warts

What are?

What are warts?

Verruca is a Latin word meaning excrescence. The warts, in fact, are small cutaneous protuberances, sometimes painful, with greyish-yellow shades and hemispherical shape.

The skin warts affect mainly at a young age, preferably located on the back of the hands, on the soles of the feet and in the nail contour. They are supported by a viral infection that is often transmitted through the promiscuous use of public spaces, especially by attending showers, swimming pools and sports fields open to the community.

There is also another type of warts: genital warts which, of course, occur at the level of the reproductive organs. Transmission generally takes place through sexual relations; not surprisingly, they are considered as real sexually transmitted diseases (for detailed information on this, see the dedicated articles: Vaginal warts and Condylomata acuminata).

However, this topic will not be explored in the following article, in which we will deal almost exclusively with cutaneous warts.

Insights on Warts

Plantar Warts Plantar Warts: Diagnosis, Prevention, Care Genital warts Condylomata acuminata (cockscombs) Warts Symptoms Wart cure drugs Dermatological Cryotherapy

Causes

What are the Causes and Risk Factors of Skin Warts?

Warts are caused by a viral infection, supported by one of over seventy papilloma viruses affecting humans (called HPV, from Human Papilloma Virus ).

The incubation period of the papilloma virus varies from two to nine months, during which there is a slow hyperproliferation of the dermis and / or epidermis cells.

Among the main risk factors that can provoke and favor the appearance of warts, we find:

Weakening of immune defenses (stress, poor diet and debilitating diseases greatly increase susceptibility to infection).
Genetic factors (resistance to pathogenic action is genetically determined).
Skin lesions (they are the main entry gate of the virus; for this reason warts are located more frequently in areas subject to trauma).
Mixed use of towels, bathrobes, slippers (plantar warts) and objects for nail care (warts located along the nail perimeter).
Moisture accumulation (use of wet socks or shoes).
Inadequate footwear and stockings (made of non-breathable synthetic materials).
Walking barefoot in the locker rooms or public baths.

Finally, even poor skin hygiene, excessive exposure to sunlight (including tanning lamps) indirectly facilitate the onset of warts.

Transmission

How are cutaneous warts transmitted from one patient to another?

Warts can appear at any age but electively affect children and adolescents.

The transmission is inter-human and occurs, for the types not involved in genital infections, mainly in highly frequented places, such as showers and saunas in gyms and swimming pools. In these locations, the hot, humid climate favors the survival of the virus which, taking advantage of water-induced skin maceration, can take root quite easily.

There is also frequent direct infection that occurs, for example, by touching other people's warts. Transmission is frequent in both men and women and can also occur through self-injection, ie through the passage of microorganisms from the site of infection to another body area.

Classification

How are cutaneous warts classified?

Leaving aside those that appear in the anogenital area, for which we refer to the dedicated article, the cutaneous warts are classified according to their histological and morphological characteristics and according to the area in which they occur.

Based on this classification, we can therefore distinguish the following types of skin warts:

Common or common warts: they are observed more frequently at the level of the back of the hands and fingers, the legs and the soles of the feet. In this last place the warts are generally painful and take on particular characteristics that differentiate them from the other types (plantar warts). The vulgar warts have a typical round shape, a hard and rough surface and are gray-brown in color.
Flat warts : usually present in the face or back of the hands, in young patients; however, they can also occur in the hands, knees and arms. Generally, these warts are small and flat-topped. Compared to the other types of warts, these have a smoother surface and their color can vary from pink to yellow, up to brownish. They are usually asymptomatic and difficult to recognize; in some cases they appear in clusters.
Deep plantar warts : these warts manifest themselves at the level of the soles of the feet, but in some cases they can also spread to the ankles. They are characterized by being particularly annoying and painful, due to the continuous pressure that is exerted on them when standing or walking. Precisely because of this pressure, the plantar warts tend to be flatter than the other types of warts and grow inward rather than outward.
Periungual warts : this type of warts occurs around the nail bed. It is characterized by a particular aspect that, in a sense, recalls the shape of a cauliflower.
Filiform warts : as can be guessed from their very name, these warts have an elongated shape. They mostly occur in the areas around the mouth, nose and eyes. In addition to the particular shape, the filiform warts are characterized by their color, typically equal to that of the skin.
Mosaic warts: mosaic warts generally appear under the toes, but in some cases they can also spread to the entire plant. They appear as small white crusts that appear in groups. However, compared to plantar warts, this type does not cause pain during walking.

In the elderly, the appearance of a fourth type of wart is more frequent, called seborrheic. However, in these cases, we speak more properly of seborrheic keratoses, since the cause of their onset does not lie in a bacterial infection, but is to be found in a predominantly family component (for more information: Seborrheic keratosis).

Diagnosis

The diagnosis of cutaneous warts is generally based on the simple clinical aspect of the latter. In fact, in most cases, the doctor only needs a quick look at the area affected by the disorder to understand what it is.

In order to carry out an accurate diagnosis, the doctor will still have to make sure that the signs and symptoms that have occurred on the patient are not attributable to other disorders or diseases, such as, for example, calluses, seborrheic keratoses, lichen planus or squamous cell carcinomas.

More rarely, instead, it is necessary to resort to biopsy. In these cases, the dermatologist will remove the entire wart and then have it analyzed.

Signs and Symptoms

Course and Evolution

In many cases, warts undergo spontaneous healing within 1-5 years. In other cases, however, they may persist for long periods of time or recur.

Unfortunately, the clinical course of this particular infection is not predictable, as there is great variability between one patient and another.

As for evolution, instead, despite the numerous rumors, these small benign tumors can hardly degenerate into carcinomas.

However, it is always good to consult your doctor if the warts or the surrounding skin show any of the following symptoms:

Ache;
Swelling;
Redness;
Bleeding;
Presence of pus.

Wart Care

See also: Drugs for the treatment of warts - Natural remedies and herbal medicine

Due to the high percentage of recurrences and the possibility of permanent scarring, the surgical removal of warts or the use of aggressive techniques such as the old electrocoagulation is no longer considered necessary or appropriate. In any case, the therapeutic choice differs according to the type of wart, its location, the depth, the number and the extent of the affected skin area.

The first choice treatment is often based on the simple use of solutions based on salicylic acid and lactic acid, to be applied directly on the wart for about 12 weeks. These active ingredients, in fact, have a keratolytic action that determines the destruction of the cells that make up the wart.

Only in case of failure of the aforementioned treatments can alternative strategies such as cryotherapy be chosen. This technique exploits the freezing activity of liquid nitrogen, sprayed directly on the wart or applied through a small pad. Treatment can be painful, although in many cases the patient only feels a slight burning sensation. Numerous applications are often required and therapy is sometimes repeated after one or two weeks.

Precisely in this regard, it is good to remember that, before implementing "the advice of a friend" or purchasing modern kits to independently perform liquid nitrogen therapy, it is essential to consult your doctor and not improvise in therapies " do-it-yourself".

Effective, but rather expensive, laser therapy can be chosen by the dermatologist in case of relapses or very large lesions. Even in this case the treatment of warts can be painful and scarring, which is generally more frequent than cryotherapy, cannot be ruled out.

The treatment of warts can also be based on the use of some chemical substances, such as podofillin resins, used mainly in the treatment of anogenital forms.

Despite numerous treatment modalities, warts tend to be difficult to eradicate and in some cases reappear after a short time. Early intervention is also very important to prevent their spread to other body areas.

Recently some innovative topical creams have been introduced on the pharmaceutical market, able to stimulate the local immune response towards papilloma viruses ( imiquimod, trade name Aldara®).

This new and extraordinary therapeutic approach helps the body to eliminate the infection, favoring spontaneous healing and reducing the recurrence rate. Used above all for the treatment of warts in the anogenital setting, this therapeutic method is not however without undesired effects (generally irritative).

Prevention

As in many other diseases, prevention also plays a key role in the case of warts. In this regard, to prevent its occurrence it is very important to adopt some simple precautions, such as:

Have an accurate personal hygiene.
Avoid contact with other people's warts or with their own (so as to avoid transmitting them to other parts of the body).
Do not share towels, shoes, slippers or nail care tools;
Keep feet dry and change stockings often.
Do not walk barefoot in swimming pools, locker rooms or sports facility showers.

Metropolitan legends

There are many urban legends about warts. However, the most widespread is certainly the one according to which it is necessary to eradicate the root to definitively eliminate a wart. In truth, this rumor is absolutely a myth to dispel since warts do not have any roots and in any case do not develop very deeply, since, generally, the infection only affects the epidermis and the dermis.