Warts - Treatments and Procedures
The common wart is caused by a virus, which invades the skin, producing the characteristic elevation of the skin or mucous membrane. Several forms occur. The common rough thickened plaques (verruca vulgaris) occur frequently in childhood. They are most familiar on the hands, fingers, and around the nails. Satellite lesions may occur, or they may appear in areas of trauma. Small capillaries, when thrombosed, may exhibit black dots, resembling seeds.
Flat warts are multiple skin-colored papules on the face, neck, or the back of the hand. Around the eye or mouth small pointed (filiform) warts may appear like soft pliable tags. A most difficult wart to eradicate is the one found on the sole or plantar wart, occurring in the thick calloused skin of the feet. It is important to differentiate these from corns or callouses. A final type of wart is seen in the genital area, called condyloma accuminata. These cauliflower shaped, warty clusters may extend into the vaginal or rectal mucosa. Usually related to sexual contact, they may become quite painful.
There are several acceptable methods of treating warts. Electric needles can be used to dry up the warts, but this usually requires local anesthesia.Chemicals such as bichloracetic acid can destroy the wart tissue and, when carefully controlled to depth of penetration, it is usually successful. More recently cryosurgery is used, freezing the lesion with liquid nitrogen or with a special instrument utilizing carbon dioxide as the cooling agent. Most treatments of warts work by liberating the virus into the circulation, thus exposing it to antibodies. The usual type of warts on the hands should be frozen with liquid nitrogen or treated with chemicals, such as salicylic acid and lactic acid (duofilm), trichloracetic acid, ammoniated mercury ointment, or cantharidine (Cantharone). These treatments will not usually leave a scar.
Electrosurgery is also effective, and for most lesions the remaining scar will not be too visible. Approximately 20% of the warts resolve spontaneously within one year. Plantar warts should be treated carefully with a nonscarring procedure. Permanent scars may be painful. Gentle excavation of the wart with a scraping instrument (curette). Also, the use of chemical irritants or freezing measures are usually quite effective. The venereal wart (condyloma accuminata) can be a real therapeutic challenge. One treatment involves an application of a special solution, 25% podophyllin in tincture of benzoin. Caution is required, because of skin irritation risk. This treatment should NEVER be used during pregnancy!
The study of warts can be challenging, because of the antigen-antibody relationships of this ubiquitous virus. It has provided a model for understanding the production of tumors. This some day may help us develop safer and more physiologic ways of fighting other viruses, such as those that cause various types of cancer.
Wart - Warts Removed
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