Declaring war on warts

Warts seem to be a never-ending battle for dermatologists.

These small, skin-coloured, rough lumps on the skin are benign (non-cancerous). Their appearance depends on where they are on the body and how thick the skin is.

Warts are caused by a viral infection called the human papilloma virus of which there are more than 100 sub-types. Common types of HPV tend to cause warts on the skin, such as on the hands and fingers, while other HPV types can cause warts in the genital area.

Warts can be categorised into four distinct groups.

Common Warts (verruca vulgaris) are the most frequently occurring and the favoured site is on the hands, reflecting the high likelihood that hands contact contaminated environmental surfaces during work or play. It is also reinforced by the natural tendency for young children to pick at or scratch at existing warts, spreading them to unaffected skin.

Plantar Warts (verruca plantaris) are also common and tend to occur on the weight-bearing surfaces of the feet, such as the heels, toes and balls of the feet. A typical scenario is a patient with a wart who walks barefoot, leaving behind viral particles that can inoculate subsequent unshielded feet that walk on that same surface. These type of warts tend to be subjected to continual, repeated pressure as one walks, causing them to grow inwards. At times, several plantar warts accumulate beneath the surface of the skin resembling one large entity that is difficult to treat.

Flat Warts (verruca planis) are light or dark brown, very slightly elevated growths most often found on the forehead, chin, neck or on the back of the hands. These are easily spread by shaving and tend to be very resistant to treatment.

Genital Warts (condyloma acuminata). Genital HPV is the most common sexually transmitted disease in the USA and is associated with cervical cancer. Women at greatest risk include those who began sexual intercourse at an early age, having multiple number of sexual partners and who are smokers. HPV may be contracted even when the male has worn a condom.

Who can get warts?

Most people get warts at some time during their life, although they are more commonly seen before the age of 20. About 10 per cent of children and adolescents have warts at any one time. Some people are more likely to develop them, especially those suffering from eczema or who have a weak immune system (e.g., following treatment for cancer or after an organ transplant).

Can warts be spread from person to person?

Yes, warts are very contagious, so close skin-to-skin contact can pass on the infection. What many persons are not aware of is that it is also possible to catch the infection indirectly from an object such as a towel. It can take weeks, or even months for a wart to appear after a person has been infected.

What can be done?
There is no ultimate cure for warts. Current therapies are divided into two categories: destructive therapy and immunomodulators.

What is of great importance is to keep in mind that warts on different areas of the body are treated in different ways. One should never try home remedies or over-the-counter drugs to treat genital warts as certain chemicals can be too strong.

Your dermatologist may attempt destructive therapy on certain sites, these may include cryotherapy with liquid nitrogen, burning with a hyfrecator machine or application of specific liquid chemicals including certain acids.

Immunomodulators include prescription creams or liquids with specified instructions on proper and safe home use.

Often enough, given months or even years, warts disappear on their own. The nature and course of these stubborn unwelcome skin growths remain somewhat a mystery even now.

Dr. Sonia Kapoor completed a full residency and clinical fellowship in Dermatology and Cutaneous surgery at the University Of Miami and conducts General and Cosmetic Dermatology clinics at the Chrissie Tomlinson Memorial Hospital.