Wart a problem!

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How often have you been troubled by what you think is a corn on the foot? Only on consulting a doctor do you understand if it is a harmless corn or a viral infection called warts. So what is the difference? Dr. T.D. Rajan helps to unravel this mysterious skin infection.

Warts are dirty looking growths on the skin which multiply without causing any pain or itching. They seem harmless over most parts of the body except when it appears on pressure-bearing areas of the feet or the fingers.

These are caused by Human Papillomavirus (HPV) which enters the skin through tiny nicks and cuts. Once it gains entry into the upper layers of the skin (epidermis), it hijacks the cell to multiply more rapidly than the surrounding cells, leading to a tiny bump with a rough surface.

Warts can occur at any age and on any part of the body. However, they are commonly seen on the fingers, hands, forearms, legs, face and neck. In housewives and canteen workers they are very common due to repeated injuries and cuts during work. Likewise, they are often seen in embroidery workers, hairdressers and butchers. On the feet, warts commonly occur among farmers and people who walk bare feet.

Types of warts
Here are the types of warts which occur in human beings.

  • The classical type, common warts (medically termed Verruca vulgaris) are cauliflower-like growths that can occur on any part of the body, but the commonest areas are the forearms, hands and feet. By themselves, warts cause no itching or pain. However, when the wart is located on the weight-bearing areas of the feet, pressure point of the hands or around the nail, pain is common.
  • Being contagious, they spread not only on one’s own body by contact; they also spread rapidly to others. Children get warts on their body from parents who have unknowingly transferred it from their fingers! School-going children may get warts on the elbows and knees due to injuries from the playground.
  • On the face, warts give an unclean appearance. There are different varieties of warts on the face. The commonest types are plane warts which look flat, rough and gray, thread-like projections called Filiform warts and multiple threads arising from a common base, called Digitate warts.
  • Unlike in women, in men warts are known to cause havoc on the face by rapidly multiplying into large numbers. By repeated cuts during shaving, a man with a couple of neglected warts may find over twenty or thirty warts all over the cheeks and chin, in a few months.
  • Warts can occur around the nail and may sometimes grow beneath the nail causing distortion of the nail itself. These often are painful and could interfere with day to day activities. Children may find it difficult to hold the pencil in such cases.
  • Warts arising on the feet (plantar warts) do not get elevated but get compressed by the weight of the body. Thus it forms a compressed mass, which looks like a corn (see box) with a dirty surface. Warts located on the heel and along the ball of the great toe cause intense pain, interfering with walking or sports activities.
  • Warts can also occur on the genital areas. Being transmissible, they can spread to the partner through sexual intercourse.
  • In extremely rare situations, some types of HPV causing genital warts have been implicated to cause cancer of the cervix (the lower part of the uterus).
  • How are warts treated?
    Although warts are generally harmless and could even disappear spontaneously when left alone, once they are noticed they need to be quickly removed as they are liable to spread and multiply. Treatment of viral warts is a challenge as they sometimes tend to reappear at newer places. Even after all warts are treated, one should be alert to the appearance of newer warts, as there is no internal medication against HPV.

    Warts around the nails can often be very painful

    Warts around the nails can often be very painful

    Local medications: Local medications containing fluorouracil, imiquimod and cantharidin are applied to the wart to allow them to shrivel and fall off. Unfortunately, these applications have to be repeated at intervals to ensure successful treatment.

    Chemical treatment: Application of a combination of acids (Salicylic acid-lactic acid in an alcoholic film) to the wart every night after soaking the wart, helps to dry up the superficial layers. By gently scraping with a file and repeating this application over a couple of weeks the wart gets shed off. The process must be continued till the doctor confirms that the entire mass has come off. These acids must be applied with caution to avoid spilling on to eyes and other sensitive areas. On the face, these acids are not usually recommended. It is best to ask your doctor to demonstrate the actual method of application so that no harm is caused to the surrounding skin.

    Electrocautery/Lase: The wart is removed by burning it through CO2 laser or electrocautery after numbing it with local anesthetic agents. The entire mass of the wart thus gets expelled and the wound thus created heals over a few days with a neat scar.

    Freezing: A cryotherapy tip freezes the wart through a flow of Nitrous oxide gas. Alternatively, ‘liquid nitrogen’ tipped applicator is used to destroy the wart. Over the next few days a bubble develops at the spot which ruptures and heals with normal skin. In some locations, the process needs to be repeated after a couple of weeks to clear the wart.

    Corn or wart?
    Plantar wart under the foot

    Plantar wart under the foot

    People think that corns and warts are the same. It is not. While warts are caused by viruses, corns are not. Corns are simple thickening of the skin, particularly on the palms and soles due to repeated friction over a small area. It could be due to the pressure of holding an instrument at work or a knife while cutting vegetables.
    On the foot, an ill-fitting shoe could cause repeated friction at one point leading to a thick, hard, mass of skin. When the skin is soaked and then scraped, powdery skin is obtained till the entire corn is scraped off. So, in short, it is nothing but thickened layers of dead cells of the skin.
    Pain occurs in both cases due to its mass compressing the deeper tissues. However, warts cause severe pain when the pressure falls on it at an angle, like when one steps on an uneven surface.

    Surgical removal: In some cases, the wart is too large to be treated by other methods and needs to be operated and removed. When warts occur under the nail or close to the nail bed, surgery to remove the nail may be necessary before removing the wart.

    Oral medications:There are no specific oral medicines to treat warts. However, nutrititonal supplements are often given to boost immunity. Tablets containing zinc are given as they work as immuno-modulators and help the body to expel the wart virus.

    Conclusion
    Warts are thus one of the most harmless of viral infections, but they need to be completely eradicated to prevent it becoming a social nuisance. Left alone, it is bound to multiply on the skin and become contagious to others who mingle together at home, school or at work. It is important to comply with the doctor’s instructions to keep treating it till the last wart is eradicated to avoid the risk of recurrence.


    Rajan

    T.D. Rajan

    The writer is a senior skin and sexually transmitted diseases specialist, practising in Mumbai. He advises pharmaceutical companies on drug branding, promotion and marketing. He is a writer on social topics in the print and electronic media, as well as in pharmaceutical magazines. Dr. Rajan is also an Hon. consultant to ONGC, Larsen & Toubro and Air India.

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