Viral warts

Viral wart is a very common condition that appears as a growth of the skin and mostly caused by infection linked with human papillomavirus (HPV). The term “verruca” is also used to describe the wart condition. 

Wart condition can affect anyone at any age. However, one of the most common groups at risk are school-aged children. Patients with eczema are prone to warts as well due to a damaged barrier of the skin. 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 receiving treatment.

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 majority clear up after a proper treatment. 

Warts are caused due to the DNA virus which is human papillomavirus (HPV). Infection is found in the superficial layer of epidermis which gives rise to the formation of keratinocytes and hyperkeratosis. HPV can be spread  by skin-to-skin contact or by autoinoculation. Any action of scratching and/or picking the wart will cause the spread of viral particles over different areas of the skin. The incubation period can last up to 12 months. 

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

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

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

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

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

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

Warts are diagnosed according to their unique features. If the top part of the wart is getting removed, pinpoint dots are expected to be observed. Dermatoscope is applied in order to distinguish some viral warts from other lesion like skin cancer and seborrhoeic keratosis . Very rare, skin biopsy is used to confirm the wart diagnosis.

Treatment of warts is quite complex and may be uncomfortable to some patients depending on their pain tolerance. Moreover, they also cause self-esteem issues because many individuals find them embarrassing to have. In order to get rid of warts, patient’s immune system needs to be stimulated so it can attack the wart virus. 

Topical treatments are very common. They consist of wart paints that contain salicylic acid which help to remove the dead surface of affected skin cells. Podophyllin is a cytotoxic agents that may be used as well. However, it is prohibited for pregnant women or women who are planning on getting pregnant. 

The wart paint should be applied daily on the affected skin but it is highly suggested to avoid applying the chemical on healthy skin. Before applying the paint, the wart needs to be soften by soaking it in warm water bath. Then the top surface of wart(s) needs to be rubbed with pumice stone. After, the paint needs to be applied. Once it dries, the lesion is suggested to be covered with band aid.  This treatment method helps to reduce the size of the wart and decrease the feeling of discomfort. After 12 weeks of daily paint applications, majority of warts disappear. 

Other option is cryotherapy which consists of using liquid nitrogen to destroy lesion(s) on the superficial skin layer. After 3-4 months of regular cryotherapy sessions (once every two weeks), majority of warts are expected to disappear. 

The technique of electrosurgery involves the burning of the base of the affected skin area. This method is applied to large and resistant to other methods wart lesions. A local anaesthetic is applied during the procedure. The wound heals within a month. The scar may appear as a result of electrosurgery. 

Another options for resistant warts is the laser treatment.

Centre for Medical and Surgical Dermatology offers various treatment options for wartswhich are unique for every patient.  For more information on warts condition, visit the following link:

https://cmsderm.ca/conditions/warts/

Centre for Medical and Surgical Dermatology offers surgical method as one of the option for wart lesion removal. For more information of surgical procedure, visit the following link:

https://cmsderm.ca/services/surgical-dermatology/