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Warts

Dr. Loretta Lanphier, ND, CN, HHP, CH

In most cases, warts are more of a nuisance than a harmful medical condition. However, everybody loves to hate warts, and for good reason. They are not very flattering, and most of us would prefer to have them removed if at all possible. But what is behind these unwelcome blemishes? Can they be avoided, or must we just learn to live with them? 

What Are Warts?

Warts are benign, noncancerous skin growths that are caused by a viral infection of the skin or of mucous membranes. The infections that produce warts are caused by the human papillomavirus (HPV). Warts manifest themselves as rapid accumulations of cells that appear on the outer most layer of the skin. While some forms of HPV have been associated with cancer, warts and the strains of HPV that cause them have not been linked to cancer in any known manner.

Warts are contagious, and can be passed from one individual to another. They can also be spread from one part of the body to another part on the same person. There are approximately sixty different strains of HPV that cause warts, and each one tends to appear on its own favorite part of the body. Different types of warts can be found on the skin of the hands and feet, on the genitals, in the rectal area, inside the mouth, and on other parts of the body.

Certain individuals seem to be more susceptible to warts than others, and may continually struggle with them. Others have a greater resistance to HPV, and may not get warts even if exposed to the virus. Warts are a bigger problem for anyone with a compromised immune system, and they are often found in areas of the body where the skin has been damaged. Thus, individuals who bite their nails, for example, will have a higher incidence of warts on their fingers and around their fingernails. The virus enters the body through the skin, and can incubate for up to eight months before warts appear.

Warts can appear on anyone at any age, but are most commonly found in children, young adults, and women. It is estimated that approximately 7-10% of the world’s population at any given time is experiencing an attack of warts. Warts are usually harmless, and are likely to disappear on their own. However, if left untreated, they can spread and cause outbreaks on other parts of your body. They are also ugly and embarrassing to many folks, and are therefore removed via various methods.

What Are the Causes and Symptoms of Warts?

Warts come in many shapes and sizes, and can be found almost anywhere on the body. Let’s take a look at some of the different types of warts, and how and where they typically form.

• Common warts are most often found on the back of the hands, around the fingernails, and on the fingers themselves. They are more likely to be a problem for individuals who bite their nails, or pick at hang nails. The virus can penetrate areas of the skin easier that are broken or irritated. You may only have one isolated wart, or they can be found in multiples. They generally appear as small bumps of flesh that are grainy and rough to the touch. Warts may be flesh-colored, pink, tan, or white. Much of the time they will exhibit one or more tiny black dots, which are sometimes called “wart seeds,” but are actually blood vessels that have clotted. Common warts are usually painless, and are only removed for cosmetic purposes or to avoid spreading them throughout the body. Young adults and kids have the highest numbers of common warts.
• Plantar warts or “foot warts” get their name from plantar, which is the medical term for the sole of the feet. They usually are flesh-colored or light brown, and may appear singly or in clusters. Any part of the underside of the foot may produce plantar warts, but they are most often found on the heel, the ball of the foot, or the bottom of the toes. These contact points of the foot are likely locations due to the wear and tear they experience from the weight of the body. Anywhere the skin of the sole is cracked or irritated is a favorite spot for plantar warts. They are often quite painful, especially when they appear at these pressure points, and can grow quite large, up to an inch in circumference or more, if left untreated. It is thought that plantar warts are often spread from one individual to another by walking barefoot in public locker rooms or showers, at swimming pools, or by walking barefoot on dirty surfaces. Adolescents between the ages of twelve and sixteen are the most common victims of plantar warts. With some folks who have diabetes or other conditions that affect their circulation, plantar warts may not heal well, and can turn into sores or ulcers on the foot.
• Flat warts have a tendency to be found in greater numbers than other types of warts, and are generally smaller and smoother as well. They can be found anywhere on the body, but are most common to the legs of women and the faces of children and teens. They also are a common problem at places where young men or women shave.
• Genital warts are considered the most common of all types of sexually transmitted diseases (STD). They are also known as condyloma acuminata or venereal warts. Genital warts are much more contagious than other types, and up to 66% of individuals who have sexual contact with an infected partner will get the warts themselves, sometimes as much as eighteen months later. Approximately one million new cases of genital warts are reported annually in the United States.

They may appear thin and tall, or be small flat bumps, and are generally not rough to the touch like other types of warts. They can be very small or quite large in some cases, often resembling a cauliflower. In females, they can be found on the genitals, the cervix, the anus, or the rectal area. Males contract them most often on the end of the penis, but they may also appear on the scrotum or in the anal area. Individuals who have oral sex with an infected partner may also find genital warts forming inside their mouth.

What Treatments Are Available for Warts?

Warts is one of those ailments that has many treatments. Your health care provider can remove them through various methods, and there are also a lot of home remedies that work well for many folks. Let’s take a look at some of the more commonly recommended ones:

• Salicylic acid is actually a derivative of the willow tree. It is mildly caustic in nature, and acts by burning away the wart tissue. However, salicylic acid can harm healthy skin around the wart if you are not careful. It is a good idea to protect such skin with petroleum jelly while using the salicylic acid directly on the wart. Sometimes drops of the acid are used, or a pad may be soaked and placed on top of the wart. Treatment with salicylic acid may take a period of weeks or months. As the wart deteriorates, layers of the skin can be peeled off. Those with diabetes or other vascular diseases should be especially careful when using salicylic acid.
• Cryotherapy employs liquid nitrogen to freeze the wart tissue and cause it to die. A blister forms around the dead wart tissue, and then it sloughs off in about a week to ten days. Cryotherapy is relatively painless, but may have to be repeated in many cases. If salicylic acid is not affective, this is often the next line of treatment, especially with children. Kids don’t mind this as much as some other remedies that are more painful.
• More invasive procedures such as burning the wart off with an electric needle, known as electrodessication and curettage, require a painful injection of anesthesia. The hands and fingers are very rich in nerve endings, so both the anesthesia and healing from the procedure can cause significant amounts of pain in these areas. Laser surgery is also an option, but it is often quite expensive. Both of these surgical procedures also have the potential to cause noticeable scarring.

Genital warts are particularly difficult to treat. The warts can be removed, but the viral infection remains, and is a chronic condition that will continue to infect patients for the rest of their lives. Many of the traditional treatments, such as those listed above, are more abrasive and painful when used on the sensitive skin of the genitalia. Your health care provider may also have a hard time locating smaller genital warts. Sometimes a vinegar-based solution is applied to the area, which can make the warts more easily visible, especially when using a magnifying device.

• One of the more interesting treatments for warts is duct tape. Even some mainstream medical doctors have jumped on the duct tape bandwagon, after seeing its highly affective results in clinical studies. It is thought the adhesive on the tape acts as an irritant to the wart tissue, similar to the action of salicylic acid. In one study, duct tape therapy was compared to cryotherapy, and it was found that the cryotherapy was only affective in about 60% of cases, while the duct tape showed a much better 85% success rate. The duct tape patients said they were glad they stuck it out (just kidding).
• As would be expected, doctors have an arsenal of drugs to use on warts patients, but most of them should be avoided due to side effects. One in particular that I would like to mention is called Imiquimod (Aldara). This “immunotherapy” drug is supposed to boost the immune response to the HPV virus and thus defeat the warts. It is often prescribed for genital warts. What they don’t tell you is that it only works in about one third of patients, and its possible side effects include: muscle weakness, fever, flu-like symptoms, blisters, scabs, swelling, pain, and fungal infections.

Some practical tips to avoid spreading warts to other parts of your body include not using a razor in areas with warts, not biting your fingernails or hang nails, not picking at warts, and washing your hands thoroughly after touching your warts. Keeping hands and other body parts dry is important as well, as warts thrive more easily in moist areas. Good foot care and hygiene is also recommended.