Wart
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- For the Nintendo character, see Wart (Nintendo).
- For toad warts, see parotoid gland.
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|---|---|---|
| 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 tumour, typically on hands and feet, that resembles a cauliflower. Warts are common, and are caused by a viral infection, specifically by the human papillomavirus (HPV) and are contageous when in contact with the skin of another. They typically disappear after a few months but can last for years and can reoccur. A few papillomaviruses are known to cause cancer. Certain types of warts, depending on location and cause, can be contagious from region to region, but are not transferable between species.
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[edit] 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
- genital wart (venereal wart, condyloma acuminatum, verruca acuminata): wart affecting the genital areas
[edit] Treatment
[edit] Prescription
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, 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 removal of the wart is sometimes also performed.
- 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.
None of these treatments are very effective on single uses except Cryosurgery; the wart often returns after the skin has healed from the treatment, but repeated treatment should get rid of the wart permanently. As they disappear after a few months and maximally a few years, treatment is necessary only if the lesions are painful or are a cosmetic problem.
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]
[edit] Over-the-counter
There are also several over-the-counter options. The most common ones involve salicylic acid. These products are readily available at most 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 this method requires a strict regimen of cleaning the area, applying the salicylic acid, and removing the dead skin with a pumice stone or emery board. It may take up to 12 weeks to remove a stubborn 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 3 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.
[edit] 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 found that the duct tape method was 85% effective, compared to a 60% success rate in the study's cryotherapy group.[4] Another study, however, found no statistically significant effect. [5] "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]
Cryo kits mentioned above can be duplicated by using a can of compressed air upside down to freeze the soft end of a q-tip. After freezing the tip of the q-tip for five or six seconds, the q-tip can be applied directly on the wart for the same amount of time. This has the same effect as liquid nitrogen treatment. Multiple treatments over weeks may be required as with any cryo treatment.
Other household remedies include the application of common household items, such as bruised garlic (held in place with a bandage or duct tape), banana skin, vinegar, hot water and washing liquid, aerosol sprays, tea tree oil and other natural oils, unskinned potatoes, potato or cauliflower juice, salt, or vegemite to the affected area. Milkweed or dandelion sap is also used. Anecdotal evidence suggests poison ivy can be effective (with extreme care). Accounts vary in regards to how long these remedies must be applied with each session and how long they take to work. Care should be taken with bruised garlic, which can burn surrounding tissue if left on too long.
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[7] 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.
[edit] References
- ^ Mosby's Medical, Nursing, & Allied Health Dictionary (5th edn), Anderson KN, Anderson LE, Glanze WD, eds, Mosby
- ^ 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
- ^ a b Gibbs S, Harvey I, Sterling JC, Stark R. (2003) Local treatments for cutaneous warts. Cochrane Database of Systematic Reviews Issue 3
- ^ 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))
- ^ Duct tape no magical cure for warts, study finds
- ^ Study Casts Doubt on Duct Tape Wart Cure. March 21, 2007.
- ^ Alternative & Complementary Therapies: Hypnotherapy & Warts
