Warts are growths of the skin caused by infection with Human Papillomavirus (HPV). More than 70 HPV subtypes are known.
Warts are particularly common in childhood and are spread by direct contact or autoinocculation. This means if a wart is scratched, the viral particles may spread to another area of skin. It may take months for the wart to first appear.
What do they look like?
Warts have a hard ‘warty’ or ‘verrucous’ surface. You can often see a tiny black dot in the middle of each scaly spot, due to a thrombosed capillary blood vessel. There are various types of viral wart.
- Common warts arise most often on the backs of fingers or toes, and on the knees.
- Plantar warts (verrucas) include one or more tender inwardly growing on the sole of the foot.
- Mosaic warts on the sole of the foot are in clusters over an area sometimes several centimetres in diameter.
- Plane, or flat, warts can be numerous and may be inoculated by shaving.
- Periungual warts prefer to grow at the sides or under the nails and can distort nail growth.
- Filiform warts are on a long stalk.
- Oral warts can affect the lips and even inside the cheeks. They include squamous cell papillomas.
- Genital warts are often transmitted sexually and predispose to cervical, penile and vulval cancer.
In some patients, even without treatment, few of the warts disappear but it is highly recommended to get them removed as soon as possible before they spread to other parts of body or to others who are in close contact with the patient.
Chemical treatment/ Topicals
Chemical treatment includes wart paints containing salicylic acid or similar compounds, which work by removing the dead surface skin cells. Podophyllin is a cytotoxic agent used in some products, and must not be used in pregnancy or in women considering pregnancy.
The paint is normally applied once daily. Perseverance is essential – although some warts will go with wart paints, it may take twelve weeks or even longer to work! Even if the wart doesn’t go completely, the wart paint usually makes it smaller and less uncomfortable.
First, the skin should be softened in a bath or bowl of hot soapy water. The hard skin should be rubbed away from the wart surface with a piece of pumice stone. The wart paint or gel should be applied accurately, allowing it to dry. It works better if covered with plaster or duct tape (particularly recommended when the wart is on the foot).
It is important to protect the surrounding skin with tapes or Vaseline. If the chemical makes the skin sore, stop treatment until the discomfort has settled, then recommence as above. Take care to keep the chemical off normal skin.
There are numerous treatments for warts and none offer a guarantee of cure. They are
- Fluorouracil cream
- Bleomycin injections
- Laser vaporisation or pulse dye laser destruction of feeding blood vessels
- Immune modulators such as imiquimod cream
What is the treatment of choice at DFA?
Electrosurgery (curettage & cautery) followed by 1064nm wavelength laser is the preferred treatment in our clinic. Under local anaesthetic, the growth is pared away and the base burned by diathermy or cautery. The wound heals in about two weeks. Recurrence rate is extremely low with this procedure.
Dr Abbasi uses long pulse Nd Yag laser with her specific technique to destroy any left over virus particles in the treated areas. This further reduces the chance of recurrence of viral warts.