Warts are benign skin growths caused by a viral infection. They are incredibly common and spread very easily.
Typically, they are found in children or adolescents – and when one youngster has them, others in proximity soon get them, too. As we age, we probably acquire an immunity to the virus and become less susceptible.
There are a variety of treatments but none will accomplish a cure in one visit.
Spotting the Small Ones
Warts can look very different depending on the type of virus that is causing the infection, as well as the part of the body affected.
One type of wart common among children is called molluscum, which appears as little (2-3 mm) white bumps that spread in a line as they are scratched.
The virus that causes these lesions is easy to remove. Typical treatments include cryosurgery (liquid nitrogen applied to the lesion), chemicals that burn the wart (salicylic or other acids), blistering agents such as cantharone, or simply scraping them off.
Whatever method is selected, several visits should be planned to prevent recurrence, as growths may show up after treatment has begun.
Flat warts are caused by a different type of virus. These spots grow in small bumps that are flesh colored. Since they are very small, they almost can go unnoticed. In some patients, they tend to cause itching, which is one way of detecting them.
Treatment options for flat warts include freezing them or using topical products such as Retin-A or Aldara/Zyclara. They can be persistent and require multiple visits or treatments.
Vexatious Verrucas
Common warts (verruca vulgaris) are larger growths, usually about the size of a pencil eraser or bigger, that become prominent above the skin. They are frequently seen in clusters. When they occur around the nails, they can deform the shape of the nail and get into or under the cuticle. If they are on the fingertips, they can become painful as they grow.
Another area that is problematic and painful is the bottom of the feet or the toes. Warts that grow here are referred to as plantar warts (not planter). As they grow into the sole of the foot they cause skin thickening, which can feel like walking on a pebble.
These warts are usually treated with nitrogen cryosurgery. If they are resistant to this method, I will use lasers, starting with the pulse dye laser. This focuses light into the blood vessels that supply the wart, causing it to shrink.
The carbon dioxide laser is also useful, destroying the tissue in the wart and surrounding areas. It is more invasive than the pulse dye laser and should be reserved for warts that will not budge.
No matter how these warts are treated (including cutting them out), because they are a viral problem they can affect surrounding areas and be difficult to eradicate. Getting rid of them requires consistent treatment.
Topical Options
Topical treatments may be used for any warts. Over-the-counter products contain salicylic acid in concentrations of up to 18 percent. These are not really strong enough to make a big difference, but they can help to keep the wart under control between treatments.
Stronger preparations are available overseas, but not in the United States unless your physician compounds them for you.
Prescription-strength products used to treat warts include Zyclara and Aldara. These are the same chemical (imiquimod), available in different formulations.
The key to treating warts is recognizing what they are, getting to them early, and making sure that you continue treatment until they are gone. Duct tape and other folk remedies may work for some people, but for most it is better to see a dermatologist to get treatment that has a reasonable chance of success.
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