WARTS - THE MYSTERIOUS PROTUBERANCE ON SKIN

What are warts?

Warts are small, harmless lumps of skin caused by a virus known as the human papillomavirus (HPV). A wart will usually have a flesh coloured appearance and the skin forming the wart will be rough. Warts are common in school-aged children but can happen at any age.

What are the symptoms of warts?

The appearance of a wart depends on its type. There are several different types of warts:

• Common warts (verruca vulgaris) — these are small, raised areas of skin, usually round, with a rough surface of skin often looking like the top of a cauliflower. These warts often appear on the hands, elbows and knees.

• Plane or flat warts — these are flat warts that are usually yellow in colour and appear on the hands and face. They are most common in children and can often

spread and group together.

• Plantar warts — these are warts that appear on the feet, usually on the sole, heel or toes. The weight of the body causes the wart to be pushed into the skin so a plantar wart will usually not be raised like other warts and may even cause some discomfort when walking. You may notice a white area of skin with a tiny black dot or dots in the centre.

• Filiform warts — these are long, thin warts that usually appear on the eyelids, armpits or neck.

• Mosaic warts — these grow in clusters and are most common on the hands and feet.

• Subungual or periungual warts — these are warts that form under or around the cuticle.

• Mucosal warts — these can appear on the lips, inside the cheeks and nose, the airway and in genital areas.

What causes warts?

HPV virus can infect from direct contact with the skin from another person who has the virus or indirectly through contaminated surfaces such as swimming pools or gymnasiums. HPV infects the cells in the outer layer of the skin, causing them to grow and form a wart. It can take up to a year for the wart to appear for the first time.

Genital warts are caused by a different family type of HPV. These are sexually transmitted and can cause cervical and vulval cancer. Ordinary skin warts do not cause cancer.

When should I see my doctor Most warts will go away without treatment in time. In children, without treatment, half of all warts disappear within 6 months and almost all 90% will go away within 2 years. It can take longer in adults. It is a good idea to show the wart to your doctor if:

• the wart is bothering you or painful

• you have warts of the face, feet or genitals

• the wart looks infected (red, swollen and warm)

• you have multiple warts or the warts are spreading

• you have reduced immunity

• you are pregnant or planning a pregnancy

How are warts treated?

*Covering the wart with strong, waterproof tape may help it to clear up. It can also stop the wart from spreading.

*Liquid or gel-A common method of treating warts involves applying a liquid or gel containing salicylic acid or lactic acid (wart paint) to the wart The liquid or gel has to be used every day, and it can take many weeks to work. Never use wart paints on the face.

*Cryotherapy (Freezing)- Freezing a wart (known as cryotherapy) needs to be carried out by a healthcare professional. It works by exposing the wart to a very cold liquid, such as liquid nitrogen or sprays. This freezes the wart and destroys its skin cells. Salicylic acid can also be used to destroy the wart.

*Burning and laser-Burning, surgical removal and laser wart removal treatments are done under local anaesthetic. These treatments are done less commonly because they can leave scars.

Immunotherapy-This involves treatments that encourage the immune system to recognise and destroy the skin cells that are infected with the wart virus. This treatment takes time and can be very itchy.

Can warts be prevented? There are steps you can take to prevent warts from spreading.

• If you have a plantar (on the bottom of the feet) wart, you need to change your socks daily.

• Do not share towels with another person. If you have a plantar wart you should avoid sharing any footwear including socks.

• If you have a plantar wart make sure you clean out the bottom of your shower or bath after use.

• Wash your hands if they come into direct contact with your wart, such as when you apply any treatments.

• Never pick, scratch or bite a wart.

• Do not share any medicines or remedies used to treat your wart. This includes emery boards and pumice stones.

• If you have a plantar wart and go swimming you should cover it up and wear thongs in communal areas. Do not go barefoot in public areas.

THE PATHOLOGIST VIEW ON WARTS-

• These are flesh coloured papules with a rough surface caused by HPV infection

• Common and plantar warts are generally caused by HPV 1, 2, 4 and 7

• Genital warts are caused by HPV 6 and 11

• The characteristic histopathological findings are hyperkeratosis, hypergranulosis, papillomatosis, koliocytosis and inward bending of rete ridges with dilated dermal capillaries.

Blog by Dr. Aditi Kumar