Wart

                                    Warts

                                                                    (Human Papilloma Virus [HPV])

Warts

A small, fleshy bump on the skin or mucous membrane caused by human papillomavirus. Warts are caused by various strains of human papillomaviruses. Different strains may cause warts in different parts of the body. Warts can be spread from one location on the body to another or from person to person by contact with the wart.

The main symptom is a fleshy, painless growth on the skin. Common areas affected include the hands, feet and genitals. Treatment may include topical medication and removal through medical procedures. Very common, more than 10 million cases per year in India. Treatable by medical professionals. Usually self diagnosable. Lab test and imaging not required. Resolves within months.

Introduction

Warts are caused usually by human papilloma virus (HPV) infection. There are more than100 HPV subtypes. Trauma and maceration facilitates epidermal inoculation. Speed may than occur by autoinoculation. Local and systemic immune factors appear to influence spread.

Common Wart. Verrucae vulgaris

Warts on Elbow

                                                        

Warts. Verrucas. HPV. at Knee

Wart over face

Wart on Scalp

Kissing Warts

Common wart (Verrucae vulgaris) are sharply demarcated rough, round and irregular, firm and light gray yellow, brown or grey black nodule 2 to 10 mm in diameter. They appear  most often on sites subject to trauma (e. g, fingers, elbows, knees, face) but may spread else where. Variants of unusual shape (e.g. Pedunculated or resembling a cauliflower) appear most frequently on head and neck, especially the scalp and beard area. They are caused by HPV types 1,2,4, and 7 and occasionally other types in immuno suppressant patients. They are usually asymptomatic but sometimes cause mild pain  when they are located on a weight bearing surface (e. g, bottom of the feet).

Wart Prevalence & Epidemiology

• School children 2-20%
• Children and young adult 10%
• General population 16%
• US Adult 75%

Shapes of Warts

Cauliflower shaped Wart

How it spreads

By skin to skin contact (Handshakes or hugs)

Presentation and characteristic with types

Wart appears as hyperkeratotic papilloma with black dots which have thrombosed capillaries within the wart. These lesion can manifest on any site of the  of the body, but specific HPV subtypes may have a  tendency to affect a certain anatomic location.

• HPV1 infection may cause palmar and planter warts.
• HPV-2 causes common warts.
• HPV=3and HPV-10 typically cause flat warts
• HPV-6 and HPV-11 are the main causes of ano genital wart, or Condyloma acuminatum
• Cervical wart or Condyloma plana  may be difficult to visualize by examination.. The require application  of acetic acid which causes subclinical leisions to become white.

Flat Warts

Genital Warts

Genital Warts affects the moist tissues of the genital areas. They can look like small flesh colored bumps or have a cauliflower like appearance. Sometimes the warts are so small to be visible.

Mode of transmission

Warts are transmitted by direct or indirect contact and predisposing factors include disruption to  the normal epithelial barrier, may effect beard areas, hands, feet and ano genital area. Planter warts are commonly acquired from swimming pool or shower room floors, whose rough surface abrade moistened keratin from infected feet and help to inoculate virus into soften skin of other peoples.

Common hand warts may spread widely around the nails in those who bite their nails or habitually suck fingers (in young children). Shaving may spread warts infection over the beard area. Occupational handling of meat, fish and poultry home has high incidences of hand warts attributed to cutaneous injury and prolonged contact with wet flesh and water.

Genital warts have a high infectivity and kissing warts appear on opposing surface of toes and anogenital region.

Identification or Diagnosis of Warts with differential diagnosis

Diagnosis of warts is based on clinical appearance. Biopsy is rarely needed. A cardinal sign of wart is  the absence of skin lines crossing their surface and the presence of pin point black dots (thrombosed capillaries) or  bleeding when warts are shaved.

Differential Diagnosis

Differential diagnosis of warts can include the following:

• Corns (clavi) : Mau obscure skin lines but do not have thrombosed capillaries when shaved.
• Skin Tags (Achrocordon) : May be pedunculated and smoother and have more flesh colored than warts.
• Seborrheic keratosis : May appear more stuck on, be pigmented and include keratin filled horn cysts.
• Lichen planus : May mimic flat warts but may be accompnied by lacy oral lesions and may be symmetrically distributed.
• Squamous cell carcinoma : May be ulcerated, persistent, and grows irregularly.

Types of Wart

Filiform Wart

Periungual Warts

                                                              "Consult a Dermatologist."

Prevention

As a prophylaxis, regular cleaning of body with dedicated  anti-microbial soaps and shower gel along with proper washing of cloths will hep in reducing the further spread and improve the efficacy of treatment as well.

No Hand Shakes

No Hand Shakes

 

No Hugs

                                                          

Avoid Swimming Pool

Avoid Nail Biting

Finger sucking to be avoided

Avoid sharing shaving Razor

Spontaneous Regression

• 66% of warts in children disappear in two years
• Flat warts turn red itch and swell while shrinking.
• Plantars seldom regress.
• Don't rely on spontaneous regression

Treatment

Treatment is less successful in patient with low immunity. Intake of immune modulators or adhering to a healthy lifestyle can help
very much in getting rid of the warts and arrest the spread. 

Tropical irritants (Salicylic acid, cantharidin, podophyllum resin).

Destructive method (eg cryosurgery, electrocautery, curettage, excision, laser)

Topical Therapies (Intra leision injection therapies or combinations)

• Podophyllum (resin 20% in Tinct Benzoin. Apply carefully with glass rod to the surface of the wart. Leave it for 1-3 hours. Than wash it out with soap and water.. Can be repeated every 5-7 days if required. Not Podophyllum is contraindicated in pregnancy and in lactating mothers.
• Tricolor Acetic Acid (TGA) 80-90% to be applied directly to the wart.
• Imiquimod(Imiquod) 5% cream applied over night thrice a week for external genital and perianal warts. For post Herpatic Neuralgia : Gabapentin 300mg/day in 3 divided doses for 3 weeks increased to 600mg/ day for 4 weeks
• Cidofovir gel for local application. It can also used for  intralesional injections.
• Imiquimod 5% cream for local application. Electro cauterization or cryosurgery (with liquid nitrogen.
• Application of formic acid derivatives on the site of warts is found to be effective in removing the warts. But it should be done in medical supervision. Otherwise the skin can get burnt causing permanant damage.

Common Warts

• Keratolytic : Salicylic acid paint or salicylic acid with lactic acid
• Co2 Laser surgery for recalcitrant, chronic lesion.

Cutenous Warts

• Surgical excision/Cryosurgery.
• Chemical cauterization
• Electrocauterization
• Pure Carbolic acid. Apply with glass rod
• Trichloroacetic acid pure to be painted on warts.
• Salicylic acid 2.5, Lactic acid 2.5, Flexible colodion15, For external use
• Salicylic acid 3.5, Alcohol (40%)120. Paint daily at night till warts falls off (7-10) Applications)
• Glycolic acid10-20% occlusion one / week for 3-4 weeks.

Ayurveda

Immunomodulators 

Guduchi, Ashwagandha. Vidanga and all can contain the spread.

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