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Viral Warts

Viral Warts

What is viral warts?
A viral wart is a common growth of the skin caused by infection with human papillomavirus (HPV). Usually, they are of different types: common (papules with a rough, papillomatous, and hyperkeratotic surface; back of fingers/toes, around nails, on knees), plantar (tender inwardly growing and painful warts; foot sole), plane (flat surface warts, often in a linear distribution; face, hands, and shins); filiform (occur like a thread or finger; face); and mucosal (oral or anogenital warts; lips and inside cheeks).

Who gets it?
Warts are particularly common in school-aged children; eczema patients (due to a defective skin barrier); and immunosuppressed population (warts might never respond to treatment). Viral warts affect individuals whose immune systems have not developed the antibodies to fight wart-causing HPV strains. However, each person’s immune system responds to the HPV virus differently, so not everyone who comes in contact with HPV develops warts.

What triggers it?
HPV, a DNA virus, is the primary cause. More than 100 HPV subtypes (common types: 2, 3, 4, 27, 29, and 57) are known to cause warts, which is responsible for the different types of macroscopic presentation. 

HPV is spread by direct skin-to-skin contact or autoinoculation. This means if a wart is scratched or picked, the viral particles may be spread to another area of skin. The incubation period can be as long as twelve months. 

How is it diagnosed?
These warts have a highly characteristic appearance, and therefore, tests are rarely needed to diagnose viral warts.  

  • Pinpoint dots (clotted capillaries) are noted on removal of the top layer of the wart

  • Dermatoscopic examination might help distinguish viral warts from other lesion types

  • Skin biopsy might be necessary in rare cases

How is viral warts treated?
Often, very small warts, not posing enough trouble, are left untreated; in most cases, they will regress on their own. However, some warts might be painful, and often visually abhorrent, and therefore, it is necessary to get rid of them. 

The body’s immune system needs to be triggered to attack HPV. Different treatments are used to treat viral warts.

  • Topical treatment: includes wart paints containing salicylic acid or similar compounds, which work by removing the dead surface skin cells. The paint is applied once daily. Treatment with wart paint usually makes the wart smaller and less uncomfortable; 70% of warts resolve within 12 weeks of daily application. 

  • Cryotherapy: involves the use of liquid nitrogen to hard freeze the wart. This therapy is repeated at 1–2-week intervals. It is uncomfortable and may result in blistering for several days or weeks. An aerosol spray with a mixture of dimethyl ether and propane can be purchased over the counter.

  • Hard freeze using liquid nitrogen might cause a permanent white mark or scar. It can also cause temporary numbness.

  • Immunotherapy: involves the injection of a surface protein such as yeast protein or tuberculosis antigen under the skin near the wart. The immune system is expected to recognize the marker as foreign, and in most cases, identifies the wart as foreign too. It usually consists of multiple injections, generally every 2–4 weeks. 

  • Electrosurgery: involves curettage and cautery, and is used for large and resistant warts. Under local anesthetic, the growth is pared away, and the base is burned. The wound heals in 2 weeks or longer; however, the chances of recurrence remains. This treatment leaves a permanent scar.

  • Laser surgery: involves the use of an intense, targeted beam of light when other forms of treatment do not help. 

  • Other treatments: involves experimental treatment for recurrent, resistant, or extensive warts and can include the following: pulsed dye laser-based destruction of feeding blood vessels, photodynamic therapy, laser vaporization, hypnosis, hyperthermia, and occlusion using duct tape.

Persistence with the treatment and extreme patience is essential.

How can it be prevented?
Avoid direct contact with warts. Do not use the same pumice stone or nail clipper on your warts as you use on your healthy skin and nails. Do not bite your fingernails. Warts occur more often in skin that has been broken. And avoid brushing, clipping, or shaving areas that have warts. Avoid tobacco smoking. HPV vaccines are available to prevent anogenital warts. However, no treatment is universally effective at eradicating viral warts. 

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