Warts

DSC01321.JPG

Fingers are a common site for wart formation.

What do skin warts look like?

Skin warts are raised round or oval growths. They can be lighter or darker than the skin around them. Some warts have tiny black dots in them, often called seeds. Warts can appear alone or in groups that join and form patches.

Different types of warts affect different parts of the body:

Common skin warts can show up anywhere on the skin but most often affect the fingers, hands, knees, and elbows.

When common warts are found around the fingernails, they are called “periungual” warts.

Plantar warts are found on the soles (bottoms) of the feet

Flat warts are usually found on the back of the hands, face, and lower legs

What causes skin warts?  Warts are caused by germs called viruses. You can get infected with the virus that causes warts by touching another person’s wart. You can also get infected by touching objects that have the virus on them. For instance, people can catch warts by walking barefoot around pools, locker rooms, or gyms.

Should I see a doctor about my wart? 

You should see a doctor  if:

You are not sure that what you have is a wart

Your wart does not go away with home treatment

You would like to use home treatment, but are not sure which treatment is right for you

Not everyone needs treatment for warts. Some warts go away on their own within 2 years. But warts can also get bigger or spread, so many people decide to treat their warts.

Is there anything I can do on my own to get rid of warts? — You can try something called “salicylic acid.” This is a mild acid that you put on warts. It is sold in drugstores and comes in different forms, such as a liquid or patch. If you decide to try salicylic acid, follow the directions on the label. But do not use this treatment if you have a form of nerve damage called “neuropathy.”

How does Dr.Paul Kattupalli treat warts? — Dr. Paul Kattupalli has a few ways to treat warts.

Freeze the wart off with a special fluid that gets very cold (called liquid nitrogen)

Treat the wart with a medicine called cantharidin  that destroys warts. This treatment is not painful at first, but it sometimes causes pain, blisters, and swelling shortly after use.

Shave the wart off with a knife (after numbing the skin)

Prescribe a skin cream that helps the body get rid of warts

Inject the wart with a medicine that helps the body fight the virus that causes warts

Common warts and plantar warts : 

First-line treatment — Topical salicylic acid and cryotherapy with liquid nitrogen are the most common treatments for common and plantar warts and have the strongest evidence for efficacy. Plantar warts may be less likely to respond than common warts.

Salicylic acid — Topical salicylic acid exfoliates the affected epidermis and may also stimulate local immunity. Advantages of salicylic acid include self-administration, painless application, and minimal risk for serious side effects.

Efficacy – A 2012 meta-analysis of randomized trials found salicylic acid superior to placebo for clearance of warts (relative risk [RR] 1.56, 95% CI 1.20-2.03). Reports of the likelihood of wart clearance following salicylic acid therapy range from 0 to more than 80 percent.

Administration – Salicylic acid is applied directly to the wart. Skin should be dry prior to application. Application is typically repeated daily. Duct tape or other tape is useful for securely attaching salicylic acid pads and occluding salicylic acid ointment on the skin. If tape is used, the tape and salicylic acid can be replaced every 48 hours. Salicylic acid treatment should not extend beyond 12 weeks without assessment by a clinician.

Paring of the wart should be repeated periodically to minimize build-up of hyperkeratotic debris. Soaking the wart for five minutes can facilitate paring and removal of hyperkeratotic debris.

Salicylic acid is often combined with other wart treatments in an attempt to improve the response. We often combine salicylic acid therapy with cryotherapy, with salicylic acid applied between cryotherapy treatments. Data to confirm benefit are limited. A meta-analysis of two randomized trials found greater benefit of combination therapy with a topical salicylic acid/lactic acid product and cryotherapy compared with topical treatment alone for hand warts but not foot warts.

Side effects – Local skin irritation is a common and expected side effect. If significant, the frequency of application should be reduced. Salicylic acid should not be used in patients with peripheral neuropathy due to a reduced ability to detect tissue damage and increased risk for poor healing.

Cryotherapy — Cryotherapy with liquid nitrogen is a common clinician-administered treatment. A disadvantage of cryotherapy is the pain associated with treatment. As a result, cryotherapy is primarily used for warts in older children and adults and often avoided in young children.

Administration – Plantar warts and other hyperkeratotic warts should be pared before treatment. Liquid nitrogen can be administered with a cryospray or a cotton bud dipped in liquid nitrogen. Wart virus can survive in liquid nitrogen; therefore, dispensing a small aliquot of liquid nitrogen into a disposable cup is recommended rather than dipping cotton buds into a communal flask.

Treatment is repeated every two to three weeks until wart resolution. If a response does not occur within six treatments, it is reasonable to transition to an alternative treatment.

Cryotherapy should be applied cautiously on the digits to prevent severe pain and possible neuropathy. Periungual warts should be treated with caution due to avoid damage to the nail matrix and permanent nail dystrophy.

Other Treatments for warts include topica immunotherapy, intralesional bleomycin, fluorouracil, cantharidin, imiquimod, trichloroacetic acid, duct tape, pulsed dye laser, intralesional immunotherapy, surgery, oral cimetidine etc. If you want to discuss these treatment options, please visit our clinic to talk to Dr.Paul Kattupalli. Thank you.

Advertisements