Viral Warts

A viral wart is a very common condition that appears as a growth on the skin caused by an infection linked with human papillomavirus (HPV). A cutaneous wart is also termed a verruca or papilloma.

Wart condition can affect anyone at any age. However, there are a few groups that are particularly at risk and have a higher prevalence of it. One of the most affected groups is school-aged children. Patients with eczema are also prone to warts due to the damaged skin barrier. Lastly, individuals who are immune suppressed with medications like ciclosporin or azathioprine, as well as those infected with human immunodeficiency virus (HIV), have a chronic condition of warts regardless of whether they are receiving treatment or not.

In children, 50% of reported wart cases disappear within the next 6 months and 90% disappear after 2 years. Adults have more persistent cases, but the majority clear up after a proper treatment is administered.

Warts are caused by human papillomavirus (HPV), which makes it a double-stranded DNA virus. The infection starts in the basal layer of the epidermis, which facilitates the formation of keratinocytes and hyperkeratosis. HPV can be spread by skin-to-skin contact or by autoinoculation. Scratching or picking the wart causes the spread of viral particles over different areas of the skin. The incubation period can last up to 12 months.

Generally, cutaneous warts tend to have a hard and keratinous surface. Sometimes a very tiny black dot in the middle of the lesion can be observed due to inner bleeding (intracorneal haemorrhage). In dermatology, warts are grouped based on their clinical features into the following categories: common wart, plantar wart, plane wart, filiform wart, and mucosal wart.

Types of Warts

Common warts appear as lesions with rough, papillomatous, and hyperkeratotic surfaces. They are usually found on fingers and/or toes. These warts can also form around nails, which can negatively affect nail growth.

Plantar warts appear on the soles of the feet. Due to applied pressure, these warts have an inward growth which may lead to callus formation. In rare cases, plantar warts may lead to the formation of verrucous carcinoma.

Plane warts appear as clusters of flat lesions. They are commonly found on the face, shins, and hands. These warts may be caused by shaving or scratching, which gives them a linear feature.

Filiform warts have a thread-like appearance and are usually found on the face.

Mucosal warts are also known as oral warts. They appear on the lips and inside of the cheeks and are much softer than other types of warts.

Diagnosis

Warts are diagnosed according to their unique features. If the top part of the wart is removed, pinpoint dots are expected to be observed. A dermatoscope is applied in order to distinguish some viral warts from other lesions such as skin cancer and seborrhoeic keratosis. Very rarely, a skin biopsy can be performed to confirm the wart diagnosis.

Treatment

Treatment of warts is quite complex and may be uncomfortable for some patients depending on their pain tolerance. Individuals with warts also report experiencing self-esteem issues related to their condition. In order to remove warts, the patient's immune system needs to be stimulated so it can respond to the wart virus.

Topical Treatments

Topical treatments are very common. They consist of wart paints that contain salicylic acid, which helps to remove the dead surface of affected skin cells. Podophyllin is a cytotoxic agent that may also be used; however, it is not recommended for pregnant women or women who are planning to become pregnant.

The wart paint should be applied daily on the affected skin, and care should be taken to avoid contact with healthy skin. Before applying the paint, the wart needs to be softened by soaking it in a warm water bath. The top surface of the wart must then be rubbed with a pumice stone, after which the paint is applied. Once it dries, the lesion is recommended to be covered with a bandage. This treatment method helps to reduce the size of the wart and decrease discomfort. After 12 weeks of daily paint applications, the majority of warts disappear.

Cryotherapy

Cryotherapy involves the use of liquid nitrogen to destroy lesions on the superficial skin layer. After 3 to 4 months of regular cryotherapy sessions held once every two weeks, the majority of warts are expected to disappear.

Electrosurgery

Electrosurgery is another treatment option. The technique involves burning the base of the affected skin area and is applied to large lesions and wart lesions that are resistant to other methods. A local anaesthetic is applied during the procedure. On average, the wound heals within a month. A permanent scar will appear as a result of electrosurgery.