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What Are Warts?

Warts are non-cancerous skin growths caused by a viral infection in the top layer of the skin. The common wart is a small, hard, rough bump that usually occurs on the hands and fingers, but they can be flat and smooth. Warts vary in color (white, pink, or brown), and may contain tiny spots that look like black hairs or specks. The appearance of a wart depends on where it is growing. Warts can occur on any area of the body, but they are most common on the fingers, hands, arms, and feet.


What Causes Warts?

Warts are tiny skin infections caused by viruses of the human papillomavirus family. Most people have a wart at some time in their lives. Warts appear more commonly in children.


How Do You Get Warts?

The viruses that cause warts are passed from person to person by close physical contact. Even a tiny cut or scratch or a lengthy immersion in water, such as competitive swimming with a person who has warts, can make the skin more vulnerable to warts.

The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is present. The causative virus thrives in warm, moist environments, making infection a common occurrence in swimming facilities.


How Do You Get Warts?

Warts are passed from person to person, sometimes indirectly. The time from the first contact to the time the warts have grown large enough to be seen is often several months. The risk of catching hand, foot, or flat warts from another person is small.


Why Do Some People Get Warts And Others Don't?

Some people get warts depending on how often they are exposed to the virus. Wart viruses occur more easily if the skin has been damaged in some way, which explains the high frequency of warts in children who bite their nails or pick at hangnails. Some people are just more likely to catch the wart virus than are others, just as some people catch colds very easily. Patients with a weakened immune system also are more prone to a wart virus infection.


How Many Kinds Of Warts Are There?

There are several different kinds of warts including:

. Common warts
. Foot (Plantar) warts
. Flat warts

Common warts - usually grow on the fingers, around the nails and on the backs of the hands. They are more common where skin has been broken, for example where fingernails are bitten or hangnails picked. These are often called "seed" warts because the blood vessels to the wart produce black dots that look like seeds.

Foot warts - are usually on the soles (plantar area) of the feet and are called plantar warts. They are often mistaken for corns or calluses—which are layers of dead skin that build up to protect an area which is being continuously irritated. You can tell the difference because plantar warts disrupt the natural lines of the skin and may have small black dots on their surface, which are tiny blood clots in blood vessels. When plantar warts grow in clusters they are known as mosaic warts. Most plantar warts do not stick up above the surface like common warts because the pressure of walking flattens them and pushes them back into the skin.

Flat wartsare smaller and smoother than other warts. They tend to grow in large numbers - 20 to 100 at any one time. They can occur anywhere, but in children they are most common on the face. In adults they are often found in the beard area in men and on the legs in women. Irritation from shaving probably accounts for this.


Do Warts Need To Be Treated?

Warts usually don't cause any symptoms and do not require treatment, although plantar warts may be painful. In children, warts can disappear without treatment over a period of several months to years. However, warts that are bothersome, painful, or rapidly multiplying should be treated. Warts in adults often do not disappear as easily or as quickly as they do in children. Although there is no specific cure for warts and most will disappear on their own in a few years, if the warts are painful or causing cosmetic problems, treatment should be considered.

Common warts: In young children, these warts can be treated at home by parents on a daily basis by applying salicylic acid gel, solution or plaster (over the counter). There is usually little discomfort, but it can take weeks of treatment to get rid of the wart. Treatment should be stopped at least temporarily if the wart becomes sore.

Foot warts: Plantar warts are more difficult to treat because the bulk of the wart lies below the skin surface. . It is important to soften the warts by soaking them in warm water and then paring them down with an emory board or pumice stone and then apply an over the counter medicine with salicylic acid. Persistent or very painful plantar warts may need to be surgically removed. Other recommendations include a change in footwear to reduce pressure on the wart and keeping the foot dry since moisture tends to allow warts to spread.

Flat warts: These wartsare often too numerous to treat with methods mentioned above. As a result, "peeling" methods using daily applications of salicylic acid is recommended. For some adults, periodic office treatments for surgical treatments are sometimes necessary.


Salicylic Acid: Most Common Over The Counter (OTC) Treatment
  • Salicylic acid softens the skin layers that form the wart so that they can be rubbed off.
  • Repeated irritation to the wart may also trigger an immune system response that can help destroy the wart.
  • Soaking in warm water prior to applying medicine will softer the wart and allow the medicine to better penetrate the wart.

Examples of common OTC brands:
. Trans-Ver-Sal
. Compound W
. Dr. Scholl's
. Occlusal
. Duofilm
. Duoplant


Directions for wart pads:
  1. Wash affected area. Must soak wart in warm water for 5 minutes.
  2. Dry area thoroughly.
  3. Apply medicated disc. If necessary, cut disc to fit wart. Repeat procedure every 48 hours as needed (until wart is removed) for up to 12 weeks.
  4. Note: Self-adhesive comfort cushions may be used to conceal medicated disc and wart.

Directions for applying gels:
  1. Wash affected area. Must soak wart in warm water for 5 minutes.
  2. Dry area thoroughly.
  3. By squeezing the tube gently, apply one drop at a time to sufficiently cover each wart. Let dry.
  4. Repeat procedure once or twice daily as needed (until wart is removed) for up to 12 weeks.
Salicylic acid may damage healthy skin surrounding the wart. To avoid damaging other skin, cover the surrounding skin with a doughnut-shaped pad or bandage when applying salicylic acid.


Do Not Use Salicylic Acid On:
  • irritated skin
  • any area that is infected or reddened
  • moles
  • birthmarks
  • warts with hair growing from them
  • genital warts
  • warts on the face
  • warts on mucous membranes, such as inside mouth, nose, anus, genitals, lips.

Duct Tape: Is This A Recommended Home Treatment?

The newest treatment recommendations are to cover the warts with duct tape for 6 out of 7 days at a time. You then soak and pare down (use an emory board) the wart and then reapply the duct tape the next morning. In one recent study, this treatment worked 80% of the time after about two months, while freezing worked less than 60% of the time.


How Do Dermatologists Treat Warts?

Dermatologists are trained to use a variety of treatments, depending on the age of the patient and the type of wart.
  • Cantharidin: Warts may be treated by "painting" with cantharidin in the dermatologist's office. Cantharidin causes a blister to form under the wart. The dermatologist can then clip away the dead part of the wart in the blister roof in a week or so.
  • Cryotherapy: For adults and older children cryotherapy (freezing) is generally preferred. This treatment is not too painful and rarely results in scarring. However, repeat treatments at one to three week intervals are often necessary.
  • Electrosurgery : Electrosurgery (burning) is another good alternative treatment.
  • Laser: Laser treatment can also be used for resistant warts that have not responded to other therapies. Laser therapy is used to destroy some types of warts. Lasers are more expensive and require the injection of a local anesthesia to numb the area treated.
  • Aldara (imiquimod) is a newer, non-destructive treatment for warts. It is a cream that was first used to treat anogenital warts, but is now being used more to treat other types of warts and molluscum contagiosum. It is applied to the warts three times a week, either with or without an occlusive dressing (bandaid). You might need to soak and then pare or trim down the wart and then apply Aldara for it to work best.

What About The Problem Of Recurrent Warts?

Sometimes it seems as if new warts appear as fast as old ones go away. This may happen because the old warts have shed virus into the surrounding skin before they were treated. In reality new "baby" warts are growing up around the original "mother" warts. The best way to limit this is to treat new warts as quickly as they develop so they have little time to shed virus into nearby skin. A check by your dermatologist can help assure the treated wart has resolved completely.


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