OVERVIEW

What are Warts?

Warts (Verruca) are skin growths that appear when the human papillomavirus (HPV) infects the top layer of the skin. Warts are often skin-colored and feel rough, but they can be dark (brown or grey-black), flat, and smooth. You are more likely to get one of these viruses if you cut or damage your skin in some way. Wart viruses are contagious. Warts can spread by contact with the wart or something that touched the wart. Warts are commonly seen on hands, feet, face and genitals.

Causes

What is the cause of warts?

Warts are infection caused by human papillomavirus. There are several factors, which are responsible for transmission of wart infection.

• Contact (touching wart on own body or another person’s wart)
• Walking bare feet on wet surface
• Using belongings like razor, shoes, socks of person who have warts.
• Weak immunity
• Skin barrier disruption (Dry skin, eczema)

Symptoms

Whatare the different types of warts?

Following are the major types of warts:

• Common warts (verruca vulgaris): These grow on fingers and toes but can grow elsewhere too. They have grainy and rough appearance and often are rounded on top. Usually they are less than 1 cm in size but may join together to present as larger wart.
• Planter warts: These grow on soles and feet. Unlike other warts they grow inside the skin. They develop as small, round rough or thickened area and slowly grow. Planter warts can make walking uncomfortable.
• Flat warts (verruca plana): These are seen on face, hands, feet, legs and arms. They are flat and skin colored or pinkish or brownish in colour. They may present as individual lesions located at distance from each other or close and joining each other.
• Filiform warts: These are shaped like a tag or flap. They are seen around mouth, nose, neck or under chin. They are skin coloured.
• Periungual warts: They are site specific presentation of common warts so looks like them only.These warts grow under and around fingernails and toenails. They can be quite painful and affect nail growth.
• Genital warts: They are only few stains of HPV that cause genital warts, also called “condyloma acuminatum”. Genital warts causing HPV stains are strongly linked to cervical cancer. If you think you have them, consult your doctor right away.

Treatment

Skin Wart Diagnosis

Dermatologist identifies them by looking at lesions only. Skin biopsy or other tests are usually not necessary.

What are the treatments for skin warts?

Treatment of warts depends on type of wart, number of wart lesions and affected site. In children warts may resolve on its own within two years. But in this period this wart may enlarge in size or may be reason for new warts. Smaller warts are easy to treat than larger lesions.

Most common indication of getting treatment of warts are increasing number, cosmetic concern and pain.

There are multiple options for treatment of warts. They range from some home-based treatment to surgical removal of warts.

Treatment you can do at home (home remedies for warts)

Salicylic acid based lotion or ointment: this is applied directly to wart.
How to use it:

• soak your affected part in warm water for five minutes.
• You can add little salt to water.
• Dry skin completley
• Remove upper layer with nail filer or some rough object.
• Apply salicylic acid in veru minute amount strictly to wart only.
• Do this daily for atleast 3-4 weeks for initial improvement. It may take 2-3 months to remove wart completely.

Wart Removal Treatments done by dermatologist

Medical Treatment: There is no directly working antiviral medicine for treatment of warts. Dermatologist may use some other medicines, which have shown good results in warts. It includes oral retinoids, 5 FU, podophylotoxin resins, zinc, canthradine and imiquimod. Selection of medical treatment depends on site and type of wart. Medical treatment is effective for flat warts, genital warts and sometimes common warts. Chances of recurrence are high.

Radiofrequency ablation: First, a local anesthetic is injected around the wart. This is followed by the removal of the growth by fine needle using radiofrequency ablation (RFA). An antibacterial ointment is applied after the treatment. Usually, this process takes 15-20 minutes. A soft scab forms over the treated area, which falls off after a few days.

Laser treatments for warts: It is suitable for any kind of warts and done under local anesthesia. After anesthesia, laser procedure removes skin wart instantly. Patient need to apply antibiotic cream for wound care. It is more précised and faster than RFA.

Cryotherapy for warts: Here, the wart is frozen using a probe containing liquid nitrogen. Following the treatment, cold liquid gas destroy wart by freeing the lesion and it falls of along with the dead tissue eventually in 1-2 weeks. Repeat sessions may be required for larger lesions. It may be little painful so it is not useful for young children.

Chemical Cautery for warts: it is useful for flat warts or plane warts. It involves application of chemical on each lesion that turns white within seconds of application. Within 10-14 days it leads to formation of scab and it fall off with clearing of lesion also. Multiple sessions may be required for thick and large lesions.

Pairing + Chemical Cautery: In this treatment before doing chemical cautery, dermatologist will do pairing for wart to increase effect of chemical cautery. Pairing means removal of most of dear skin from wart lesion then chemical cautery will be done. Mostly done for palmo-planter warts.

Intralesional vaccine/injectionsor immunotherapy for warts: In this treatment dermatologist will inject small amount of vaccine like Mw vaccine, MMR Vaccine, Vit D injection, Bleomycin injection in largest skin wart. Repeat dosages may be required.  It is useful when other therapies have not cleared warts or number of warts is huge. Sometimes part of wart tissue is also placed under skin to induce immunity of body, which helps in clearing other lesions. It is also called immunotherapy.

TIPS

1. If you have single lesion, you can wait and watch for self resolution.
2. Don’t touch or scratch wart lesions with nails as it may spread to nail which is veru difficult to treat.
3. If single lesion is increasing in size or new lesions are developing then you should visit dermatologist.
4. Don’t use not approved medicines as they may lead to irritation and wound that may leave scar.
5. It is contagious infection so avoid sharing belongings.
6. Keep your hands clean and nails short.

When should I see a doctor for warts?

If a wart shows any of the following changes, you should see a doctor:

• You are not sure if you skin growth is a wart.
• If a sensitive part of body like mouth, nostril or genitals are affected.
• If it Grows in size or number
• If it Itches or pain
• If it Bleeds
• If it Changes shape
• If you have diabetes or immunocompromised status.
• Your skin wart does not improve with home treatment.

Why should I choose Dr. Kothiwala’sSkinEva Clinic for wart removal treatment?

• Detailed consultation with best dermatologist in Jaipur Dr Sunil Kothiwala
• Discussing about Pros & Cons of each treatment option in detail
• Selection of best treatment modality for your wart removal
• Procedure will be done by doctor only, not technician.
• Personalized post procedure care support

Are warts dangerous?

Usually common wart or flat warts are not dangerous but as they are infection, have tendency to spread other parts of body. Sometimes Planter warts may cause severe pain in sole, which may cause difficulty in walking. Some strains causing genital warts may lead to pre cancerous lesions or in female it predispose to cervical cancer.

How can I remove warts at home?

For smaller or few lesions you can use Salicylic acid at home. If it is not improving then you ma need to visit dermatologist.

Is genital warts sexually transmitted disease?

Yes, genital warts are one of most common STD. there are specific strains of HPV that causes genital warts. In female HPV warts are risk factor for cervical cancer.

Are warts a sign of a weak immune system?

Not necessarily. They are transferred from environment or some other infected to skin and ruptured skin barrier allow them to enter in skin. But Yes, weak immune system make a person more susceptible to get HPV infection and severity of disease will also be more in immune-compromised people.

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