Warts

Warts are caused by the human papilloma virus (HPV). More than 100 types of HPV are known to exist. Low risk types (most commonly HPV 1, 2, and 3) cause warts on the hands, feet, and other parts of the body. Types (6 and 11) can cause warts on the genitals or anus (genital warts) and other types (HPV 16, 18, and 32) can cause cancer of the cervix, external genitalia and anus.

The human papilloma virus (HPV) is the virus that causes warts and is transmitted via skin to skin contact.  The virus hides out inside the top layer of dead skin cells (keratinocytes) and because there’s a limited amount of blood supply, it evades the body’s immune system. Warts may be rough or smooth and are typically flesh colored, but some may be darker.  They can be large or small and can be found as a single growth or in groups.

Warts are commonly diagnosed with visual inspection on clinical examination. In some cases, the lesion may be surgically removed and sent to the laboratory for microscopic evaluation to confirm the diagnosis and identify the virus type.

Yes, genital warts are cause by the same HPV virus that causes common warts and are also spread via skin to skin contact. There are certain viral strains found more commonly in genital warts (HPV 6,11,16, and 18) but essentially any viral strain can infect the skin of the genitalia.

Only a small percentage of people infected with HPV will develop genital warts. Many people are “carriers” of HPV who may never develop warts but may still be able to pass the HPV to their sexual partners. The incubation period from contracting HPV until the development of a wart may be several months; although, some people may not develop warts for years after contact with HPV. People who have lower immunity due to cancer, AIDS, organ transplantation, or immune suppressive medications are more susceptible to getting warts.

The treatment of warts depends on the number of lesions, their specific location, and other factors. Recurrences are always possible. There are both surgical and nonsurgical treatment options.

   Nonsurgical treatment: include chemicals that destroy the skin cells where the virus is hiding and also create irritation to elicit an immune response to kill the virus. These methods typically require multiple treatment sessions in the office in 3 to 4 week intervals or done at home daily.

–Topical salicylic acid (over the counter):  is a powerful exfoliant that makes the skin cells less cohesive.  It’s comes as a topical solution you paint on and cover with a Band-Aid or impregnated within a medicated Band-Aid. It’s best to apply this to your wart at night time and remove in the morning.  You will notice that the skin under the Band-Aid is white and mushy once the covering is removed. At this time, it’s important to mechanically exfoliate the dead skin off with a disposable emery board and then cover with a regular Band-Aid.  As the top layer of dead skin cells slough off, the virus has nowhere to hide and is eliminated with it.

–Topical imiquimod (prescription):  helps the body produce proteins that act against HPV and boost the local immune response.  This prescription cream get applied three nights a week for 3-4 months.  The warts will gradually get smaller and then disappear.  This works best on smaller warts that have been present for <1 year.  It’s important to finish the entire course of treatment because sometimes even though the wart looks like it’s gone small microscopic viral particles may remain to prevent regrowth.

–Topical podofilox (prescription): stops the growth of the wart infected cells.  This is a prescription cream that gets applied three nights a week and can cause skin irritation if overused. Again this must be used for a full course of treatment which last about three months in order to prevent recurrence.

–Topical retinoids (prescription): promote rapid cell turnover and thus the removal of cells infected with HPV. It’s also a little irritating and this irritation will stimulate a local immune response.  When cells from the immune system come to the area they recognize the virus and kill it.

Surgical methods: are invasive often requiring local anesthesia and downtime for healing. These are typically not first line treatment options but can be used in more aggressive cases that failed to respond to topical treatment alone.

–Cryosurgery (freezing with liquid nitrogen): uses subzero temperatures to freeze and kill the skin cells where the virus is hiding.  The liquid nitrogen is so cold that it is a little painful and it usually takes 3 to 4 treatments for warts to go away.

–Simple excision or shave removal:  what can be cut out if they are too large for conventional treatments or in sensitive locations. Surgery is not commonly performed since warts are often in too many spread out locations. Also, some studies have shown that if a wart occurs in a scar it will be even more difficult to treat.

–Lasers: work by constricting blood supply to the ward, burning the virus, and eliciting an immune response to clear the virus. there are several different laser options which include pulsed dye laser (PDL), Neodymium: Yttrium/Aluminum/Garnet (Nd:YAG)laser, Erbium: Yttrium/Aluminum/Garnet (Erb:Yag) laser and the  Carbon Dioxide laser (CO2)