wart

(wôrt)

1. 1. A hard rough lump growing on the skin, caused by infection with certain viruses and occurring typically on the hands or feet.
   2. A similar growth or protuberance, as on a plant.
2. A genital wart.
3. 1. One that resembles or is likened to a wart, especially in unattractiveness or smallness.
   2. An imperfection; a flaw.

warts and all Slang.

1. All defects and imperfections notwithstanding: They love each other, warts and all.

[Middle English, from Old English wearte.]

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For more information on wart, visit Britannica.com.

If the artist can flatter with the brush then Sir Peter Lely must have felt that his talents had been neglected when Oliver Cromwell asked him to ‘Paint my picture … pimples, warts and everything as you see me.’

Others, both before and after Cromwell, have been rather more concerned about their warts. Hippocratic physicians used the terms condyloma and myrmecia to describe the ‘knuckles’ or ‘anthills’ that were recognizable on the hands and feet of their patients from teenage onwards; whilst according to Galen, warts were composed of ‘heterogeneous and unnatural substances, pushed with violence toward the skin by dint of the internal faculties’. Celsus in his De Medicina described three sorts of wart according to their size, colour, and shape. This form of taxonomy was continued by David Low in his Chiropodologia (1785) with the division of warts or cutaneous fibrillae into round, flat, and pendulous types.

Low followed Galen in suggesting that warts were caused by ‘saline, gross and atrabilious humours’. Other authors focused on immorality as a possible cause for warts. Masturbation was also picked out, as the ‘Medical News’ section of the 1849 Lancet repeated the assertion that women with ‘solitary habits’ who gather hens' eggs are likely to catch warts.

Debates dealing with the taxonomy and causes of warts have been matched only by those dealing with cures. From classical times onwards, opinion has been divided over whether to use surgical techniques (cautery, ligature, or incision, or, in the present day, cryotherapy), or external remedies, or simply to leave the wart alone. The Swiss physician Paracelsus (1493-1541) urged practitioners not to employ their ‘unfounded arts’ of ‘caustics and cutting’, whilst in his Pseudodoxia Epidemica (1646) the English writer Thomas Browne (1605-82) attacked the superstition of ‘common female doctrines’ such as rubbing one's hands in the moonlight.

Browne's sentiment was in no way universal. His contemporary, Sir Kenelm Digby (1603-65), regarded ‘moon beames’ as an ‘infalliable cure’ for warts. Elizabethan and Stuart therapeutics relied heavily on Pliny's folklore-laden Natural History, with its suggestion that: ‘Warts can be removed by those who, after the twentieth of the month, lie on their backs on a path, gazing upward with their hand stretched over their heads, and rub the wart with whatever they have grasped.’

The line between learned and folk remedies for warts was blurred. The London Pharmacopoeia (1696) suggested that given the ‘hot and dry’ qualities of ants, a ‘liquor’ could be made which would ‘cure the itch, and dissipates corns and warts’, whilst David Low assured his readers that given ‘a person of knowledge and experience … a real Chiropodist … no mischief [can] flow from the application of a spider's web.’ A ‘wart-charming’ stone in the museum of the Royal College of General Practitioners is testimony to the durability of charms and magic in English medicine.

Until well into the eighteenth century, lay and learned medicine shared a belief in the curing of warts by sympathy or transmission. Moral considerations combined with long held customs and beliefs. Warts could be transferred by rubbing them against the father of an illegitimate child, whilst in Cheshire warts could be ‘bought’ by reciting the rhyme, ‘Ashen tree, ashen tree, Pray buy these warts of me’, and sticking a pin into the tree and then into one's warts.

‘Wortflower’ and ‘wortgrass’ were local names for buttercup and petty spurge, plants that were believed to cure warts. John Gerard (1545-1612) noted in his Herball (1626) that ‘wartwort … taketh awaie all maner of warts, knobs and hard callouses.’ The link between the symbolism and the cure of warts has a classical heritage, with the Romans using the term thymus to compare the appearance of genital warts to the leaves of the herb, thyme; whilst a popular cure was to kill, boil, and apply the residue from a toad with a comparable number of spots. Similar classifications continued as Linnaeus (1707-78) named the bush cricket Decticus verrucivorus after the reputed cure available from its bite.

Present day dermatology classifies over thirty different types of wart according to their structure, location, and relation to a particular virus from the papova group; a wart is a papilloma — benign tumour of the skin, or more rarely of a mucous membrane, caused by virus infection. Warts usually disappear spontaneously; a variety of treatments can hasten the disappearance, but recurrence is common.

— Alexander Goldbloom

See also skin.

A small, crocky feature that sticks out of an otherwise clean design. Something conspicuous for localized ugliness, especially a special-case exception to a general rule. For example, in some versions of csh(1), single quotes literalize every character inside them except !. In ANSI C, the ?? syntax used for obtaining ASCII characters in a foreign environment is a wart. See also miswart.

Definition

Warts are small, benign growths caused by a viral infection of the skin or mucous membrane. The virus infects the surface layer. The viruses that cause warts are members of the human papilloma virus (HPV) family. Warts are not cancerous, but some strains of HPV, usually not associated with warts, have been linked with cancer formation. Warts are contagious from person to person and from one area of the body to another on the same person.

Description

There are approximately 60 types of HPV that cause warts, each preferring a specific bodily location. For instance, some types of HPV cause warts to grow on the skin, others cause them to grow inside the mouth, while still others cause them to grow on the genital and rectal areas. However, most can be active anywhere on the body. The virus enters through the skin and produces new warts after an incubation period of one to eight months. Warts are usually skin-colored and feel rough to the touch, but they also can be dark, flat, and smooth.

Warts are passed from person to person, directly and indirectly. Some people are continually susceptible to warts, while others are more resistant to HPV and seldom get them. The virus takes hold more readily when the skin has been damaged in some way, which may explain why children who bite their nails tend to have warts located on their fingers. People who take a medication to suppress their immune system or are on long-term steroid use are also prone to a wart virus infection. This tendency is seen in people with AIDS.

Demographics

Particularly common among children, young adults, and women, warts are a problem for 7–10 percent of the population.

Causes and Symptoms

The more common types of warts include the following:

• common hand warts
• foot warts
• flat warts
• genital warts

Hand Warts

Common hand warts grow around the nails, on the fingers, and on the backs of hands. They appear more frequently where skin is broken, such as in areas where fingernails are bitten or hangnails are picked.

Foot Warts

Foot warts are called plantar warts because the word plantar is the medical term for the sole of the foot, the area where the wart usually appears as a single lesion or as a cluster. Plantar warts, however, do not stick up above the surface like common warts. The ball of the foot, the heel, and the plantar part of the toes are the most likely locations for the warts because the skin in those areas is subject to the most weight, pressure, and irritation, making a small break or crack more likely.

Plantar warts are familiar to all ages groups, appearing frequently in children between the ages of 12 and 16. Adolescents often come into contact with a wart virus in a locker room, swimming pool area, or by walking barefooted on dirty surfaces. The blood vessels feeding them are the black dots that are visible on the wart. If left untreated, these warts can grow to an inch or more in circumference and spread into clusters of several warts. They are known to be very painful at times, the pain usually compared to the feeling of a permanent stone in the shoe particularly if the wart is on a pressure point of the foot. People with diabetes mellitus are prone to complications from plantar warts related to the development of sores or ulceration and the poor healing potential associated with diabetes.

Flat Warts

Flat warts tend to grow in great numbers and are smaller and smoother than other warts. They can erupt anywhere, appearing more frequently on the legs of women, the faces of children, and on the areas of the face that are shaved by young adult males.

Genital Warts

Genital warts, also called condyloma acuminata or venereal warts, are one of the most common forms of sexually transmitted disease (STD) in this country. Most experts contend that they are contracted by sexual contact with an infected person who carries HPV and are more contagious than other warts. It is estimated that two-thirds of the people who have sexual contact with a partner with genital warts will develop the disease within three months of contact. As a result, about 1 million new cases of genital warts are diagnosed in the United States each year.

Genital warts tend to be small flat bumps but they may be thin and tall. They are usually soft and not scaly like other warts. In women, genital warts appear on the genitalia, within the vagina, on the cervix, and around the anus or within the rectum. In men, genital warts usually appear on the tip of the penis but may also be found on the scrotum or around the anus. Genital warts can also develop in the mouth of a person who has had oral sexual contact with an infected person.

When to Call the Doctor

Individuals who notice warts in their genital area should see a doctor. A physician should be consulted for warts that bleed, are particularly painful, or that do not disappear after six to nine months.

Diagnosis

A physician may be able to diagnose warts with a simple examination. If the warts are small, the doctor may put a vinegar-like liquid on the skin, which makes the warts turn white and easier to see, and then use a magnifying glass to look for them.

Treatment

Most people attempt to treat warts themselves. Professional treatment is usually sought after self-treatment has been unsuccessful.

Home/Self Treatment

Many of the nonprescription wart remedies available at drug stores will remove simple warts from hands and fingers. These medications may be lotions, ointments, or plasters and work by chemically removing the skin that was affected by the wart virus. The chemicals are strong, however, and should be used with care since they can remove healthy as well as infected skin. These solutions should be avoided by diabetics and those with cardiovascular or other circulatory disorders whose skin may be insensitive and not appreciate irritation.

Flat warts are best treated with topical retinoides (retinoic acid) or a gel containing salicylic acid. The acid does not actually kill the wart virus, but waterlogs the skin so that the surface layer, with the virus, peels off. These products can take up to three months of treatment depending on the size and depth of the wart. Patches are also good to use. Rather than applying drops, a small pad is placed on the wart and left for 48 hours and then replaced with a new one. The patch usually contains a higher concentration of salicylic acid and may irritate the surrounding skin. If this occurs, people should switch to a gel or stop medication for a period. To help the healing process for flat facial warts, men should shave with an electric shaver or temporarily grow a beard. Women with flat warts on areas that are shaved should use other methods to remove hair such as depilatory cream or wax.

Professional Treatment

Physicians should be consulted if there are no signs of progress after a month of self treatment. Doctors have many ways of removing warts, including using stronger topically applied chemicals than those available in pharmacies. Some of these solutions include podofilox, topical podophyllum, and trichloracetic acid (TCA). Some burning and discomfort for one or more days following treatment can be expected. Although these chemicals are effective, they may not completely destroy all warts. A second method of removal is freezing or cryosurgery on the wart using liquid nitrogen. Cryotherapy is relatively inexpensive, does not require anesthesia, and usually does not result in scarring. Although temporarily uncomfortable, it provides an effective and safe way to deliver freezing temperatures to a particular area on the skin, and healing is usually quick. Physicians may also choose to burn the wart with liquid nitrogen or numb the skin and then scrape off the wart. Another removal process is electrocautery (electric burning), destroying the wart by burning it with an electric needle. Laser surgery is also an option for removing warts.

Genital warts are the most difficult to treat. They can be removed, but the viral infection itself cannot be cured. Often, because the warts are so small, more than one treatment may be needed. The virus continues to live in the deeper skin, which is why warts often return after they have been removed. Strong chemicals may be applied as well as surgical excision with or without electrocautery. This therapy requires a small operative procedure and a local anesthetic. Laser therapy, although more expensive, is often used for treating venereal warts that are more extensive. The use of lasers, which vaporize the lesion, can theoretically transmit the HPV. It is not at all clear, however, if this occurs.

There is no single recommended method for eliminating plantar warts. If detected early, cryotherapy is usually enough. However, they can be very resilient, requiring repeated treatment over several months. Treatment ranges from the conservative approach of applying chemical solutions to the more aggressive option of surgery. Persons with diabetes or vascular disease are usually treated with the more conservative methods.

Alternative Treatment

There are a variety of alternative approaches to the treatment of warts. The following suggestions apply to common warts and plantar warts. They are not recommended for genital or cervical warts. Since genital and cervical warts are transmitted sexually, they should be treated by a physician.

For the treatment of common or plantar warts, practitioners may recommend the following remedies:

• Apply a paste made of vitamin C powder to the wart for one to two weeks.
• Place a crushed or sliced garlic clove over the wart for seven consecutive nights while sleeping.
• Soak the wart in water, put cross-hatches over it with a sterile needle, and apply drops of thuja (Thuja occidentalis) tincture onto the wart. Repeat the crosshatching and tincture application until the wart is saturated with the tincture. Repeat several times each day for one to two weeks. (A tincture is an herbal extract made with alcohol.)
• Tape a piece of banana peel, smooth side down, over the wart and leave it on overnight. Repeat nightly for one to two weeks.

Prognosis

Even though genital warts may be removed, the virus itself continues to live. The HPV can cause tissue changes in the cervix of women with cervical infection. The general recommendation for women who have a history of genital warts is to see their doctors every six months for Pap smears to monitor any changes that may occur.

For plantar warts, the treatment goal is to destroy the wart and its virus without causing much damage to healthy skin. It is not unusual for treatment to cause pain until the foot heals because of the weight put on the foot.

Prevention

Plantar warts can be prevented by wearing shoes, changing shoes daily, keeping feet clean and dry, and not ignoring skin growths and changes in the skin. Genital warts can be prevented by using condoms and avoiding unprotected sex. Barrier protection will not, however, prevent the spread of wart-causing HPV to uncovered areas such as the pubis and upper thighs.

Nutritional Concerns

Because warts are caused by a virus, general immune system support can be effective in helping to keep warts from coming back after treatment or to keep them from multiplying or growing. Eating a well balanced diet high in sources of vitamins A, C, and E can help strengthen the immune system. Avoiding stress, which is believed to compromise the immune system, may also be helpful.

Parental Concerns

Parents can help to prevent plantar warts by urging their children to wear shoes, change their shoes daily, and keep their feet clean and dry. Parents should also pay attention to growths and other changes in their child's skin. Instructing children in condom usage is a personal, parental decision. However, parents should tell their children that genital warts can be prevented by using condoms and avoiding unprotected sex. Barrier protection will not, however, prevent the spread of wart-causing HPV to uncovered areas such as the pubis and upper thighs.

Resources

Books

Darmstadt, Gary L., and Sidbury, Robert. "Diseases of the Epidermis." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman, et al. Philadelphia: Saunders, 2003, pp. 2195-9.

Genital Warts: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: ICON Health Publications, 2003.

Plantar Warts: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: ICON Health Publications, 2003.

Royston, Angela. Warts. London: Heinemann, 2001.

Swerlick, Robert A., and Lawley, Thomas J. "Eczema, Psoriasis, Cutaneous Infections, Acne, and Other Common Skin Disorders." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald, et al. New York: McGraw-Hill, 2001, pp. 309–14.

Warts: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: ICON Health Publications, 2003.

Periodicals

Bellew, S. G., et al. "Childhood warts: an update." Cutis 73 (2004): 379–84.

Clemons, R. J., et al. "Comparing therapy costs for physician treatment of warts." Journal of Drugs in Dermatology 2 (2004): 649–54.

Laube, S. "Skin infections and ageing." Ageing Research Reviews 3 (2004): 69–89.

Silverberg, N. B. "Human papillomavirus infections in children." Current Opinions in Pediatrics 16 (2004): 402–9.

Tucker, S. B., et al. "Plantar wart treatment with combination imiquimod and salicylic acid pads." Journal of Drugs in Dermatology 2 (2003): 124–6.

Organizations

American Academy of Dermatology. 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 60168–4014. Web site: www.aad.org/.

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211–2672. Web site: www.aafp.org/.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. Web site: www.aap.org/default.htm.

American Association of Naturopathic Physicians. 8201 Greensboro Drive, Suite 300, McLean, VA 22102. Web site: .

American College of Physicians. 190 N Independence Mall West, Philadelphia, PA 19106–1572. Web site: www.acponline.org/.

American Podiatric Medical Association. 9312 Old Georgetown Road Bethesda, MD 20814–1698. Web site: www.apma.org/.

Web Sites

"Human Papillomavirus and Genital Warts." National Institute of Allergy and Infectious Disease, July 2004. Available online at www.niaid.nih.gov/factsheets/stdhpv.htm (accessed December 4, 2005).

"Warts." American Academy of Family Physicians. Available online at (accessed December 4, 2005).

"Warts." National Library of Medicine. Available online at www.nlm.nih.gov/medlineplus/warts.html (accessed December 4, 2005).

"Warts." University of Illinois. Available online at www.mckinley.uiuc.edu/health-info/dis-cond/warts/warts.html (accessed December 4, 2005).

"What are plantar warts?" American Podiatric Medical Association. Available online at www.apma.org/topics/Warts.htm (accessed December 4, 2005).

[Article by: L. Fleming Fallon, Jr., MD, DrPH]

There are more folk cures for warts than for any other ailment, featured in virtually every regional collection. Some simply advise rubbing them with a specified plant product, for example the inner skin of broad-bean pods, sliced potato, the juice of dandelion, spurge, or greater celandine. If the wart is a large, fleshy one, it can be starved of blood by tying a thread or hair tightly round the base, and will soon shrivel and drop off. But very often magical actions are prescribed; the warts are touched with some object(s) such as pebbles, pins, or knotted cord, or identified with them by counting, after which the object(s) is/are thrown away or buried. Such methods have been recommended since the Middle Ages; recently recorded examples include: ‘Rub wart with raw meat and bury meat afterwards’ (‘at a crossroads at midnight’, according to some); ‘Tie as many knots as there are warts in a piece of string, throw away the string’; ‘Count warts, take the same number of buds from an alder bush, bury them’. Some older sources suggest rubbing the wart with a snail or slug, which is then impaled on a thorn bush and left to die.

The underlying assumption is that the fate of the object(s) determines that of the warts: as it rots or is lost, so will the warts be; as the snail dies, so does the wart. Sometimes, it is thought they will be transferred to someone else; in 1807 Robert Southey wrote:

Stealing dry peas or beans, and wrapping them up, one for each wart, he carries the parcel to a place where four roads meet, and tosses it over his head, not looking behind to see where it falls; he will lose the warts, and whoever picks it up will find them. (Letters from England, no. 50)

Wait till you see a funeral then stroke the wart in the direction in which the funeral is going, saying at the same time: ‘Corpse, corpse, take my wart with you’….[I]t never fails, but again secrecy is important, for no one must see or hear what you are doing. (N&Q 11s:3 (1911), 446)

Ashy tree, ashy tree,
Pray buy these warts off me,

One, two, three,
Warts go away from me,
One, two, three, four,
Never come back no more.

Bibliography
The full bibliography list is available here.

• For samples of cures, see Opie and Tatem, 1989: 422-4
• Roud, 2003: 489-502.
• Susan Drury, Folklore 102 (1991), 97-100.
• For material from the 1960s and 1990s, see Gabrielle Hatfield, Warts: Summary of the Wart-Cure Survey for the Folklore Society (1998)

A raised, brownish area of skin caused by a virus infection.

Small skin lesions on face, fingers, or elbows, and sometimes on the genitals, caused by a virus, as distinct from moles, which are birthmarks. The general medical term for a wart is verruca, but warts on the genitals or around the anus are known as condylomae, or venereal warts.

Warts often appear and disappear without any obvious cause, and this characteristic tended to reinforce belief in many old folk cures or wart-charming. In eastern Massachusetts, central New York, and parts of England, it used to be believed that warts could be removed by rubbing them with spittle. Other widespread superstitions about warts:

To cure warts, wash hands in the moon's rays in a dry metal basin, saying:

I wash my hands in this thy dish,
O man in the moon, do grant my wish
And come and take away this!

Water taken from a gravestone and rubbed on warts will cure them.

Striking warts with an undertaker's hammer will cure them.

To remove warts from the hand, watch for a funeral procession to pass and as it goes by, say secretly: "I do sincerely hope that these warts will pass off my hands as that body decays in the ground."

If a person steals an egg and secretly buries it in the ground, his or her warts will disappear when the egg decays.

Pick up an old marrow bone, touch it to your warts, walk off, throw it behind you, and don't look back.

If you take as many pins as you have warts and give them to someone else, your warts will be transferred to the other person.

Take as many pebbles as you have warts and touch each wart with a pebble, then wrap the stones in cloth or paper and throw them away in the roadway. Whoever picks up the parcel of pebbles will get your warts, and you will lose them.

Take a piece of string and tie as many knots in it as there are warts and lay the string under a stone. Whoever treads on the stone will be attached to the warts.

Such superstitions are often very ancient. Pliny (23-79 C.E.) recommended that warts be touched with chick peas on the first day of the moon, and that the peas then be wrapped in cloth and thrown away behind you. The pebble charm was known to Marcellus of Bordeaux in the fourth century, and it is cited in his book De Mendicamentis.

Apart from natural remission, it is possible that many wart cures worked through a process analagous to selfhypnosis. Other wart remedies were of a pseudomedical nature, such as rubbing warts with milkweed, or the fluid from grasshoppers, or the fresh blood of mice. Modern medical remedies involve treating warts with a substance that dissolves the hard layer and cauterizes the remainder, which is then scraped off.

During the witchcraft manias of the sixteenth and seventeenth centuries, warts and moles were considered "devil's marks" if they did not bleed when pricked.

Wart. Called also verruca.

A benign, viral, warty skin lesion with a rough, papillomatous surface. It is caused by a common contagious papovavirus.

• Afflictions and Conditions - wart: small, hard, benign growth in skin, caused by virus; verucca
• Appearance or Style

For the Nintendo character, see Wart (Nintendo). For toad warts, see parotoid gland.

Warts
Classification and external resources
Warts on the big toe
ICD-10	B07
ICD-9	078.1
DiseasesDB	28410
MedlinePlus	000885
eMedicine	emerg/641
MeSH	D014860

A filiform wart on the eyelid.

A wart is generally a small, rough growth, typically on a human’s hands or feet but often other locations, that can resemble a cauliflower or a solid blister. They are caused by a viral infection, specifically by one of the many types of human papillomavirus. There are as many as 10 varieties of warts, the most common considered to be mostly harmless. It is possible to get warts from others; they are contagious and usually enter the body in an area of broken skin.^[1] They typically disappear after a few months but can last for years and can recur.^[2]

Contents 1 Types 2 Cause 3 Pathophysiology 4 Prevention 5 Treatment 5.1 Medication 5.2 Procedures 6 Folk remedies 7 In other animals 8 References 9 External links

Types

A range of types of wart have been identified, varying in shape and site affected, as well as the type of human papillomavirus involved.^[3][4] 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;

Cause

Micrograph of a common wart (verruca vulgaris) showing the characteristic features (hyperkeratosis, acanthosis, hypergranulosis, rete ridge elongation, and large blood vessels at the dermoepidermal junction. H&E stain.

Main article: Human papilloma virus

Warts are caused by the human papilloma virus (HPV). There are about 130 known types of human papilloma viruses.^[5] 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. Many of the more common HPV and wart types are as follows:

• Common warts - HPV types 2 and 4 (most common); also types 1, 3, 26, 29, and 57 and others.
• Cancers and Genital dysplasia - "high-risk" HPV types are associated with cancers, (cervical cancer and can also cause some vulvar, vaginal,^[6] penile, anal^[7] and some oropharyngeal cancers. "low-risk" types are associated with warts or other conditions.^[8][9])

• High-risk: 16, 18 (cause the most cervical cancer); also 58, 33, 45, 31, 52, 35, 39, 59, and others.

• Plantar warts (myrmecia) - HPV type 1 (most common); also types 2, 3, 4, 27, 28, and 58 and others.
• Anogenital warts (condylomata acuminata or venereal warts) - HPV types 6 and 11 (most common); also types 42, 44 and others.^[10]

• Low-risk: 6, 11 (most common); also 13, 44, 40, 43, 42, 54, 61, 72, 81, 89, and others.

• Flat warts - HPV types 3, 10, and 28.
• Butcher's warts - HPV type 7.
• Heck's disease (Focal epithelial hyperplasia) - HPV types 13 and 32.

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.

Prevention

Gardasil is a HPV vaccine aimed at preventing cervical cancers and genital warts. Gardasil is designed to prevent infection with HPV types 16, 18, 6, and 11. HPV types 16 and 18 currently cause about 70% of cervical cancer cases,^[8][9] and also cause some vulvar, vaginal,^[6] penile and anal cancers.^[7] HPV types 6 and 11 are responsible for 90% of documented cases of genital warts.^[11] Unfortunately the HPV vaccines do not currently prevent the virus strain responsible for verrucas (plantar warts).

Treatment

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.^[12] The reviewers also concluded that there was little evidence of a significant benefit of cryotherapy over salicylic acid or duct tape.^[12]

One complicating factor in the treatment of warts is that the wart may regrow after it has been removed.

Medication

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.

Treatments that may be prescribed by a medical professional include

• Application of podophyllum resin paint [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)]
• 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.^[13] 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.^[14][15]
• 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 a known mutagen, able to cause genetic mutations. So a physician must administer DNCB. This drug induces an allergic immune response resulting in inflammation that wards off the wart-causing virus.^[16]
• 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.^[17]
• Salicylic acid can be prescribed by a dermatologist in a higher concentration than that found in over-the-counter products. Examples include a topical solution marketed by Elorac, Inc. under the trade name Durasal.

There are several over-the-counter options. The most common ones involve salicylic acid. These products are readily available at drugstores 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^{[citation needed]}.

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.^[18] 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,^[19][20][21]. 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^[19]. Other trials have found that topical zinc sulfate solution^[22] or zinc oxide^[23] 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.^[24]
• Electrodesiccation^[25]
• Cryosurgery, which involves freezing the wart (generally with liquid nitrogen), creating a blister between the wart and epidermal layer, after which the wart and surrounding dead skin falls off by itself. An average of 3 to 4 treatments are required for warts of thin skin. Warts on calloused skin like plantar warts might take dozens or more treatments.^[14]
• 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.^[14]
• 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.^[26]
• 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.^[27][28] Thus it is not recommended as routine treatment.^[29]

Folk remedies

A variety of traditional folk remedies and rituals claim to be able to remove warts. In The Adventures of Tom Sawyer, Mark Twain has his characters discuss a variety of such remedies. Tom Sawyer proposes "spunk-water" (or "stump-water", the water collecting in the hollow of a tree stump) as a remedy for warts on the hand. You put your hand into the water at midnight and say:

Barley-corn, barley-corn, injun-meal shorts,

Spunk-water, spunk-water, swaller these warts

and then "walk away quick, eleven steps, with your eyes shut, and then turn around three times and walk home without speaking to anybody. Because if you speak the charm's busted." This is held to be superior to Huckleberry Finn's preferred remedy which involved throwing a dead cat into a graveyard. Another remedy involves splitting a bean, drawing blood from the wart and putting it on one of the halves, and burying that half at a crossroads at midnight. The theory of operation is that the blood on the buried bean will draw away the wart.^[30] Mark Twain has been recognized as an early collector and recorder of genuine American folklore.^[31]

Similar practices are recorded elsewhere. In Louisiana, one remedy for warts involves rubbing the wart with a potato, which is then buried; when the "buried potato dries up, the wart will be cured".^[32] Another remedy similar to Twain's is reported from Northern Ireland, where water from a specific well on Rathlin Island is credited with the power to cure warts.^[33]

In other animals

See also: Papillomavirus and Bovine papillomavirus

References

1. ^ http://www.webmd.com/skin-problems-and-treatments/tc/warts-and-plantar-warts-topic-overview
2. ^ medline plus warts National institutes of Health.
3. ^ Mosby's Medical, Nursing, & Allied Health Dictionary (5th edn), Anderson KN, Anderson LE, Glanze WD, eds, Mosby
4. ^ "MedlinePlus: Warts". 2010. http://www.webmd.com/skin-problems-and-treatments/tc/warts-and-plantar-warts-topic-overview. 
5. ^ de Villiers EM, Fauquet C, Broker TR, Bernard HU, zur Hausen H (Jun 2004). "Classification of papillomaviruses". Virology 324 (1): 17–27. doi:10.1016/j.virol.2004.03.033. PMID 15183049. 
6. ^ ^{a b} "FDA Approves Expanded Uses for Gardasil to Include Preventing Certain Vulvar and Vaginal Cancers". 2008-09-12. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116945.htm. Retrieved 2009-08-04. 
7. ^ ^{a b} Cortez, Michelle Fay and Pettypiece, Shannon. "Merck Cancer Shot Cuts Genital Warts, Lesions in Men". Bloomberg News. (Bloomberg.com) 13 Nov 2008.
8. ^ ^{a b} Lowy DR, Schiller JT (2006). "Prophylactic human papillomavirus vaccines". J. Clin. Invest. 116 (5): 1167–73. doi:10.1172/JCI28607. PMC 1451224. PMID 16670757. http://www.jci.org/articles/view/JCI28607. Retrieved 2007-12-01. 
9. ^ ^{a b} Muñoz N, Bosch FX, Castellsagué X, Díaz M, de Sanjose S, Hammouda D, Shah KV, Meijer CJ (2004-08-20). "Against which human papillomavirus types shall we vaccinate and screen? The international perspective". Int J Cancer 111 (2): 278–85. doi:10.1002/ijc.20244. PMID 15197783. 
10. ^ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Mitchell, Richard (2007). "Chapter 19 The Female Genital System and Breast". Robbins Basic Pathology (8 ed.). Philadelphia: Saunders. ISBN 1-4160-2973-7. 
11. ^ Steinbrook, Robert (March 16, 2006). "Perspective - The Potential of Human Papillomavirus Vaccines". http://content.nejm.org/cgi/content/full/354/11/1109. 
12. ^ ^{a b} Gibbs S, Harvey I, Sterling JC, Stark R (2003). Gibbs, Sam. ed. "Local treatments for cutaneous warts". Cochrane Database Syst Rev (3): CD001781. doi:10.1002/14651858.CD001781. PMID 12917913. 
13. ^ "Medscape Imiquimod article". http://www.medscape.org/viewarticle/740315. Retrieved 10 August 2011. 
14. ^ ^{a b c} Aafp.org
15. ^ Champion, R.H., et al. Rook's Textbook of Dermatology. Blackwell Science. 1998. p. 1044
16. ^ Health.harvard.edu
17. ^ Podiatrytoday.com
18. ^ [1] Sterling, J. C.; Handfield-Jones, S.; Hudson, P. M.; British Association of Dermatologists (2001). "Guidelines for the management of cutaneous warts". British Journal of Dermatology 144 (1): 4–11. doi:10.1046/j.1365-2133.2001.04066.x. PMID 11167676.  edit
19. ^ ^{a b} Stefani M, Bottino G, Fontenelle E, Azulay DR (2009). "Efficacy comparison between cimetidine and zinc sulphate in the treatment of multiple and recalcitrant warts". An Bras Dermatol 84 (1): 23–9. PMID 19377755. http://www.scielo.br/scielo.php?pid=S0365-05962009000100003&script=sci_arttext&tlng=en. 
20. ^ Yaghoobi R, Sadighha A, Baktash D (April 2009). "Evaluation of oral zinc sulfate effect on recalcitrant multiple viral warts: a randomized placebo-controlled clinical trial". J. Am. Acad. Dermatol. 60 (4): 706–8. doi:10.1016/j.jaad.2008.09.010. PMID 19293025. http://www.eblue.org/article/S0190-9622%2808%2901148-1/fulltext. 
21. ^ Al-Gurairi FT, Al-Waiz M, Sharquie KE (March 2002). "Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebo-controlled clinical trial". Br. J. Dermatol. 146 (3): 423–31. doi:10.1046/j.1365-2133.2002.04617.x. PMID 11952542. 
22. ^ Sharquie KE, Khorsheed AA, Al-Nuaimy AA (September 2007). "Topical zinc sulphate solution for treatment of viral warts". Saudi Med J 28 (9): 1418–21. PMID 17768472. 
23. ^ Khattar JA, Musharrafieh UM, Tamim H, Hamadeh GN (April 2007). "Topical zinc oxide vs. salicylic acid-lactic acid combination in the treatment of warts". Int. J. Dermatol. 46 (4): 427–30. doi:10.1111/j.1365-4632.2006.03138.x. PMID 17442091. 
24. ^ Warts at About.com
25. ^ Pubmedcentral.nih.gov
26. ^ Halazs C. L. G., Treatment of common warts using the infrared coagulator. The Journal of dermatologic surgery and oncology ISSN 0148-0812. 1994, vol. 20, no4, pp. 252-256 (21 ref.)
27. ^ Wenner, R; Askari, SK, Cham, PM, Kedrowski, DA, Liu, A, Warshaw, EM (2007 Mar). "Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial". Archives of dermatology 143 (3): 309–13. doi:10.1001/archderm.143.3.309. PMID 17372095. 
28. ^ Ringold, S; Mendoza, JA, Tarini, BA, Sox, C (2002 Oct). "Is duct tape occlusion therapy as effective as cryotherapy for the treatment of the common wart?". Archives of pediatrics & adolescent medicine 156 (10): 975–7. PMID 12361441. 
29. ^ Stubbings, A; Wacogne, I (2011 Sep). "Question 3. What is the efficacy of duct tape as a treatment for verruca vulgaris?". Archives of disease in childhood 96 (9): 897–9. doi:10.1136/archdischild-2011-300533. PMID 21836182. 
30. ^ Mark Twain, The Adventures of Tom Sawyer, ch. 6
31. ^ J. R. LeMaster, The Mark Twain Encyclopedia (Taylor and Francis, 1993; ISBN 082407212X), pp. 293-294
32. ^ Julie Yvonne Webb, "Louisiana Voodoo and Superstitions Relating to Health", HSMHA Health Reports, April 1971, vol. 86, no. 4, pp. 291, 296-297
33. ^ Linda-May Ballard, "An Approach to Traditional Cures in Ulster", Ulster Med J. 2009 January; 78(1): 26–33.

External links

Look up wart in Wiktionary, the free dictionary.

• Wart photo library, Dermnet

v d e Diseases of the skin and appendages by morphology Growths Epidermal wart callus seborrheic keratosis acrochordon molluscum contagiosum actinic keratosis squamous cell carcinoma basal cell carcinoma merkel cell carcinoma nevus sebaceous trichoepithelioma Pigmented Freckles lentigo melasma nevus melanoma Dermal and subcutaneous epidermal inclusion cyst hemangioma dermatofibroma keloid lipoma neurofibroma xanthoma Kaposi's sarcoma infantile digital fibromatosis granular cell tumor leiomyoma lymphangioma circumscriptum myxoid cyst Rashes With epidermal involvement Eczematous contact dermatitis atopic dermatitis seborrheic dermatitis stasis dermatitis lichen simplex chronicus Darier's disease glucagonoma syndrome langerhans cell histiocytosis lichen sclerosus pemphigus foliaceus Wiskott-Aldrich syndrome Zinc deficiency Scaling psoriasis tinea (corporis cruris pedis manuum faciei) pityriasis rosea secondary syphillis mycosis fungoides systemic lupus erythematosus pityriasis rubra pilaris parapsoriasis ichthyosis Blistering herpes simplex herpes zoster varicella bullous impetigo acute contact dermatitis pemphigus vulgaris bullous pemphigoid dermatitis herpetiformis porphyria cutanea tarda epidermolysis bullosa simplex Papular scabies insect bite reactions lichen planus miliaria keratosis pilaris lichen spinulosus transient acantholytic dermatosis lichen nitidus pityriasis lichenoides et varioliformis acuta Pustular acne vulgaris acne rosacea folliculitis impetigo candidiasis gonococcemia dermatophyte coccidioidomycosis subcorneal pustular dermatosis Hypopigmented tinea versicolor vitiligo pityriasis alba postinflammatory hyperpigmentation tuberous sclerosis idiopathic guttate hypomelanosis leprosy hypopigmented mycosis fungoides Without epidermal involvement Red Blanchable Erythema Generalized drug eruptions viral exanthems toxic erythema systemic lupus erythematosus Localized cellulitis abscess boil erythema nodosum carcinoid syndrome fixed drug eruption Specialized urticaria erythema (multiforme migrans gyratum repens annulare centrifugum ab igne) Nonblanchable Purpura Macular thrombocytopenic purpura actinic purpura Papular disseminated intravascular coagulation vasculitis Indurated scleroderma/morphea granuloma annulare lichen sclerosis et atrophicus necrobiosis lipoidica Miscellaneous disorders Ulcers Hair telogen effluvium androgenic alopecia trichotillomania alopecia areata systemic lupus erythematosus tinea capitis loose anagen syndrome lichen planopilaris folliculitis decalvans acne keloidalis nuchae Nail onychomycosis psoriasis paronychia ingrown nail Mucous membrane aphthous stomatitis oral candidiasis lichen planus leukoplakia pemphigus vulgaris mucous membrane pemphigoid cicatricial pemphigoid herpesvirus coxsackievirus syphilis systemic histoplasmosis squamous cell carcinoma

v d e Infectious skin disease: Viral cutaneous conditions, including viral exanthema (B00–B09, 050–059) DNA virus Herpesviridae Alpha HSV (Herpes simplex, Herpetic whitlow, Herpes gladiatorum, Herpetic keratoconjunctivitis, Herpetic sycosis, Neonatal herpes simplex, Herpes genitalis, Herpes labialis, Eczema herpeticum, Herpetiform esophagitis) · Herpes B virus (B virus infection) VZV (Chickenpox, Herpes zoster, Herpes zoster oticus, Ophthalmic zoster, Disseminated herpes zoster, Zoster-associated pain, Inflammatory skin lesions following zoster infection, Modified varicella-like syndrome) Beta Human herpesvirus 6/Roseolovirus (Exanthema subitum, Roseola vaccinia) Cytomegalic inclusion disease Gamma KSHV (Kaposi's sarcoma) Poxviridae Ortho Variola (Smallpox, Eczema vaccinatum, Alastrim) · MoxV (Monkeypox) · CV (Cowpox) · VV (Vaccinia, Generalized vaccinia, Progressive vaccinia) Buffalopox Para Farmyard pox: Milker's nodule · Bovine papular stomatitis · Pseudocowpox · Orf Sealpox Other Yatapoxvirus: Tanapox · Yaba monkey tumor virus MCV (Molluscum contagiosum) Papillomaviridae HPV (Wart/Plantar wart, Heck's disease, Genital wart (giant), Laryngeal papillomatosis, Butcher's wart, Bowenoid papulosis, Epidermodysplasia verruciformis, Verruca plana, Pigmented wart, Verrucae palmares et plantares ) BPV (Equine sarcoid) Parvoviridae Parvovirus B19 (Erythema infectiosum, Reticulocytopenia, Papular purpuric gloves and socks syndrome) RNA virus Paramyxoviridae MeV (Measles) Togaviridae Rubella virus (Rubella, Congenital rubella syndrome) · Alphavirus infection · Chikungunya fever Picornaviridae CAV (Hand, foot and mouth disease, Herpangina) · FMDV (Foot-and-mouth disease) · Boston exanthem disease Ungrouped unknown/multiple: Asymmetric periflexural exanthem of childhood · Post-vaccination follicular eruption · Lipschütz ulcer · Eruptive pseudoangiomatosis · Viral-associated trichodysplasia · Gianotti–Crosti syndrome M: VIR virs(prot)/clss cutn/syst (hppv/hiva, infl/zost/zoon)/epon drugJ(dnaa, rnaa, rtva, vacc) M: INT, SF, LCT anat/phys/devp noco(i/b/d/q/u/r/p/m/k/v/f)/cong/tumr(n/e/d), sysi/epon proc, drug (D2/3/4/5/8/11)

v d e Papillomavirus – Human papillomavirus Related diseases Cervical cancer · Factor in other cancers (Anal, Vaginal, Vulvar, Penile, Head and neck cancer (HPV-positive oropharyngeal cancer)) · Warts (genital, plantar, flat, Laryngeal papillomatosis), Epidermodysplasia verruciformis, Focal epithelial hyperplasia, Papilloma Vaccine HPV vaccine (Cervarix, Gardasil) Screening Pap test (stain) - Cytopathology/Cytotechnology results Bethesda System Experimental techniques (Speculoscopy, Cervicography) Colposcopy Biopsy histology Cervical intraepithelial neoplasia (CIN) · Koilocyte · Vaginal intraepithelial neoplasia (VAIN) · Vulvar intraepithelial neoplasia (VIN) Treatment Cervical conization · Loop electrical excision procedure (LEEP) History Georgios Papanikolaou · Harald zur Hausen M: VIR virs(prot)/clss cutn/syst (hppv/hiva, infl/zost/zoon)/epon drugJ(dnaa, rnaa, rtva, vacc)

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Dansk (Danish)
n. - vorte

idioms:

• warts and all    en nøgtern beskrivelse af en person

Nederlands (Dutch)
wrat

Français (French)
n. - verrue, excroissance

idioms:

• warts and all    (décrire qn) avec tous ses défauts

Deutsch (German)
n. - Warze

idioms:

• warts and all    ungeschminkt (bis ins kleinste Detail), mit allen Fehlern

Ελληνική (Greek)
n. - κρεατοελιά

idioms:

• warts and all    με όλα τα κουσούρια, ατελής, ελαττωματικός

Italiano (Italian)
porro, verruca, condiloma

idioms:

• warts and all    nel bene e nel male

Português (Portuguese)
n. - verruga (f), papila (f) (Bot.)

idioms:

• warts and all    com todos os defeitos

Русский (Russian)
бородавка, нарост (на дереве), "прыщ" (о человеке), несовершенство

idioms:

• warts and all    изображать без прикрас

Español (Spanish)
n. - verruga

idioms:

• warts and all    con todos sus defectos

Svenska (Swedish)
n. - vårta

中文（简体）(Chinese (Simplified))
疣, 瑕疵, 瘤

idioms:

• warts and all    不掩盖地, 据实地

中文（繁體）(Chinese (Traditional))
n. - 疣, 瑕疵, 瘤

idioms:

• warts and all    不掩蓋地, 據實地

한국어 (Korean)
n. - 사마귀, (나무 줄기의) 혹, 옹두

日本語 (Japanese)
n. - いぼ, こぶ

idioms:

• warts and all    ありのままに

العربيه (Arabic)
‏(الاسم) ثؤلول, بثر صغير في سطح الجلد‏

עברית (Hebrew)
n. - ‮יבלת, אדם דוחה‬

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