Warts

Warts
Warts are pesky bumps caused by a virus called HPV. They are quite contagious and often difficult to treat. No matter what therapy is used, warts generally require multiple treatments to get better. It is not possible to predict how many times a particular wart has to be treated before it completely goes away. Some warts seem to be “friendlier” than others and may go away with very few treatments. Other times, a wart may still not go away even after lots of treatments and different medications.
Overall, warts tend to resolve at some time even without any treatment. The problem with leaving them without treatment is that they may spread to other body parts or other people. There are many ways to treat warts and we are committed to finding the best therapy designed for your wart. It is very important to keep your follow up appointments for best results.

Photo of finger wart: HPV


Please check with your own Dermatologist for your personalized wart medication. This is a sample treatment and not intended to serve as medical advice.
PERSONALIZED WART TREATMENT:
1. It is important to remove the thick skin overlying the wart. This is much easier after soaking the wart, or after a shower or bath. You may file down the wart with a coarse emery board or callus peeler (from drugstore).2. Apply the following each morning under a piece of tape ( electrical or silver duct tape or Band-aid.: : ( if too irritating, stop the tape or use every other day)
40% salicylic acid patch
3. Apply the following each evening: ( if too irritating, stop tape or decrease use to every other night)
Aldara cream or Efudex cream
Photo of common wart: HPV Child face
4. If your skin gets red, raw or too sore, please stop the medications and call us at 949-582-7699 to return for a re- check. If you have any allergic reaction, stop the medication and call our office.5. Return to the doctor in 2-3 weeks for your follow up check.
 
 
 
Photo of plantar wart: HPV wart on sole of foot

 

 

 

 

 

 

 

 

Photo of nose wart: HPV in nostril may be caused from picking nose with finger wart


 
 WARTS    “20+ ways to lose a wart”

Warts, officially called verrucae , are extremely common. There are several types: the common wart ( verruca vulgaris), flat warts ( verruca plana), foot sole warts (verruca plantaris), and genital warts (condylomata accuminata). About 7-10% of the population is affected at some time by these pesky warts. They pose a cosmetic and treatment concern. The highest incidence of warts is in children ages 10-19. They can incubate anywhere from 1-9 months before they become apparent. Warts can last anywhere from as little as 2-3 months and up to more than 5-10 years. Fortunately, even without any treatment at all, about 25% disappear by 3-6 months. Another 50-65% may disappear by 2 years
spontaneously.Warts are most common on locations like fingers, hands & elbows. This may be because of more local trauma and contact with these areas. Warts can also spread in scratched areas or spread in areas of trauma. Any small breaks or abrasions in the skin create a nice open door and can cause the warts to spread there.All Warts are caused by a virus. They are quite contagious and in general, very challenging and difficult to treat. The virus is called Human Papilloma Virus ( HPV) and there are many different kinds of these viruses. Some of these virus types are “ friendlier’ than others, meaning that they aren’t as pesky and somewhat easier to treat. There is absolutely no unanimously single effective treatment for a wart. They are at best unpredictable and generally require multiple treatments regardless of the therapy used. Even after they go away, there is a 5-10% chance that they recur.
Overall warts are hard to treat. Some of the even more difficult areas are around the nails, under the nails, and plantar ( sole of the foot) warts.It is very important to complement any physician applied in-office treatments with home maintenance. Good at-home treatments include strong 40% salicylic acid patches ( available without prescription) and filing / gently shaving down the wart . With treatment, we can expect some improvement over 2-4 weeks. However, there is never any guarantee with warts and they are somewhat unpredictable. With continuous treatment, they can resolve as soon as 4-12 weeks. Overall, the best treatments for warts combine several therapies all at the same time for maximum clearing.Not everything that looks like a wart is always a wart. What other things can look like a wart? Benign irritated barnacles ( seborrheic keratosis), soft corn, callus, Molluscum ( another viral condition common in children), irritated moles, “picker’s wart” , or an irritated skin tag.

 

WART TREATMENT MENU:
1. Salicylic acid preparations- available at the pharmacy, over the counter without a prescription
Some names include Tenamed, Mediplast , Duofilm, Occlusal HP, Trans Ver sal.
Apply these directly to the wart daily.
PROs- Not painful, can be self applied, inexpensive, overall good treatment
CONs- needs repeated daily application, can irritate surrounding skin, may be slow
2. Liquid nitrogen (freezing)- doctor applied therapy
For best results, need to repeat every 2-4 weeks
PROs- quick/ fast application, physician supervised
CONs- May be very uncomfortable in some areas ( fingers) and some patients, painful for some children, causes blister, requires cost and time of doctor visit every few weeks until gone3. No treatment- remember that even without any treatment, some warts spontaneously clear
PROs- Free
CONs- warts may spread to other sites, may not go away, and may spread to other people4. Scraping off and burning (Currettage and dessication)- doctor’s office procedure using local anesthesia
For resistant or recurrent warts.5. Power of suggestion “ charming of warts”
Distant Healing, hypnosis

6. Acupuncture / Acupressure

7. Duct Tape applications
8. Condylox 0.5% topical solution- prescription product applied by patient at home
Best for moist warts
9. Cantharidin- “ beetle juice”- physician applied in-office to warts
Potent blistering agent. Comes from the blister beetle.
10. Formalin (4ml of 40% formaldehyde in Aquaphor) apply daily by patient at home11. Lasers-
More for resistant or recurrent warts.
Not a fast cure-all. Still may need multiple treatments.12. Interferon therapy
Topical and injected interferon alpha and beta13. Aldara cream- presciption product
Helps body’s own immune system recognize the wart and remove it
Need to apply 3 times a week or daily for up to 16 weeks
14. Podophyllin resin 20-25%
Physician applied in office with cotton tip applicator
Patient will wash off at home in 4-6 hours
15. Retin A or Tretinoin cream
Mild treatment, no scarring, and good for numerous flat warts, facial or neck lesions16. Efudex 5% cream- prescription cream
Applied at home by patient17. cimetidine ( Tagamet) – pills taken by mouth
Off label use of a well known stomach ulcer medication
Best for patients with numerous warts, particularly in pediatrics18. Bleomycin- chemotherapy medication injected directly into the wart

19. Trichloracetic acid ( saturated solution) 50-90%- Physician applied in office every 1-3 weeks

20. Hot water immersion ( Hyperthermia)
for 30-45 minutes 2-3x/week , about 16 trts
CAUTION- do not burn skin

21. Squaric acid sensitization- physician applied initially, then patient resumes at home

22. Cidofovir – new antiviral ( not yet widely available)

23. Photodynamic therapy with 5- Aminolaevulinic acid ( PDT with 5-ALA)

24. Smallpox vaccine
Not recommended
30-60% remission, but risk of scar

25. Surgical removal or excision
More for very resistant or recurrent warts. Recurrence still is possible and no guarantee of cure.


 


The Skin Center   Diplomate, American Board of Dermatology

Personalized Wart Handout         

26081 Merit Circle, Suite #109   Laguna Hills, CA 92653   

 949-582-skin Phone/ Fax 949-582-7691

Warts are pesky bumps caused by a virus called HPV. They are quite contagious and often difficult to treat. No matter what therapy is used, warts generally require multiple treatments to get better. It is not possible to predict how many times a particular wart has to be treated before it completely goes away. Some warts seem to be “friendlier” than others and may go away with very few treatments. Other times, a wart may still not go away easily even after lots of treatments, doctor visits, and different medications. It is very important to understand that no wart treatment (including surgery) is 100% effective. Overall, warts tend to resolve at some time even without any treatment. The problem with leaving warts without treatment is that they may spread to other body parts or other people. There are many ways to treat warts and we are committed to finding the best therapy designed for your wart. Some creams or treatments may not be specifically FDA approved as “anti-wart” medicines. If your insurance does not cover your prescription or it is too costly, we would be happy to change to another medication per your request. There is no “crystal ball” to tell when warts will clear. It is very important to keep your follow up appointments for best results. Our goal is to help you clear your warts as fast and painlessly as possible. Often, combination treatments using in office special care and home applications are best. Please let us know how we can best design your personalized anti-wart recipe.

 

PERSONALIZED WART TREATMENT

 

1.      ONCE  DAILY: It is important to remove the thick skin overlying the wart. This is much easier after soaking the wart, or after a shower or bath. You may file down the wart with a coarse emery board or callus peeler (from drugstore).                                                                                                                           

2.      AM: Apply cream each morning under a piece of tape (clear tape, electrical tape, silver duct tape, or Band-aid.) If too irritating, stop the tape, decrease use of products to every other day, or just stop the cream.

Aldara cream    or                Efudex cream   or         Retin A   or                       Tazorac                                  

3.      PM: Apply the following 40% salicylic acid patch each evening and cover with piece of tape. Use a small piece of patch only on the wart . Do not use on regular skin. If too irritating, stop tape or decrease use.

*purchase at pharmacy*    40% salicylic acid patch:  Trans Ver Sal patch  or   Mediplast or   Tinamed               

4.      Only if directed by physician for numerous warts or resistant warts- Take Cimetidine pills to help boost your immune system and decrease warts. This pill is not an approved “anti-wart” medicine and its use is called ‘off-label” for warts. It is a safe FDA approved pill for stomach upset and acid reflux type problems.

Take Cimetidine (Tagamet)  200mg   400mg  800mg:            # pills           2    times a day                                

5.      If your skin gets red, raw or too sore, please stop the medications and call 949-582-SKIN for a re-check appointment.  If you have any allergic reactions, stop the medication and call The Skin Center.

6.      We would like to see you in 2 weeks for your follow up check.

We look forward to your next visit & helping you get rid of those pesky warts!




REFERENCES: NIH WARTS

Warts

Plane juvenile warts; Periungual warts; Subungual warts; Plantar warts; Verruca; Verrucae planae juveniles; Filiform warts; Verruca vulgaris

Last reviewed: December 11, 2009.

Warts are small, usually painless growths on the skin caused by a virus called human papillomavirus (HPV). They are generally harmless. However, warts can be disfiguring and embarrassing, and occasionally they itch or hurt (particularly on the feet).

The different types of warts include:

  • Common warts usually appear on the hands, but can appear anywhere.
  • Flat warts are generally found on the face and forehead. They are common in children, less common in teens, and rare in adults.
  • Genital warts(condyloma) are usually found on the genitals, in the pubic area, and in the area between the thighs, but they can also appear inside the vagina and anal canal. (See: Genital warts for more information)
  • Plantar warts are found on the soles of the feet.
  • Subungual and periungual warts appear under and around the fingernails or toenails.

Causes, incidence, and risk factors

The typical wart is a raised round or oval growth on the skin with a rough surface. Compared with the surrounding normal skin, warts may appear light, dark, or black (rare). Most adults are familiar with the look of a typical wart and have little trouble recognizing it. Unusual warts with smooth surfaces or flat warts in children may be more difficult for parents to recognize.

Common warts tend to cause no discomfort unless they are in areas of repeated friction or pressure. Plantar warts, for example, can become extremely painful. Large numbers of plantar warts on the foot may cause difficulty walking or running.

Some warts will disappear without treatment, although it can sometimes take a couple of years. Treated or not, warts that go away often reappear. All warts can spread from one part of your own body to another.

Unsightly or painful warts can be treated. Warts around and under your nails are much more difficult to cure than warts in other places.

Symptoms

  • Abnormally dark or light skin surrounding the lesion
  • Numerous small, smooth, flat (pinhead sized) lesions on forehead, cheeks, arms, or legs
  • Rough growths around or under fingernails or toenails
  • Rough, round, or oval lesions on soles of feet — flat to slightly raised — painful to pressure
  • Small, hard, flat or raised skin lesion or lump

Signs and tests

Warts can generally be diagnosed simply by their location and appearance. Your doctor may want to cut into a wart (called a biopsy) to confirm that it is not a corn, callus, skin cancer, or other similar-appearing growth.

Treatment

Over-the-counter medications can remove warts. These are applied to the wart every day for several weeks. Do NOT use these medications on your face or genitals. It helps to file the wart down when damp (for example, after a bath or shower) before applying these medications. Do NOT treat warts on your face or genitals yourself. See your health care provider.

Pain and pressure from plantar warts can be treated with special cushions that are available at drug stores.

Your health care provider may use stronger (prescription) medications, such as podophyllin or salicylic acid, for removal of persistent warts. Surgical removal or removal by freezing (cryotherapy), burning (electrocautery), or laser treatment may be needed.

Immunotherapy, done by injecting a substance that causes an allergic reaction, may also be considered by your health care provider. A topical medication called imiquimod may also be used.

A vaccine called Gardasil prevents infection against the strains of viruses that often cause genital warts and cervical cancer in women.

Do NOT attempt to remove a wart yourself by tearing or picking.

Expectations (prognosis)

Warts are generally harmless growths that often go away on their own within 2 years. They can be contagious, but transmission from person to person is uncommon. Warts may be unsightly or cause discomfort, especially on the feet.

Complications

  • Spread of warts
  • Return of warts that disappeared
  • Minor scar formation if the wart is removed
  • Formation of keloids after removal

Calling your health care provider

Call for an appointment with your doctor if:

  • There are signs of infection (red streaking, pus, discharge, or fever) or bleeding. Warts can bleed a little, but if bleeding is significant or not easily stopped by light pressure, see a doctor.
  • The wart does not respond to self-care and you want it removed.
  • You have pain associated with the wart.
  • You have anal or genital warts.
  • You have diabetes or a weakened immune system (for example, HIV) and have developed warts.
  • There is any change in the color or appearance of the wart.

Prevention

  • Avoid direct skin contact with a wart on someone else.
  • After filing your wart, wash the file carefully since you can spread the virus to other parts of your body.
  • After touching any of your warts, wash your hands carefully.

References

  • Warts, herpes simplex, and other viral infections. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 12.
  • Gibbs S, et al. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2006;(3):CD001781. [PubMed: 16855978]
Review Date: 12/11/2009.Reviewed by: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Disclaimer

Copyright © 2011, A.D.A.M., Inc.

 
 


Call to Schedule an appointment at (949) 582-SKIN 
Dr. Gary Cole and Dr. Nili Alai are Board-Certified Dermatologists.
For more information, please call (949) 582-7699 or visit the practice website at
www.lagunaskincenter.com.

Information in this publication and site is not intended to serve as medical advice. Individuals may use the information as a guide to discuss their treatments with their own physicians. This site does not promote nor endorse the unauthorized practice of medicine by non-physicians or state licensed health care providers.
Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of these artciles have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert.

 

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