Warts
(Jan 2000)
Warts are common but often misunderstood skin growths that may develop at any age but are most common in children. Warts are non-cancerous and are caused by a viral infection in the top layers of the skin or mucous membranes. The appearance of warts depends to a great extent on where they are growing. Warts are usually skin colored and feel rough to the touch but can be dark, flat and smooth. The human papilloma virus (HPV) causes warts. There are numerous HPV variants, each with a different DNA pattern and different skin behavior.
There are several types of warts including common warts, foot warts, flat warts and mucous membrane warts. Common warts usually grow around the nails, on the fingers and on the backs of the hands. They are more common if the skin has been bitten or picked. Foot warts are usually found on the soles of the feet and are called plantar warts. These warts can become painful because the pressure of walking presses them into the skin and deeper tissue of the foot. Common and planter warts are often treated with over the counter remedies.
Flat warts are smaller and smoother than other warts. They tend to be numerous and can occur anywhere but are most common on the faces of children. In adults, they are often found on the bearded area of men and on the legs of women. Irritation from shaving probably spreads the warts in these areas.
Warts may affect other more private areas in adults and this has become an increasingly common problem. Warts in these areas are not transferable to or from other areas of the body but can spread from person to person. These warts are called condyloma and have been linked to serious health problems, especially in women. Condyloma and flat warts are more difficult to treat safely and effectively and are best treated under the personal guidance of a dermatologist.
The wart virus is contagious. Warts are spread from person to person by skin to skin contact. Warts usually do not develop until at least a few months after they are caught by skin contact. People are more likely to catch the wart virus and develop warts if the skin has been damaged in some way such as by picking or biting nails. Some people are simply more prone to warts than others. Subtle inherited differences in immune system from person to person may explain this difference in susceptibility from person to person. People with weakened immune systems are particularly prone to wart virus infections.
Warts do not necessarily need to be treated. They will often disappear within months to years without treatment, especially in children. However, since warts may spread and are often socially or physically uncomfortable, treatment is often reasonable. In adults, warts are slower to disappear without treatment and certain warts such as condyloma should definitely be treated due to associated health risks.
Dermatologists are trained to use a variety of methods to treat warts depending on the age of the patient, the type and location of the warts, and other patient-specific factors. Safe and effective treatment is available for both children and adults suffering from warts. Over the counter wart remedies applied on a daily basis sometimes cure warts. Many warts will eventually go away on their own without treatment, but how long they are likely to last without treatment is difficult to predict. For stubborn or unusual warts, it is generally best to consult with a dermatologist. Warts can be difficult to treat, but in most cases dermatologists can effectively remove them with minimal discomfort or risk of scarring. Modern wart treatments such as bleomycin, cantharone, podophyllin, imiquimod, cryotherapy and curretage require careful patient selection and therapy administration to maximize safety and effectiveness. Some warts are resistant to treatment and may require several attempts at treatment before they go away.
Craig Kraffert, M.D.
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