WARTS

What are warts?

Warts are a harmless skin growth caused by infection with a type of virus. The virus enters cells within the skin and makes the skin thicken, causing the growth to appear. Warts are quite common and can be a persistent nuisance. They can occur in any area of skin on the body, though specific viral types tend to infect only specific body areas. Because of this factor, warts can be divided into different categories. Common warts usually occur on the hands, knees and face. Plantar warts appear only on the feet. Genital warts occur only on the genital and anal areas. Flat warts appear as numerous tiny flat bumps widely distributed over the legs, hands and face. Different subtypes of wart viruses cause all these different categories of warts.

How do people get warts?

Because viruses cause warts, they can be spread from person to person and to different body areas on the same person. The latter often occurs if the warts are picked or bitten. Some types of wart viruses are more contagious than others and there is considerable individual variation in resistance to infection by wart viruses. Some people seem quite susceptible to these viruses and get warts repeatedly. Other people never acquire a single wart, even with frequent direct contact with others who have warts.

What is the treatment for warts?

In most people, especially young children, the warts eventually go away by themselves once the body has developed immunity against the virus. The different folk remedies passed on depend on this spontaneous disappearance for their success. However, this can take from one to three years to occur and many people never seem to develop this natural immunity. Therefore, some form of treatment for warts is usually necessary.

Most treatments for warts depend on destruction of tissue containing the wart virus for their success. This always involves trade-offs in terms of discomfort of surgery and wound healing with risk of permanent scarring. In addition, all available destructive surgical methods, including laser, have significant failure rates since the wart virus can lay dormant inside normal appearing areas of skin and then activate following destructive surgery, causing recurrence of the wart in the same location. No single method is 100% effective, pain-free or risk-free.

For these reasons, warts are most often treated initially with a simple freezing technique. This involves some mild discomfort and wound healing afterwards, but has only a small risk of permanent scarring unlike cutting off the warts or burning them with cautery. However, repeat treatments are usually necessary, as the freezing spray cannot penetrate to the base of very thick or deep warts. For the immediate 1 or 2 weeks after freezing, the healing wounds should be treated with over-the-counter antibiotic ointments (Polysporin or Bacitracin) and covered with band-aides if necessary. After the area has healed, any remaining warts should be pared flat daily by sanding aggressively with a nail file or pumice stone or shaving away the surface callous with a blade or scissors. After paring the surface, the warts can then be treated at home with daily applications of mild acid solutions purchased at drug stores, such as Duofilm liquid, Compound W, Occlusal or Duoplant gel for plantar warts. You should then return to the office every 3 to 4 weeks for repeat freezings until the warts have cleared entirely. Do not wait months between freezings as this will allow the warts to thicken back up to their original size and the benefit of the earlier freezing treatments will be lost.

If repeated freezing is unsuccessful, other methods can be tried such as surgical excision, electrocautery or laser surgery, but these methods present greater risks with regards to wound healing and scarring. Different factors such as wart size, depth, location and number all influence the decision regarding which treatment approach is best. Unfortunately, no single method works in all cases and extensive numbers of warts require repeated treatments. Despite these limitations, most people do achieve success in ridding themselves of these stubborn growths if persistent with therapy.