mucous membrane. The virus infects the surface layer. The viruses that cause warts are members of the human papilloma virus (HPV) family. Warts are not cancerous but some strains of HPV, usually not associated with warts, have been linked with cancer formation. Warts are contagious from person to person and from one area of the body to another on the same person.
Particularly common among children, young adults, and women, warts are a problem for 7-10% of the population. There are close to 60 types of HPV that cause warts, each preferring a specific skin location. For instance, some types of HPV cause warts to grow on the skin, others cause them to grow inside the mouth, while still others cause them to grow on the genital and rectal areas. However, most can be active anywhere on the body. The virus enters through the skin and produces new warts after an incubation period of one to eight months. Warts are usually skin-colored and feel rough to the touch, but they also can be dark, flat, and smooth.
Warts are passed from person to person, directly and indirectly. Some people are continually susceptible to warts, while others are more resistant to HPV and seldom get them. The virus takes hold more readily when the skin has been damaged in some way, which may explain why children who bite their nails tend to have warts located on their fingers. People who take a medication to suppress their immune system or are on long-term steroid use are also prone to a wart virus infection. This same is true for patients with AIDS.
Causes and symptoms
The more common types of warts include:
- common hand warts
- foot warts
- flat warts
- genital warts
Common hand warts grow around the nails, on the fingers, and on the backs of hands. They appear more frequently where skin is broken, such as in areas where fingernails are bitten or hangnails picked.
Foot warts are called plantar warts because the word plantar is the medical term for the sole of the foot, the area where the wart usually appears as a single lesion or as a cluster. Plantar warts, however, do not stick up above the surface like common warts. The ball of the foot, the heel and the plantar part of the toes are the most likely locations for the warts because the skin in those areas is subject to the most weight, pressure and irritation, making a small break or crack more likely.
Plantar warts are familiar to all ages groups, appearing frequently in children between the ages of 12-16. Adolescents often come into contact with a wart virus in a locker room, swimming pool area, or by walking barefooted on dirty surfaces. The blood vessels feeding them are the black dots that are visible on the wart. If left untreated, these warts can grow to an inch or more in circumference and spread into clusters of several warts. They are known to be very painful at times, the pain usually compared to the feeling of a permanent stone in the shoe particularly if the wart is on a pressure point of the foot. People with diabetes mellitus are prone to complications from plantar warts related to the development of sores or ulceration and the poor healing potential associated with diabetes.
Flat warts tend to grow in great numbers and are smaller and smoother than other warts. They can erupt anywhere, appearing more frequently on the legs of women, the faces of children, and on the areas of the face that are shaved by young adult males.
Genital warts, also called condyloma acuminata or venereal warts, are one of the most common causes of sexually transmitted disease (STD) in this country. According to the Journal of the American Medical Association's STD Information Center, they are contracted by sexual contact with an infected person who carries HPV and are more contagious than other warts. It is estimated that two-thirds of the people who have sexual contact with a partner with genital warts will develop the disease within three months of contact. As a result, about one million new cases of genital warts are diagnosed in the United States each year.
Genital warts tend to be small flat bumps or they may be thin and tall. They are usually soft and not scaly like other warts. In women, genital warts appear on the genitalia, within the vagina, on the cervix, and around the anus or within the rectum. In men, genital warts usually appear on the tip of the penis but may also be found on the scrotum or around the anus. Genital warts can also develop in the mouth of a person who has had oral sexual contact with an infected person.
Patients who notice warts in their genital area should see a doctor. The doctor may be able to diagnose the warts with a simple examination. If the warts are small, the doctor may put a vinegar-like liquid on the skin, which makes the warts turn white and easier to see, and then use a magnifying glass to look for them.
Many of the nonprescription wart remedies available at drug stores will remove simple warts from hands and fingers. These medications may be lotions, ointments, or plasters and work by chemically removing the skin that was affected by the wart virus. The chemicals are strong, however, and should be used with care since they can remove healthy as well as infected skin. These solutions should be avoided by diabetics and those with cardiovascular or other circulatory disorders whose skin may be insensitive and not appreciate irritation.
Flat warts are best treated with topical retinoides (retinoic acid) or a gel containing salicylic acid. The acid doesn't actually kill the wart virus, but waterlogs the skin so that the surface layer, with the virus, peels off. These products can take up to three months of treatment depending on the size and depth of the wart. Patches are also good to use. Rather than applying drops, a small pad is placed on the wart and left for 48 hours and then replaced with a new one. The patch usually contains a higher concentration of salicylic acid and may irritate the surrounding skin. If this occurs, patients should switch to a gel or stop medication for a period. To help the healing process for flat facial warts, men should shave with an electric shaver or temporarily grow a beard. Women with flat warts on areas that are shaved should use other methods to remove hair such as depilatory cream or wax.
Physicians should be consulted if there are no signs of progress after a month of self treatment. Doctors have many ways of removing warts, including using stronger topically applied chemicals than those available in drugstores. Some of these solutions include podofilox, topical podophyllum, and trichloracetic acid (TCA). Some burning and discomfort for one or more days following treatment can be expected. Although these chemicals are effective, they may not destroy all warts completely. A second method of removal is freezing or cryosurgery on the wart using liquid nitrogen. Cryotherapy is relatively inexpensive, does not require anesthesia, and usually does not result in scarring. Although temporarily uncomfortable, it provides an effective and safe way to deliver freezing temperatures to a particular area on the skin, and healing is usually quick. Physicians may also choose to burn the wart with liquid nitrogen or numb the skin and then scrape off the wart. Another removal process is electrocautery (electric burning), destroying the wart by burning it with an electric needle. Laser surgery is also becoming a more common option for removing warts.
Genital warts are the most difficult to treat. They can be removed, but the viral infection itself cannot be cured. Often, because the warts are so small, more than one treatment may be needed. The virus continues to live in the deeper skin, which is why warts often return after they have been removed. Strong chemicals may be applied as well as surgical excision with or without electrocautery. This therapy requires a small operative procedure and a local anesthetic. Laser therapy, although more expensive, is often used for treating venereal warts that are more extensive. The use of lasers which vaporize the lesion can theoretically transmit the HPV. It is not at all clear, however, if this occurs.
There is no one recommended method for eliminating plantar warts. If detected early, cryotherapy is usually enough. However, they can be very resilient, requiring treatment over several months. Treatment ranges from the conservative approach of applying chemical solutions to the more aggressive option of surgery. Patients with diabetes or vascular disease are usually treated with the more conservative methods.
There are a variety of alternative approaches to the treatment of warts. The suggestions described below apply to common warts and plantar warts, not to genital or cervical warts. Since genital and cervial warts are transmitted sexually, they should be treated by a physician
For the treatment of common or plantar warts, alternative practitioners may recommend these remedies.
- Apply a paste made of vitamin C powder to the wart for one to two weeks.
- Place a crushed or sliced garlic clove over the wart for seven consecutive nights while sleeping.
- Soak the wart in water, put cross-hatches over it with a sterile needle, and apply drops of thuja (Thuja occidentalis) tincture onto the wart. Repeat the cross-hatching and tincture application until the wart is saturated with the tincture. Repeat several times each day for one to two weeks. (A tincture is an herbal extract made with alcohol.)
- Tape a piece of banana peel, latex side down, over the wart and leave it on overnight. Repeat nightly for one to two weeks.
Because warts are caused by a virus, general immune system support can be effective in helping to keep warts from coming back after treatment or to keep them from multiplying or growing. Eating a well balanced diet high in sources of vitamins A, C, and E can help strengthen the immune system. Avoiding stress, which is believed to compromise the immune system, is also helpful.
Even though genital warts may be removed, the virus itself continues to live. The HPV can cause tissue changes in the cervix of women with cervical infection. The general recommendation for women who have a history of genital warts is to see their doctors every six months for Pap smears to monitor any changes that may occur.
For plantar warts, the treatment goal is to destroy the wart and its virus without causing much damage to healthy skin. It is not unusual for treatment to cause pain until the foot heals because of the weight put on the foot.
Genital warts can be prevented by using condoms and avoiding unprotected sex. Barrier protection will not, however, prevent the spread of wart-causing HPV to uncovered areas such as the pubis and upper thighs. Plantar warts can be prevented by wearing shoes, changing shoes daily, keeping feet clean and dry, and not ignoring skin growths and changes in the skin.
Condyloma acuminata — Another term for genital warts.
Cryotherapy — Freezing with liquid nitrogen for removal.
Endometritis — Inflammation of the endometrium or mucous membrane of the uterus.
Epidermis — The outer layer of human skin.
Human papilloma virus (HPV) — A family of viruses that causes hand warts, foot warts, flat warts and genital warts.
Retinoic acid — Vitamin A1 acid which is used topically to treat acne.
Salicylic acid — An agent prescribed in the treatment of hyperkeratotic skin conditions and fungal infections.
American Academy of Dermatology. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. Fax: (847) 330-0050. http://www.aad.org.
American Academy of Family Physicians. 8880 Ward Parkway, Kansas City, MO 64114. (816) 333-9700. http://www.aafp.org.
American Podiatric Medical Association. 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (301) 571-9200. http://www.apma.org.
Dermatology College of Medicine. The University of Iowa, 200 Hawkins Dr., Iowa City, IO 52242. (319) 356-2274. http://tray.dermatology.uiowa.edu.