Warts or verruca are caused by Human Papilloma Virus (HPV) infection. There are more than 130 subtypes of HPV. These are DNA virus giving rise to a variety of presentation on human skin. Warts are especially common among children and young adults of both the sexes. These growths are usually benign. Warts usually grow on the fingers of hands and toes of the feet. But warts may be seen on other parts of the body. Persons with low body immunity, on immunosuppressant drugs like Cyclosporin or Azothiaprin, suffering from HIV or Cancer are more prone to develop it. Virus enters human body through a damaged or weak skin and start multiplying. Some warts are itchy and painful and sometimes may bleed. Warts are somewhat contagious and it has property of auto-inoculation. Incubation period may be as long one year.
After Acne,it the most common dermatological complain. Three out of four persons develop warts at some time during their life-time.
Types of Warts
Depending upon character and location on body warts may be categorized as written below: –
Verruca vulgaris – commonest type, characterized by
- Round or oval-shaped.
- Raised from skin surface.
- Firm in consistency.
- Surface is rough and irregular, may resemble cauliflower.
- Size may vary from 1 mm to 10 mm.
- Often seen on fingers, toes, knees and on the knuckles.
Planter warts also called Verrucas – characterized by
- Usually develop on soles of feet.
- Flat, not raised.
- Whitish colour with a tiny black spot on the centre due to necrosed capillary vessels.
- May be painful due to location on weight-bearing part of body.
Genital warts – characterized by
- Warts, rashes, bumps, sores, blisters on or around genital organ or anus.
- During micturition pain, itching or burning sensation.
- Vaginal discharge which is fowl- smelling.
- Infants may develop laryngeal papilloma due to exposure of HPV during birth.
Filiform warts or Verruca filiformis – characterized by
- Thread or finger like appearance.
- Common sites are eyelids, lips and face.
Plane warts or Verruca plana – characterized by
- Colour – yellowish or flesh like.
- Round, smooth and flat-topped.
- Diameter 2mm to 4 mm.
- Common in young children.
- Common body sites are hands, legs and face.
Periungual warts – characterized by
- Rough surface.
- Distorting the shape of fingernail or toenail.
- Usually painful.
Mosaic warts characterized by
- Cluster forming.
- Tiles – like appearance.
- Seen on soles of feet and palm of hands.
Diagnosis and Differential diagnosis:
Though they are clinically obvious, sometimes biopsy may be performed to confirm it. Histopathological findings of verruca vulgaris differs from verruca planna. Commonly the following characteristic appearance is seen on a microscope : thickening of stratum corneum , thickening of stratum spinosum, thickening of granulosum, rete ridge enongation and presence of large blood vessels at dermo-epidermal junction.
Seborrhoic dermatitis and skin cancer are the two conditions to be kept in mind as differential diagnosis.
Complications of viral warts – rarely malignant changes occur particularly in genetically predisposed or immune-compromized persons.
Aim of treatment is to remove them without relapse or scarring at the site.
Topical – application of the agent may be needed for 3 months or more.
- Salicylic acid
- Podophylline and Cantharidin
- Chemicals – silver nitrate, formaldehyde, glutaraldehyde
- Dimethyl ether propane spray
- Antiviral drug Cidofovir
– in cryotherapy liquid nitrogen is applied for 5 to 10 minutes on the wart to destroy it. Subsequently blister followed by scab formation, that falls off in a week. This procedure is slightly painful and hence not performed in children. If cryotherapy is not effective within 3 months, further treatment may not be effective. Side effects of cryotherapy are hypo-pigmentation or hyper-pigmentation.
Laser therapy, Electro-cauterry and surgical procedures, Duct therapy are some other measures to treat the warts. Surgical removal of warts is usually not satisfactory on account of re-occurances.
Duct tape therapy
– a duct tape is applied over the lesion for 6 days. After 6 days tape is removed and area is soaked in water and rubbed with pumice stone. This procedure is repeated up to 2 months to get the desired result.
It may be mentioned that not a single procedure may give cent percent satisfaction. Some do reappear after treatment and some naturally regresses to disappear. Natural regression may take few months to 2 years duration depending on the body immunity. Pregnant ladies with wart are usually treated with salicylic acid, cryotherapy or duct therapy. During pregnancy cytotoxic drugs (eg. Podophylline) are not to be used.
Patient comes to a doctor mostly due to embarrassment when wart is located on a visualized part of body. A physician has to stimulate the immune system of the patient’s body in order to get rid of the warts. For the treatment of wart patience is essential.