WARTS
Introduction:
A wart is a skin growth caused by some types of the
virus called the human papillomavirus (HPV). There are more than 100 known types
of HPV. HPV infects the top layer of skin, usually
entering the body in an area of broken skin. The virus causes the top layer of
skin to grow rapidly, forming a wart. Most warts go away on their own within
months or years.
Classifications:
A range of types of wart have been identified, varying in shape
and site affected, as well as the type of human papillomavirus involved. These
include:
- Common wart
(Verruca vulgaris), a raised wart with roughened surface, most
common on hands, but can grow anywhere on the body;
- Flat wart
(Verruca plana), a small, smooth flattened wart, flesh-coloured,
which can occur in large numbers; most common on the face, neck, hands,
wrists and knees;
- Filiform
or digitate wart, a thread- or finger-like wart, most common on the face,
especially near the eyelids and lips;
- Genital wart
(venereal wart, Condyloma acuminatum, Verruca acuminata), a
wart that occurs on the genitalia.
- Mosaic wart,
a group of tightly clustered plantar-type warts, commonly on the hands or
soles of the feet;
- Periungual wart,
a cauliflower-like cluster of warts that occurs around the nails.
- Plantar wart
(verruca, Verruca plantaris), a hard sometimes painful lump, often
with multiple black specks in the center; usually only found on pressure
points on the soles of the feet
Causes:
Warts
are caused by the human papilloma virus (HPV). There are about 130 known types
of human papilloma viruses. HPV infects the squamous epithelium, usually of the
skin or genitals, but each HPV type is typically only able to infect a few
specific areas on the body. Many HPV types can produce a benign growth, often
called a "wart" or "papilloma", in the area they infect.
Various types of this virus thrive in warm, damp
environments such as showers, locker room floors, and swimming pool
areas.
You are most likely to develop a wart where you have broken
skin, such as a cut, hangnail, closely bitten nail, or scrape. Plantar
warts are common to swimmers whose feet are not
only damp and softened but are also scratched and broken by rough pool
surfaces. Common warts are often seen among those who handle meat, chicken, and
fish.
. Genital warts are spread through
direct skin-to-skin contact during oral, genital, or anal sex with an infected partner. Warts are the most easily recognized
symptom of genital HPV infection, and types 6 and 11 are responsible for 90% of
genital warts cases. Although 90% of those who contract HPV will not develop
genital warts, those infected can still transmit the virus. Some types of HPV
can cause cervical cancer
and anal cancers, but
these are not the same types of HPV that cause genital warts. However, it is
possible to be infected with different varieties of HPV, such as a low-risk HPV
that causes warts and a high-risk HPV that may cause cancer, either
concurrently or at different times. HPV is so common that more than half of all
sexually active people will get it at some point in their lives.
How
are warts spread?
Warts are easily spread by direct contact with a human
papillomavirus. You can reinfect yourself by touching the wart and then another
part of your body. You can infect others by sharing towels, razors, or other
personal items. After exposure to a human papillomavirus, it can take many
months of slow growth beneath the skin before you notice a wart.
It is unlikely that you will develop a wart every time you
are exposed to a human papillomavirus. Some people are more likely to develop
warts than others.
Pathophysiology:
Common
warts have a characteristic appearance under the microscope. They have
thickening of the stratum corneum (hyperkeratosis), thickening of the stratum
spinosum (acanthosis), thickening of the stratum granulosum, rete ridge
elongation, and large blood vessels at the dermoepidermal junction.
Clinical Features:
Warts occur in a variety of shapes and sizes. A wart may
appear as a bump with a rough surface, or it may be flat and smooth. Tiny blood
vessels (capillaries) grow into the core of the wart to supply it with blood.
In both common and plantar warts, these capillaries may appear as dark dots
(seeds) in the wart's center.
Following
are descriptions of the main types of warts:
- Common
warts
usually appear singly or in groups on the hands, although they may grow on
any part of the body. They usually are rough, gray-brown, dome-shaped
growths.
- Plantar
warts
can develop on any part of the foot. Sometimes dark specks are visible
beneath the surface of the wart. When pressure from standing or walking
pushes a plantar wart beneath the skin's surface, a layer of thick, tough
skin similar to a callus develops over it. As the callus and wart get
larger, walking can become painful, much like walking with a pebble in
your shoe. Multiple plantar warts can form in a large, flat cluster known
as a "mosaic wart."
- Flat
warts
are usually found on the face, arms, or legs. They are small (usually
smaller than the eraser on the end of a pencil), and there are usually
several in one area. They have flat tops and can be pink, light brown, or
light yellow. Flat warts are often spread by shaving.
- Filiform
warts,
a kind of flat wart, can grow around the mouth, nose, and beard area. The
surface of this type of wart has many flesh-colored, finger-shaped
projections.
- Periungual
warts
are found under and around the toenails and fingernails. They appear as
rough, irregular bumps. They can affect nail growth.
- Genital
warts
can be extremely small and difficult to detect. For more information, see
the topic Genital Warts.
Common
and flat warts usually do not cause pain. But they can be
bothersome and can spread easily if they are in areas that are constantly
irritated by rubbing or shaving. Visible warts can be embarrassing for some
people. Plantar warts often cause pain, especially if they are located over
bony areas of the foot.
Other
skin conditions may look like warts. These include:
- Seborrheic
keratoses, which are noncancerous growths of the skin. They vary in color
from light tan to black and in size from very small to the size of a coin.
The growths may look waxy, pasted on, or stuck on.
- Skin tags
(acrochordon), which are small, soft pieces of skin that stick out on a
thin stem. They most often appear on the neck, armpits, upper trunk, and
body folds. They commonly appear after middle age.
- Corns,
which are areas of thick, hardened, dead skin.
- Skin
cancer. Skin cancer may appear as a growth or mole, a change in sssa
growth or mole, a sore that does not heal, or irritation of the skin.
Warts
cover the lines and creases in the skin-this is one way to tell a wart from
other skin conditions.
Management:
There are many treatments and procedures associated with
wart removal. One review of 52 clinical trials of various cutaneous wart
treatments concluded that topical treatments containing salicylic acid were the best supported,
with an average cure rate of 75%, compared with 48% for the placebo in six
placebo-controlled trials including a total of 376 participants. The reviewers
also concluded that there was little evidence of a significant benefit of cryotherapy over salicylic acid.
One complicating factor in the treatment of warts is that
the wart may regrow after it has been removed.
Two viral warts on a middle finger,
being treated with a mixture of acids (like salicylic acid) to remove them. A
white precipitate forms on the area where the product was applied.
- Imiquimod,
a topical cream that helps the body's immune system fight the wart virus
by encouraging interferon production. Approved by the U.S. Food and Drug
Administration (FDA) for genital warts. The drug is very expensive.
- Cantharidin,
a chemical found naturally in many members of the beetle family Meloidae
which causes dermal blistering. Either used by itself or compounded with
podophyllin. Not FDA approved, but available through Canada or select US
compounding pharmacies.
- Bleomycin,
not US FDA approved. One or two injections used. It can cause necrosis of
digits and Raynaud syndrome.
- Dinitrochlorobenzene
(DNCB), like salicylic acid, this is applied directly to the wart. Studies
showed this method was effective with a cure rate of 80%. But DNCB must be
used much more cautiously than salicylic acid; the chemical is known to
cause genetic mutations, so it must be administered by a physician. This
drug induces an allergic immune response resulting in inflammation that
wards off the wart-causing virus.
- Fluorouracil,
which inhibits DNA synthesis, is being used as an experimental treatment.
It is applied directly to the wart (especially plantar warts) and covered
(for example: with tape). This treatment is combined with the use of a
pumice stone, but tends to work very slowly.
- Salicylic
acid can be prescribed by a dermatologist in a higher concentration than
that found in over-the-counter products. There are several
over-the-counter options, commonly involving salicylic acid, readily
available at pharmacies and supermarkets. There are typically two types of
products: adhesive pads treated with salicylic acid or a bottle of
concentrated salicylic acid solution. Removing a wart with salicylic acid
can be done by cleaning the area, applying the acid, and removing the dead
skin with a pumice stone or emery board. It may take up to a year to
remove a wart.. Application of natural salicyclic acid sources such as
podophyllum resin paint may also be effective. [podophyllum resin I.P.'66
(20% w/v), benzoin I.P. (10% w/v), aloes I.P. (2% w/v), isopropyl alcohol
I.P. to make (100% v/v)]
Another product available over-the-counter that can aid in
wart removal is silver nitrate in
the form of a caustic pencil,
which is also available at drug stores. In a placebo-controlled study of 70
patients, silver nitrate given over nine days resulted in clearance of all
warts in 43% and improvement in warts in 26% one month after treatment compared
to 11% and 14%, respectively, in the placebo group. The instructions must be
followed to minimize staining of skin and clothing. Occasionally pigmented
scars may develop.
Cryosurgery or cryotherapy devices using a dimethyl
ether – propane mixture are inexpensive. A disadvantage is that the sponge
applicator is too large for small warts, and the temperature achieved is not
nearly as low as with liquid nitrogen. Complications include blistering of
normal skin if excess freezing is not controlled.
Several randomized, controlled trials have found that zinc sulfate, consumed orally, often
reduces or eliminates warts. The zinc sulfate dosage used in medical trials for treatment of warts was between 5
and 10 mg/kg/day. For elemental zinc, a lower dosage of 2.5 mg/kg/day
may be appropriate as large amounts of zinc may cause a copper deficiency. Other trials have
found that topical zinc
sulfate solution or zinc oxide are also effective.
Procedures
Liquid nitrogen spray
tank
- Keratolysis,
of dead surface skin cells usually using salicylic acid, blistering
agents, immune system modifiers ("immunomodulators"), or
formaldehyde, often with mechanical paring of the wart with a pumice
stone, blade etc.
- Electrodesiccation.
- Cryosurgery,
which involves freezing the wart (generally with liquid nitrogen), creating
a blister between the wart and epidermal layer, after which the wart and
the surrounding dead skin fall off by themselves. An average of 3 to 4
treatments are required for warts on thin skin. Warts on calloused skin
like plantar warts might take dozens or more treatments.
- Surgical
curettage of the wart;
- Laser
treatment – often with a pulse dye laser or carbon dioxide (CO2)
laser. Pulse dye lasers (wavelength 582 nm) work by selective
absorption by blood cells (specifically haemoglobin). CO2
lasers work by selective absorption by water molecules. Pulse dye lasers
are less destructive and more likely to heal without scarring. CO2
laser works by vaporizing and destroying tissue and skin. Laser treatments
can be painful, expensive (though covered by many insurances), and can
cause little scarring when used appropriately. CO2 lasers will
require local anaesthetic. Pulse dye laser treatment does not need
conscious sedation nor local anesthetic. It takes 2 to 4 treatments but
can be many more for extreme cases. Typically, 10–14 days are required
between treatments. Preventative measures are important.
- Infrared
coagulator – an intense source of infrared light in a small beam like a
laser. This works essentially on the same principle as laser treatment. It
is less expensive. Like the laser, it can cause blistering pain and
scarring.
- Duct
tape occlusion therapy involves placing a piece of duct tape over the
wart. The evidence as to whether or not it is effective is poor. Thus it
is not recommended as routine treatment.
Homoeopathic
Management:
Homoeopathy treats the person as a whole. It
means that homeopathic treatment focuses on the patient as a person, as well as
his pathological condition. The homeopathic medicines are selected after a full
individualizing examination and case-analysis, which includes the medical
history of the patient, physical and mental constitution etc. A miasmatic
tendency (predisposition/susceptibility) is also often taken into account for
the treatment of chronic conditions. The medicines given below indicate the
therapeutic affinity but this is not a complete and definite guide to the
treatment of this condition. The symptoms listed against each medicine may not
be directly related to this disease because in Homoeopathy general symptoms and
constitutional indications are also taken into account for selecting a remedy.
The
following homeopathic medicines are often found indicated in cases of warts:
Antim-c, Bufo, Calc-c, Caust, Cinnab, Dulc, Ferr. pic, Lyco, Mag-s, Nat-c,
Nat-m, Nit-ac, Ruta, Sil, Staph, Sul, Sul-ac, Thuja.
ANTIM. CRUD:
It is the leading remedy for warts, and has great practical
use in homoeopathy. The warts are situated especially on hands; they are hard,
horny, soft or smooth, which characteristic stinging pain. Warts are surrounded
by circle of ulcers. Warts tend to develop which are pron to pressure and
friction, especially suited to individuals who have tendency to grow fat. Warts
develop in individuals who have suppression of eruption or ulcers.
Horny excrescences. smooth warts, often soft. Ulcers
breaking out around a wart. Tendency to grow fat. Worse warm weather - heat of
sun. children can't bear to be touched or looked at. Feels as if he had eaten
too much. Heartburn with good appetite. Characteristic - while coated tongue.
For children and young people inclined to grow fat; for the
extremes of life. Old people with morning diarrhea, suddenly become
constipated, or alternate diarrhea and constipation; pulse hard and
rapid. Sensitive to the cold < after taking cold.
BELLADONA:
It plays a very useful role whenever warts are inflamed
with burning pain. They are hot & tender to touch with characteristic
throbbing pain.
Adapted to bilious, lymphatic, plethoric constitutions;
persons who are lively and entertaining when well, but violent and often
delirious when sick.
CALC. CARB.:
Warts are present on face, neck & upper extremities,
male genitalia, canthi, fingers. They are black & fleshy, hard & horny,
sometimes inflamed & painful; the warts tend to suppurate. Giving an odour
of stale cheese. The skin is icy cold to touch with cold & profuse
perspiration. Development of warts in patient having history of suppression of
eruption & perspiration. Development of warts in individual with
scrofoulous diathesis with faulty development of bones. It has a typical physically
constitution, i.e. fat, flabby, fair, perspiring, cold & damp.
Warts : round, soft at base, almost the colour of skin;
upper surface hard, rough, whitish, horny. Wart appears, itches, bleeds &
disappears. Warts : inflamed; stinging; suppurating; form ulcers. Warts thickly
studding mouths of sheep. Calc. suits phlegmatic people; large head &
features; pale skin & chalky look. Better dry weather, from being touched.
Worse milk: from suppressed perspiration.
Leucophlegmatic, blond hair, light complexion, blue eyes,
fair skin; tendency to obesity in youth. Psoric constitutions; pale, weak,
timid, easily tired when walking. Disposed to grow fat, corpulent,
unwieldy.
CAUSTICUM:
Warts are present on nose, eyebrows, face, lips, near the
nail, tips of fingers, upper limbs. They are large, horny, broad, fat &
hard, moist and pedenculated. They tend to bleed easily. They are also prone to
easy suppuration. Warts are present in individual after suppressed eruptions.
Large, jagged, often pedunculated warts exuding moisture
and bleeding easily. Small, non-pedunculated warts all over the body internal
& external, and on eyelids. In caust., injuries which had healed become
sore again. Years ago there was an epidermic of warts on calves at a little
farm - cured by causticum. Caust. is worse cold, dry weather, in clear, fine
weather. Better damp & wet weather.
Adapted to persons with dark hair and rigid fibre;
weakly, psoric, with excessively yellow, sallow complexion; subject to
affections of respiratory and urinary tracts.
DULCAMARA:
Warts are present on face, hands, fingers, close to nail;
the warts are smooth, hard; they usually comes in crops; they always tend to
aggravate when skin is washed with cold water.
In black type we find : warts, fleshy or large, smooth on
dorsum of hands and on face. Dulc. is one of our very great skin medicines.
Typical dulc. is worse from exposure to damp cold weather or air - a cellar or
dairy. A few years ago, dulc. cured for a patient a big wart on right lower
lids, not easy to see over. Big warts on face can be very trying, yet, with
'the remedy', they just drop off. Dulc. in one's mind, stands especially for
warts & for umbilicalpain or eruptions.
Aggravation of sufferings, chiefly in the evening or at
night, an during repose, better by movement. Pains with coldness of the
body.
NAT-MUR.:
The warts especially situated on palms, hands &
knuckles. There is a cutting pain in wart, the look of the skin is oily, dry,
harsh, unhealthy or yellow. Tendency to develop warts in individual after
cautery with silver nitrate.
For the anaemic and cachectic, whether from lots of vital
fluids- profuse menses, seminal losses- or mental affections. Great
emaciation; losing flesh while living well. Throat and neck of children
emaciate rapidly during summer complaint. Great liability to take cold.
Irritability: child cross when spoken to; crying from slightest
cause; gets into a passion about trifles, especially when consoled with.
Awkward , hasty, drops things from nervous weakness. Marked disposition
to weep; sad weeping mood, without cause, but consolation from others
<. her troubles.
NIT. ACID:
The warts appear on female genitals, anus, cervical region
inside nose, external throat, sternum, eyelids, canthi. They usually develop
after abuse of mercury. The following are the characteristics : moist,
cauliflower like, hard, rhagadic, large, indented, inflamed, pricking pain <
night. They emit foetid discharge, they bleed on touch.
Warts : sticking & pricking : on upper lip. Smart &
bleed on washing; painful to touch. Soft with thin epidermis and moist: large,
jagged, often pedunculated, exuding moisture & bleeding readily :
condylomata, etc. splinter - sensations anywhere. Worse : touch, jar, cold at
night.
SILICEA:
The warts are situated on throat, upper limb, back and
forearm. They are large, fleshy & suppurating. They are painful to touch.
Development of warts in individual with scrofulous diathesis. The patient is
keenly sensitive to noise, pain and cold.
Adapted to the nervous, irritable, sanguine temperament;
persons of a psoric diathesis. Persons of light complexion; fine dry
skin; pale face; weakly, with lax muscles. Constitutions which suffer from
deficient nutrition, not because food is lacking in quality or quantity,
but from imperfect assimilation; oversensitive, physically and mentally.
SULPHUR:
Warts are situated on face, near eyelids, on upper lip.
Warts covered with thin epidermis. The appearance of the skin is dry, rough,
wringled and scaly. Warts alternate with other complaints. Suppression of warts
leads to asthma.
Callous warts; especially around the fingers. Itching
eruptions, or itching skin; 'feels so good to scratch.' Fantastic illusions :
everything seems beautiful : as an old rag or stick. Redness about anus- red
eyelids. Perspiration of single parts : of back part of body. Flushes of heat.
Heaviness, abdomen; as if it needs to be bandaged or supported. Sulphur
sometimes feels small, sometimes largs.
Adapted to persons of a scrofulous diathesis, subject to
venous congestion; especially of portal system. Persons of nervous temperament,
quick motioned, quick tempered, plethoric, skin excessively sensitive to
atmospheric changes. For lean, stoop-shouldered persons who walk and sit
stooping like old men. Standing is the worst position for sulphur patients;
they cannot stand; every standing position is uncomfortable. Dirty, filthy
people, prone to skin affections. Aversion to being washed; always <. after
a bath. Too lazy to rouse himself; too unhappy to live.
THUJA:
Warts are situated on back, cervical region, upper limb,
face, nose, eyebrows, eyes, eyelids, external throat. They are broad, conical,
flat pedunculated, indented, fan shaped in appearance. They are reddish in
colour, bleed easily. The warts have a tendency to split from their edge or
from the surface.
Warts on any part of body, with little necks called fig
warts; tubular warts; i.e. long warts of the same size all the way out.
Wart-like excrescences on back of hand, on chin and other places. Warts and
condylomata, large, seedy & pedunculated; sometimes oozing & bleeding
readily. Effects of vaccaination. Dreams of the dead : of falling.
Adapted to hydrogenoid constitution of Grauvogl. Acts
well in lymphatic temperament, in very fleshy persons, dark complexion, black
hair unhealthy skin. Ailments from bad effects of vaccination; from
suppressed or maltreated gonorrhoea. Fixed ideas: as if a strange person were
at his side; as if soul and body were separated; as if a living animal
were in abdomen; of being under the influence of a superior power.
Prognosis of Homoeopathy treatment varies
from case to case - some warts disappear readily with medication whereas others
require long-term treatment and are slow to disappear. The important thing
about Homeopathic treatment is that besides healing them, it prevents the warts
from spreading to other parts of the body. Proper constitutional treatment
removes the tendency for wart formation from the roots thereby giving lasting
results.
Overall, the treatment of warts with Homoeopathy
gives good results in most cases and the best part are that the treatment is
safe and without any side-effects. Homoeopathy is strongly suggested for all
cases of warts.
