Warts

Warts

Everybody, from school children on can recognize a wart. The ones on the bottom of the feet are a bit tricky and are called Plantar warts. They are hard and thick, callous, and feel like a painful pebble in the shoe. Kids can get cauliflower-like, fleshy growths on their hands and fingers, around their fingernails, on the face and eyelids, and on their elbows, and knees. Sometimes skin tags and various moles can be mistaken for them and vice-versa. Adult patients can get them in more private places, which will be covered later.

Warts are usually caused by the HPV or Human Papilloma Virus. There are over 130 Human Papilloma Virus strains thus far discovered. Most of the human wart infections are caused by HPV 1, 2, and 3. These are spread to an uninfected person essentially by direct or indirect contact with an infected person. HPV is a rather sturdy and can remain on a floor, a towel, or a wrestling mat for the uninfected to come in contact with. Genital warts are likewise a skin to skin spread infection. Catching a wart virus has to do with one’s immunity as well. One child in the household may have warts and none of the other family members develop them. A current vaccine, is available to boost immunity to HPV 6, 11, 16, and 18. It is used to prevent cervical cancer that has been linked to HPV in women. The HPV vaccine is currently recommended for women ages 9-26. Since HPV can be spread through sexual contact, the vaccine has recently been approved by the FDA for males in the age range. It is though that vaccinating both male and female patients will further decrease the spread of this potentially deadly HPV.

The warts can come in many shapes and sizes. The plantar wart is most often caused by HPV. Common and filiform types are usually on a thread-like strand or stalk and are caused by HPV 2. Other flat ones, like the ones kids often get on their elbows and knees, are caused by HPV3.

A number of medical options may be prescribed. One is to prescribe salicylic acid plasters to be changed every day. This causes the pathology to gradually shrink in size. However the normal tissue surrounding the wart can get inflamed, red, painful and can lead to many other problems. The ones on the hands seem to respond favorably to electrocautery or freezing. Plantar warts are a bit trickier. They usually have to be shrunk in layers, as with salicylic acid plasters, and gradually cored out because they tend to be on a deep stalk. Sometimes a laser can be used to destroy the abnormal tissue. See your MD to discuss your options.

Anogenital warts are a different problem. These are usually caused by HPV 6 and 11, and can lead to cancer in the anus, cervix, or other infected areas. They could be treated with topical substances which stir up the body’s immune system to the affected area. One such substance is 20% Podophyllin in benzoin which is painted on at intervals as tolerated. But again the problem is painful damage to surrounding tissue with the acid. Often a person has to have surgical removal if these warts grow too large or too numerous. This can be followed with laser or electrocautery treatments. Care must be taken to look for any underlying or developing cancer in these lesions. See your MD as this can be a very serious condition.

A final type of HPV which needs to be mentioned is HPV 16 and 18. This is the specific kind of HPV which causes cervical cancer, and is spread by sexual contact. There may be 3 – 5 others not specifically yet proven but are highly symptomatic of causing cervical cancer. For the average person they may be embarrassing, irritating, and require treatment. The body’s immune system will cause many to regress and go resolve by themselves, however, some can last many years and lead to further complications. It is good advice to practice hygienic habits to prevent the spread of this virus. If they do occur, there are many treatments that your doctor can tailor to your particular lifestyle or preference.

John Drew Laurusonis, M.D.