Warts

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More about Warts: Causes and symptoms Genital warts Diagnosis Treatment Alternative treatment Prognosis Prevention Resources

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

Particularly common among children, young adults, and women, warts are a problem for 7-10% of the population. There are close to 60 types of HPV that cause warts, each preferring a specific skin 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 same is true for patients with AIDS.

— Ruthan Brodsky

Dictionary: 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.]

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.

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

Definition

Warts, also called verrucae, are small benign growths usually caused by a viral infection of the skin or mucous membrane. The virus infects the surface layer of skin. The viruses that cause warts are members of the human papilloma virus (HPV) family, of which there are many different strains. 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

Particularly common among children, young adults, and women, warts are a problem for 7–10% of the population. There are close to 60 types of HPV that cause warts, each preferring a specific skin 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. The same is true for patients with AIDS.

The main categories of warts are common warts (face and hands), plantar warts (feet), and venereal warts.

Hand warts (verruca vulgaris) can grow anywhere on the hands, but usually occur where skin has been damaged in some way (e.g. picking or nail biting). This is a rough horny lesion varying in size from 1 mm–2cm in diameter.

Foot warts (verruca plantaris) known as plantar warts, are the most painful type of wart, due to the pressure exerted on them. They are most common in children and young adults, since they are often contracted in locker rooms and swimming pool areas. If left untreated, they can grow to an inch or more in circumference and spread into clusters. Those suffering from diabetes are more likely to suffer from plantar warts, and may also suffer complications due to the reduced potential for their bodies to heal themselves.

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 neck and dorsum of the hands, the faces of children, and on the areas of the face that are shaved by young adult males.

Genital warts, also called condylomata acuminata, moist warts, fig warts, or venereal warts, are one of the most common sexually transmitted diseases (STDs). Genital warts are more contagious than other types of warts. Approximately one million new cases of genital warts are diagnosed in the United States every year. It is estimated that two-thirds of persons coming into contact with genital warts will develop symptoms within three months.

Genital warts tend to be small flat bumps or they may be thin and pointed in shape. They are usually soft, moist, pink to red in color, occurring as a single lesion or in clusters that resemble a cauliflower, and not scaly like other warts. In women, genital warts appear on the external 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. They may also appear, less often, between the toes.

Filiform wart is a long, horny, finger-like projection that is usually found in multiples. Seen most commonly in adult males, they occur in the bearded area of the face or on the eyelids and neck.

Causes & Symptoms

Since warts are caused by a virus, they can only be caught by contact with a source of infection. This can be direct physical contact, or secondary contact with the shed skin of a wart (through a floor or a towel for example). As the incubation period for warts is quite long, it is often difficult to pinpoint sources of infection. Individuals whose immune systems are deficient most often contract warts. AIDS patients commonly suffer from warts, and it is not uncommon for warts to appear at the site of a trauma (burns, cuts or abrasions.)

Diagnosis

Common warts are rough, irregular, skin colored or brownish. Warts that are brownish in color, or that do not respond to treatment, should be checked by a physician to exclude the possibility that they may be malignant growths.

Treatment

Warts may need no treatment at all, since a large proportion of them (67% over a two-year period) disappear spontaneously. This is particularly so in the case of flat warts. However, a wart that appears unusual in any way should be checked by a physician, as a small proportion can become malignant. Generally, the main criterion for treatment of warts is a cosmetic one, if it is found to be embarrassing by the sufferer, or unpleasant to others.

Acupuncture

The aim with acupuncture will be to raise the general well-being of the patient, improve the functioning of the immune system, and free blockages of "chi" or life force. Warts and other health problems will be less likely to occur as general health and resistance are improved.

Aromatherapy

Since warts are caused by viral infections, the aim of an aromatherapy treatment would be to kill the virus with the application of an appropriate essential oil. There are many oils that have antiviral properties, so the therapist will also endeavor to choose oils that are appropriate for the patient. Onion and garlic oils both have powerful antiviral properties, but perhaps tea tree oil, which also possesses remarkable anti-viral properties, might be more acceptable as far as smell is concerned.

Colloidal Silver

The use of colloidal silver against viruses of all kinds has proved very successful. It should be topically applied to the wart, but can be taken internally to promote functioning of the immune system, and thus prevent warts from occurring.

Herbal Medicine

Herbal remedies for genital warts and other STDs have attracted considerable recent attention because of the epidemic spread of these diseases in developing countries where most people cannot afford allopathic treatments. One traditional herbal remedy from Colombia that is being studied is extracts of plants belonging to the Euphorbia family. These compounds have been used to treat ulcers, tumors, and warts for generations, and some of them appear to be effective in treating genital warts.

Before applying any herbal cure to a wart, as much of the wart as possible should be removed, in order to give the cure a head start.

Apple juice: Apply the juice of a sour apple. Action is due to the magnesium in the juice.

Banana skin: First the wart should be rubbed with an abrader, and a fresh banana skin (immediately after opening) should be applied and left overnight.

Cabbage: Apply fresh juice from a white cabbage.

Chickweed: Apply the juice to the wart.

Dandelion: The juice of the dandelion is a very old English cure for warts.

Garlic: Rub a raw clove on the wart every night until it disappears.

Green figs: The white milk from a green fig is excellent at removing warts.

House leek: This is a plant commonly found in rock gardens. It has thick fleshy leaves and its juice is rich in supermalate of calcium, which will destroy warts.

Pineapple: Cotton wool should be soaked in the fresh juice of a pineapple. The enzymes of the pineapple will dissolve the wart.

Rubber plant: If the stem of a leaf from a rubber plant is broken, white liquid will ooze out. If this is applied to the wart over a period of two to three days, the wart should disappear.

Naturopathy

Naturopathy, in common with many alternative therapies, works on the principle that given the right circumstances, such as pure air, pure water, and first class nutrition, the body will heal itself and become extremely resistant to illness. Naturopaths believe that such symptoms as warts are the result of toxins in the body, and an immune system that is not running efficiently. They may prescribe treatments such as colonic irrigation, alongside a program of healthy eating to raise the general level of health. A naturopath may suggest a paste made with vitamin C, applied to the wart daily for a period of a few weeks.

Visualization

This method, also known as creative imagery, has skeptically been described as "willing yourself well," but practically it has been found to be very effective for a range of conditions, both physical and emotional. The patient is required to sit in a relaxed state, breathing evenly, and visualize the self in the condition he or she would like to be. In this case, perhaps he or she visualizes the body overcoming the warts and absorbing them, leaving behind healthy skin. This method has been found particularly suitable for children, as it has no side effects and therapists claim it has a good success rate.

Folk Remedies

There are many remedies for warts that have been handed down from generation to generation all over the world. The following remedies have excellent track records.

Thread: a length of thread should be tied around the wart, and tightened every day until the wart drops off.

Human saliva: the sufferer applies his or her saliva to the wart first thing every morning.

Allopathic Treatment

Warts may be self-treated by a number of allopathic remedies, but care should be taken as they are fairly strong chemicals (usually salicylic acid). Those suffering from diabetes, heart disease or circulation problems, or any degree of peripheral neuropathy, should not attempt to treat themselves with any of these preparations, because of the risk of damage to tissue, and because of their increased susceptibility to infection.

In addition, the face and mucous membranes may scar, so it may be preferable to seek professional advice.

A physician may use cautery (use of heat) or cryosurgery (use of extreme cold, usually in the form of liquid nitrogen) to remove warts. These are processes that require precision, and therefore are highly skilled procedures. Another drawback is that they can be painful. Increasingly, laser treatments are also being used to treat warts, whereby the laser beam vaporizes the wart tissue. Pulsed laser treatments appear to be particularly effective in treating warts in the anogenital region of children.

A newer allopathic medication that shows promise in the treatment of resistant viral facial warts is diphencyprone (DPC), a drug that was developed to treat a type of hair loss known as alopecia areata. DPC has shown effectiveness in removing facial warts that were resistant to both cryosurgery and other topical drugs.

Expected Results

Allopathic methods for the treatment of warts are generally successful, but they carry more risk of scarring than natural methods. More than one alternative method may have to be tried before success is achieved, but they carry the added bonus of adding to the well-being of the patient, and not harming the body. Allopathic treatments involve the use of strong chemicals, which carry risks and are not compatible with body chemistry. Usually, warts either disappear spontaneously or are treated successfully with no scarring or lasting effects. However, occasionally, what appears to be a wart is the beginning of a type of cancer, so those that are resistant to treatment should be seen by a physician.

Recurrent genital warts are a serious personal and public health concern. Even though genital warts may be removed, the virus itself continues to live. Certain types of HPV can cause tissue changes in the cervix of women with recurrent infection that may lead to cervical cancer. 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.

Prevention

To avoid foot warts, footwear should always be worn in public places and feet should be kept clean and dry. In general, warts should not be picked, to avoid cross infection, and any patch of damaged skin should be protected. Every effort should be made to keep the immune system in peak working condition.

Genital warts can be prevented by using condoms and avoiding unprotected sexual contact. Barrier protection will not, however, prevent the spread of wart-causing HPV to such uncovered areas as the pubis and upper thighs.

Although vaccines to prevent the spread of human papilloma virus are under investigation as of 2002, they will not be available for general use for at least several years.

Resources

Books

Buchman, Dian Dincin. Herbal Medicine. London: Tiger Books International, 1991.

Kenton, Leslie. The Joy of Beauty. London: Century Publishing, 1993.

The Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life Books, 1997.

Renner, John H. The Home Remedies Handbook. Publications International, Ltd., 1994.

Stupik, Ramona. AMA Complete Guide to Women's Health. New York: Random House, 1996.

Periodicals

Betancur-Galvis, L. A., G. E. Morales, J. E. Forero, and J. Roldan. "Cytotoxic and Antiviral Activities of Colombian Medicinal Plant Extracts of the Euphorbia Genus." Memorias do Instituto Oswaldo Cruz 97 (June 2002): 541-546.

Brentjens, M. H., K. A. Yeung-Yue, P. C. Lee, and S. K. Tyring. "Human Papillomavirus: A Review." Dermatologic Clinics 20 (April 2002): 315-331.

Centers for Disease Control and Prevention. "Sexually Transmitted Diseases Treatment Guidelines 2002." MMWR Recommendations and Reports 51 (RR-6) (May 10, 2002): 1-78.

Garland, S. M. "Human Papillomavirus Update with a Particular Focus on Cervical Disease." Pathology 34 (June 2002): 213-224.

Pollock, B., and A. S. Highet. "An Interesting Response to Diphencyprone (DPC) Sensitization on Facial Warts: Review of DPC Treatment for Viral Warts." Journal of Dermatological Treatment 13 (June 2002): 47-50.

Tuncel, A., M. Gorgu, M. Ayhan, et al. "Treatment of Anogenital Warts by Pulsed Dye Laser." Dermatologic Surgery 28 (April 2002): 350-352.

Vermani, K., and S. Garg. "Herbal Medicines for Sexually Transmitted Diseases and AIDS." Journal of Ethnopharmacology 80 (April 2002): 49-66.

Organizations

American Academy of Dermatology. P.O. Box 4014, 930 N. Meacham Rd., Schaumburg, IL 60168-5014. (847) 330-2300. Fax: (847) 330-0050. .

American Academy of Family Physicians. 8880 Ward Parkway, Kansas City, MO 64114 (816) 333-9700. .

American Podiatric Medical Association. 9312 Old Georgetown Rd, Bethesda, MD 20814–1698. (301) 571-9200. .

Centers for Disease Control and Prevention (CDC). 1600 Clifton Road, Atlanta, GA 30333. (404) 639-3311. .

Other

Medscape. http://www.medscape.com/micromedex/CareNotes/dermatology/ElectrocauteryWartRemoval.html.

[Article by: Patricia Skinner; Rebecca J. Frey, PhD]

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]

For more information on wart, visit Britannica.com.

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.

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

Warts
Classification & external resources

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

A wart is generally a small, rough tumor, typically on hands and feet, that can resemble a cauliflower or a solid blister. Warts are common, and are caused by a viral infection, specifically by the human papillomavirus (HPV) and are contagious when in contact with the skin of another. It is also possible to get warts from using towels or other objects. They typically disappear after a few months but can last for years and can reoccur. A few papilloma viruses are known to cause cervical cancer.

Types of wart

A range of different types of wart have been identified, which differ in shape and site affected, as well as the type of human papillomavirus involved.^[1] These include:

• common wart (Verruca vulgaris): a raised wart with roughened surface, most common on hands and knees
• flat wart (Verruca plana): a small, smooth flattened wart, tan or 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
• plantar wart (verruca, Verruca pedis): 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
• mosaic wart: a group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet
• donkey wart (venereal wart, Condyloma acuminatum, Verruca acuminata):

Treatment

Prescription

Two viral warts on a middle finger, being treated with a mixture of acids (like salicylic acid) to remove them. A white precipitation forms on the area where the product was applied.

Treatments that may be prescribed by a medical professional include:

• Keratolysis, removal of dead surface skin cells usually using salicylic acid, blistering agents, immune system modifiers ("immunomodulators"), or formaldehyde.
• Cryosurgery, which involves freezing the wart (generally with liquid nitrogen), after which the wart and surrounding dead skin falls off by itself.
• Surgical curettage of the wart.
• Laser treatment.
• Imiquimod, a topical cream that helps the body's immune system fight the wart virus by encouraging interferon production.
• Candida injections at the site of the wart, which also stimulate the body's immune system.^[2]
• Cantharidin, a chemical found naturally in many members of the beetle family Meloidae which causes dermal blistering.

The wart often regrows after the skin has healed.

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% observed with salicylic acid compared with 48% for placebo in six placebo-controlled trials including a total of 376 participants.^[3] The reviewers also concluded that there was little evidence of a significant benefit of cryotherapy over placebo or no treatment.^[3]

Over-the-counter

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. Removing a wart with salicylic acid requires a strict regimen of cleaning the area, applying the acid, and removing the dead skin with a pumice stone or emery board. It may take up to 12 weeks to remove a wart.

Another over-the-counter product that can aid in wart removal is silver nitrate in the form of a caustic pencil, which is also available at drug stores. This method generally takes three to six daily treatments to be effective. The instructions must be followed to minimize staining of skin and clothing.

Over-the-counter cryosurgery kits are also available, however they can often cost three times as much as the previously named products.

Like prescription treatments, over-the-counter treatments usually require multiple applications and are only necessary if the warts are problematic. Additionally, these treatments are capable of destroying healthy skin as well as warts, so caution must be exercised by those attempting them without medical supervision.

Household remedies

Duct tape occlusion therapy involves placing a piece of duct tape (or medical tape) over the affected area for a week at a time. The procedure is otherwise identical to that of using salicylic acid adhesive pads. One study by Focht et al. found that the duct tape method was 85% effective, compared to a 60% success rate in the study's cryotherapy group.^[4] Another study by Wenner and coworkers, however, found no statistically significant effect in a double-blind, randomized and controlled clinical trial in 90 adults when duct tape was compared to mole skin.^[5] There was no statistically significant difference for resolution of the target wart between patients treated with moleskin versus patients treated with duct tape. Eight of 39 patients [21%] in the treatment group vs 9 of 41 patients in the control group [22%] had complete resolution of the target wart. Fewer of the patients achieving resolution of their wart in the moleskin group had recurrence of their wart. Of the patients who had complete resolution, 6 (75%) in the treatment group and 3 (33%) in the control group had recurrence of the target wart by the sixth month. "Whether or not the standard type of duct tape is effective is up in the air," said co-author Dr. Rachel Wenner of the University of Minnesota, who started the new study as a medical student. "Theoretically, the rubber adhesive could somehow stimulate the immune system or irritate the skin in a different manner."^[6]

Fig latex, the sap from a fig tree, is also a common treatment for warts. Studies on cows comparing treatment with fig latex to salicylic acid showed that fig latex worked equally well. An Iranian study compared fig latex treatment on humans to cryotherapy and found the fig latex to be only slightly less effective, but with the benefit of fewer side effects.^{[citation needed]}

Tempra paint serves as a successful treatment as well. Dabbed onto the surface of a wart and allowed to dry completely, it will noticably reduce the size of the wart over a period of days. Removal of the wart can take a week or more. Children who frequently fingerpaint with Tempra show it to be successful as a remedy. Caution and close observation is advised however, as infection and permanent scarring can occur.

Other household remedies include the application of common household items, such as a bruised garlic (held in place with a bandage or duct tape), banana skin, vinegar ^[7], hot water and washing liquid, aerosol sprays or compressed air, Thuja occidentalis, tea tree oil and other natural oils, unskinned potatoes, potato or cauliflower or tomato juice, salt, or vegemite to the affected area. Milkweed, dandelion, and poison ivy sap have also been used. Accounts vary in regards to how long these remedies must be applied with each session and how long they take to work.

Without controlled studies for most household remedies, it is difficult to know whether the warts disappear because the remedies work, or if they disappear due to the individual's own immune system response to the virus (possibly augmented by a placebo effect). The success of hypnosis in curing warts^[8] at least suggests that the condition may be cured by belief in a remedy, the placebo effect or other psychological means.

Some household remedies are potentially dangerous. These include attempts to cut or burn away the warts. Incense is sometimes used in Asian countries to burn warts. These methods are very painful, and can lead to infection and/or permanent scarring.

References

1. ^ Mosby's Medical, Nursing, & Allied Health Dictionary (5th edn), Anderson KN, Anderson LE, Glanze WD, eds, Mosby
2. ^ Horn TD, Johnson SM, Helm RM, Roberson PK (2005) Intralesional immunotherapy of warts with mumps, Candida, and Trichophyton skin test antigens. Arch Dermatol 141: 589–94
3. ^ ^{a b} Gibbs S, Harvey I, Sterling JC, Stark R. (2003) Local treatments for cutaneous warts. Cochrane Database of Systematic Reviews Issue 3
4. ^ Focht DR III, Spicer C, Fairchok MP (2002) The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart). Archives of Pediatrics & Adolescent Medicine 156(10): 971-4 (reviewed in Miller KE (2003) Duct tape more effective than cryotherapy for warts. American Family Physician 67(3) & DeMichele J (2003) A new medical breakthrough: wart to do when verruca vulgaris attacks. Journal of Young Investigators 7(5))
5. ^ Wenner et al. Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial. Arch Dermatol. 2007 Mar;143(3):309-13.
6. ^ Study Casts Doubt on Duct Tape Wart Cure. March 21, 2007.
7. ^ Apple Cider Vinegar for Warts.
8. ^ Alternative & Complementary Therapies: Hypnotherapy & Warts

See also

• Laryngeal papillomatosis
• Molluscum contagiosum

External links

• "Warts," The Merck Manual
• Warts 'n' All by artist James R Ford
• Wart photo library at Dermnet

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

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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