Warts

Anyone can get warts, but they are most common in teenagers and children. Around 33% of children and teenagers tend to have warts at some time or the other. Most warts are painless and tend to go away by themselves. Only 3 to 5 % of all adults tend to develop warts. Most people opt for treatment when warts do not disappear by themselves and are unpleasant and unsightly.

What are warts?

Warts are a widespread viral skin condition that occurs in the form of small growths on the outer surface of the skin. A common virus called the human papillomavirus (HPV) causes them. Warts appear in different shapes and sizes. They can be very tiny or big with varying colours such as white, pink, or brown or the colour of your skin. They can be rough or smooth, flat or raised or long and skinny. Warts commonly grow on the hands, feet, and face, though they may occur at any place on the body.

Warts are classified into different categories based on where they grow and the way they look. Here are different types of warts:

• Common Warts
  Also called verruca vulgaris, common warts generally appear on the hands, especially on the fingers, near the nails and on the back of the hands. They commonly occur in places where the skin is broken, cracked, or scratched. Skin damage due to biting of fingernails or picking nails is common in children, and they generally tend to develop warts in that area Common warts may contain black dots in them that look like seeds. These are called seed warts. Common warts are rough and bumpy to touch and tend to spread to the face due to continually touching the face or due to nail-biting. Nail biting passes the virus to the skin near the mouth and warts begin to develop there.
• Foot Warts
  Foot warts are also called plantar warts because they grow on the plantar side or the bottom side of your feet. Plantar warts mostly occur on the soles and tend to grow closer to each other in small clumps or clusters. Most of them are flat or may grow inwards into the skin thereby causing a lot of pain. Sometimes they have tiny black dots embedded into their surface.
• Flat Warts
  Flat warts can appear at any part of the body. Children are prone to getting them on the face while men generally get them in the jaws and cheeks where the beard grows. Women often get these kinds of warts on their legs. These warts are flatter, smoother, and generally smaller than other kinds of warts. They make up in number for what they lack in size and tend to grow in large numbers. Their numbers may vary from anywhere between 20 to 100 or more warts at a time.
• Filiform Warts
  Filiform warts grow very quickly and are more common on the face around the mouth, eyes, and nose. They look like long threads or skinny fingers sticking out of the skin. As these warts tend to occur on the face and look unsightly, they are quite bothersome.
• Mosaic Warts
  Mosaic warts are flat, white, and extremely small. They usually occur under the toes or the balls of the feet. Though small, they may spread and cover large areas on the soles. They are different from plantar warts and do not cause pain while walking as they are flat.

The characteristic symptom of warts is the presence of small skin growths that may occur on different parts of the body. Warts may develop singly or may show up in groups or clumps that cover a wide area. Some warts may cause itching, tightness or a sense of pressure at the place where they are located. Some warts tend to have small black dots (also called seeds) within them. Warts are generally painless and do not cause any discomfort. Warts formed on the soles can cause pain while walking if they grow inwards.

Causes

Warts are a result of an infection caused by the human papillomaviruses (HPV), and there are more than 100 different kinds of HPV. They infect a person by entering the body through small breaks in the skin such as cuts and scratches. These viruses cause increased cell growth in the form of warts, and the outer skin of the wart turns thick and hard. Warts are more likely to occur when the skin is soft, moist, or injured. They spread from one person to another through direct skin contact or indirect contact through shared towels or razors.

Risk Factors

Warts can infect anyone, but certain groups of people are more prone to developing warts. These are:

• People with a weak or suppressed immune system due to an organ transplant, and diseases like cancer, or HIV-AIDS.
• Those who frequently use public washrooms or bathrooms, such as common showers shared by sportspersons and swimmers.
• People who are in close or daily contact with those having warts, such as family members or roommates.
• Children in crowded classrooms with other infected children.
• Those who have skin conditions such as eczema.

Warts can spread by touch from one person to another and other body parts of the same person. Certain precautions can help to prevent the spread of infection.

• Avoid touching warts. Constantly rubbing warts helps the HPV virus to move to new locations and/or infect other people.
• Avoid going barefoot in common changing rooms and shower rooms. If you do go barefoot, make sure you wash your feet properly and dry them thoroughly. Warts develop in moist, humid places.
• Do not share personal items such as towels, shoes, socks, razors and gloves.

Warts are diagnosed by a dermatologist on the basis of their appearance. On certain occasions, the dermatologist may perform a biopsy to confirm the diagnosis. A small sample of the wart will be taken and sent to the laboratory for analysis under a microscope.

Most warts do not require any treatment and tend to go away by themselves. Over a period of time, the body tends to make antibodies against them, and they disappear. However, at times this can take months or even years. Treatment is sought as warts tend to look unattractive and can severely damage one's self-esteem or if they are painful.

It is highly recommended to consult a dermatologist to examine your war to rule out the presence of any other underlying medical condition.

Home treatment

Different kinds of home remedies are available to treat warts. These include:

• Salicylic acid
  This is the most common home remedy for treating warts. Salicylic acid is available over the counter in most countries, and it is available in different concentrations. Most creams or gels have detailed instructions on how to apply them. It is advised that you follow the instructions carefully as salicylic acid can cause skin peeling and irritation.
  You may need to apply the medication several times during the day for several weeks before any improvement is noticed. Gently scraping to remove the top layer of the wart and cleaning the wart before applying medication helps to accelerate the effect of medicines. However, one needs to maintain high levels of cleanliness and hygiene to ensure that the virus does not spread to other parts of the skin. Salicylic acid works by irritating the skin with the hope that your immune system kicks into action and develops antibodies to destroy the virus. It is impossible to eradicate the virus directly.
• Duct tape
  Some doctors suggest the application of duct tape to the wart. The tape is peeled off after a few days. It is believed that peeling off layers of infected skin triggers the immune system to fight the virus.
  First, soak the wart in warm water to soften the skin, and then gently sand the wart with a disposable emery board. Apply a small piece of duct tape to the area. Keep changing the tape every 5 to 6 days, until the wart disappears.

It is essential to see a dermatologist right away if your warts increase in number, hurt or itch in any way or if you are unsure about the kind of growth on your skin.

Medical treatment

• Cryotherapy
  A dermatologist can conduct a procedure called cryotherapy in which the outer hard cells of the wart are destroyed by freezing it with liquid nitrogen and then allowing the skin to heal. The skin may turn red or swell due to the low temperature of liquid nitrogen. Repeated sessions may be required depending on the number and size of warts. Generally, a gap of 7 to 10 days is kept between sessions to allow the skin to heal. Your dermatologist may apply an anaesthetic cream before the treatment.
• Cantharidin
  Your dermatologist will treat the wart by painting or coating it with the medicine that will heal the wart. The dead wart is then removed after a week or so.
• Electrosurgery and curettage
  Electrosurgery involves burning the wart and is useful in common warts, filiform warts, and foot warts. Curettage involves cutting or scraping the wart with a sharp knife. Generally, both the procedures are performed together, and the wart may be first burnt and then scraped off or vice-versa.
• Cutting
  It involves cutting and removal of the wart from the surface of the skin.

Treatment of warts is effective, but it should be noted that warts might occur again, particularly if the virus is still present on the skin or if it infects again. Apart from your body developing antibodies against the virus that causes warts, there is no permanent treatment for them.

Prognosis

People with a healthy immune system eventually develop antibodies to the virus and warts disappear over time. The amount of time taken by warts to disappear can vary widely depending on the type of the wart and the general health of the person. People having a weak immune system find it difficult to get rid of warts.

Complications

Warts do not cause any significant complications apart from being unattractive to look at. It is essential to consult a dermatologist when you have warts because certain kinds of skin cancers tend to look like warts, though these are very rare.