Banishing warts – includes related information on common warts, home wart cures and modern wart treatments

Banishing warts – includes related information on common warts, home wart cures and modern wart treatments

Banishing warts (I ficky, ficky thee: an old wart charm)

Since the discovery that transmissible viruses cause warts and that some warts may lead to cancer, fresh attention is focussing on their eradication.

Reports about warts date back to antiquity, and even in Roman times physicians suspected that warts might be infectious and sometimes sexually transmitted. Warts are very common and can occur at any age but are especially prevalent among children aged 12 to 16 – perhaps because of their intimacy and the frequency of open scrapes and scratches through which wart infections gain entry. One British study found that about 16 per cent of teenagers had warts on the hands, feet or face.

These somewhat distasteful, flesh-coloured skin protrusions appear on the fingers, face, feet or other parts of the body, including the genitals (where they may be tiny, flat and almost invisible). Some warts persist for years but unless uncomfortable, unsightly or a health risk may be ignored. While most warts are harmless and reasonably inconspicuous, some become exceptionally big, growing several centimetres across. If they occur in a prominent part of the body, such as the face, warts present a cosmetic problem; if on the soles of the feet they may be painful to walk on. Venereal or genital warts may lead to cervical cancer in women.

Warts are caused by viruses

Warts are due to an invasion of the skin or mucous membranes (lining tissues) by viruses known as papillomaviruses. These wart viruses were first seen under the electron microscope in the 1950s. Since then, 50 different sub-types of the human papillomavirus (HPV) family have been identified, each responsible for warts at specific body sites. Some individual warts contain several strains of papillomaviruses.

Quite contagious, these viruses enter the body through small cuts or abrasions in the skin and can be transferred from one body part to another – say, from hands to feet or face – or from person to person. It is possible to become infected by wart viruses from damp towels touched by an infected person or to pick up the foot HPV virus from the floors of changing rooms or showers. Genital warts are spread by sexual contact. Nasal wart viruses can be passed on among cocaine users who snort the drug through a shared holder, sometimes rolled dollar bills.

The amount of wart virus present in an infected area is greatest six to 12 months after infection, gradually declining thereafter, so that warts will usually disappear after a few months to a couple of years. There may be a time lag or “incubation period” of three months or longer between the time of exposure, when the virus enters the skin, and the appearance of a wart. With genital warts, people may have to think back to past sex partners to discover who gave them the infection.

Warts often vanish spontaneously

Most warts start out as small, pinhead-sized bumps that get larger over a few weeks or months, sometimes becoming flecked with little black spots. If cut, they bleed in pinpoint flecks. Warts vary in size and shape but generally have a limited life span. Left alone, most get smaller and disappear within three months to five years with an average vanishing time around two years. Many wart “cures” claim to take 12 weeks – a time span within which some warts would disappear without any treatment. How and why warts regress are still debated questions. Possibly the body’s immune defenses fight off the wart infection. Many wart treatments work by irritating the warts slightly so that they release wart antigen (active ingredient) into the blood, stimulating an immune response – either a cell-mediated (T-cell) response or antibody production. Treating warts in one place may get rid of others elsewhere.

Multiple, large, treatment-resistant warts can become a major problem, especially in people with any kind of immune system weakness or deficiency such as AIDS, those with leukemia or Hodgkin’s disease (a type of cancer), people on immunosuppressant drugs (such as organ transplant recipients) and cancer patients undergoing radiation or chemotherapy.

Removal of genital warts increasingly promoted

The latest medical wisdom calls for removal of genital warts because of their possible link to cervical cancer. But eradicating an underlying genital HPV viral infection is not easy nor necessarily accomplished by wart removal, since the virus invades large areas of the skin which may appear normal. Nonetheless, removal of genital warts is thought to reduce the virus load, diminish viral shedding, lessen infectivity and possibly stimulate the immune defenses. In males, long-term HPV infection and sub-clinical (hard-to-see) genital warts may produce dome-shaped, glistening Bowenoid papules or spots that look and test like precancerous lesions but are usually considered harmless. Nonetheless, as these spots contain viruses which could endanger sex partners, they too are best removed.

To prevent the spread of genital warts experts suggest that condoms be worn for several months after wart removal. Although not foolproof in stopping viral spread, they may reduce the chance of infecting sex partners. Follow-up doctor visits are advised to check for re-infection by examination with acetic acid (vinegar).

Wart cures old and new

The number and variety of wart remedies demonstrate the difficulty of ridding the body of this stubborn viral nuisance. Many wart cures, charms, incantations and spells date back to antiquity, the most popular incorporating the idea of magical transference of warts from the victim to something or someone else. For instance, Sir Francis Bacon, the 16th century scientist, rubbed warts with pork fat which he then hung out in the sun, hoping that his warts would disappear as the fat melted. In some parts of Britain, warts are still said to be removed by applying cow dung or rubbing the wart with a fresh potato and then throwing it away. In the Western U.S. mountain regions, folklore claims that rubbing warts with a coin and then throwing the coin away will eradicate them while in other parts of the world warts are said to be abolished by rubbing them onto the father of an illegitimate child. The reputed “success” of some bizarre wart cures may rest on the fact that most warts clear up within a few months on their own.

Home wart treatments require caution

Those who treat their own warts should realize that success depends on patience and may require at least 12 weeks of steady perseverance. Home wart-cures often fail because people give up too soon. Physicians warn that the wart treatment should never be worse than the problem itself. Since warts are generally harmless, treatment should be gentle and relatively painless without creating excessive blisters or irritation. Wart removers available as over-the-counter products usually contain salicylic acid and used properly can cure 70-80 per cent of common warts and 80-90 per cent of plantar foot warts. But great care must be taken not to over-irritate or inflame the area and apply the wart paint just to the warts, not to the healthy surrounding skin.

A rundown on some common warts

Common warts (Verruca vulgaris)

These solitary, raised, “spiky” bumps may grow larger over a few weeks, developing deep, scaly furrows of keratin (a hard protein). They bleed in pinpoint spots when pared or cut. Common warts may occur singly or in groups anywhere on the body but especially on hands, fingers and face – typically seen on children’s hands. Some common warts form a thin filamentous strand – especially on the neck and face or in the folds around the nail (very hard to remove). Regular treatment with over-the-counter peeling agents (such as salicylic acid and lactic acid in a collodion base) often succeeds in removing common warts, especially if applied after a good wash with soap and water and gentle abrasion with an emery board or callus-file.

Plantar warts

These foot warts are more common in adults than children. They are stubborn, long-living, deep-rooted, painful warts on the soles (plantar regions) of the feet. Under the constant pressure of walking they tend to flatten out or be pushed inwards into the foot, becoming very difficult to eradicate. Mosaic plantar warts are larger, broader foot warts that are particularly hard to get rid of. To distinguish an ordinary foot callus (skin thickening) from a real plantar wart, the test is what happens on cutting or paring the skin: a wart has tiny bleeding points, a callus doesn’t usually bleed.

Treatment of plantar warts is usually with a salicylic acid paint, cryotherapy (liquid nitrogen freezing) or laser treatment. Surgery, X-ray therapy and electrocautery are not recommended for foot warts, particularly if they occur on weight-bearing surfaces because of the danger of scarring and permanent discomfort. Gentle planing with an emery board may be all that’s needed until they disappear on their own. Quite often foot warts are better left alone rather than irritating the walking surface with harsh treatments. A scar on the foot due to treatment can end up being a lifetime nuisance – more painful than the wart it was meant to eradicate.

Plane or flat warts

Affecting both adults and children, these tiny, flat, slightly brownish warts usually appear on the face, arms, hands, neck or occasionally around the eyes. Localized, single flat warts are probably best left alone. Strong wart remedies should never be used on the face as they can cause lasting scars. Multiple severe, flat warts often require light liquid nitrogen freezing or use of prescribed vitamin A (retinoid) cream to cause superficial peeling and trigger the immune system into action by releasing a little wart antigen.

Genital warts (Condyloma acuminata)

The former Greek term for warts, condylomata, is now reserved exclusively for genital warts which occur around the anus and on the penis, vagina, vulva and cervix. Genital warts are increasingly common and affect as many as one third of young women in Canada. These warts, spread by sexual contact, are often flat, tiny and difficult to spot and diagnose. About two thirds of women and one third of men with genital warts also have signs of other sexually transmitted diseases such as chlamydia, gonorrhea or syphilis. There is mounting evidence that certain genital warts may trigger cancer of the cervix in women and, although rare, cancer of the penis in men.

Tips on home wart cures

* Treat warts every night unless the skin gets sore and irritated (in which case stop for a few days). * Soften the wart first by soaking it in hot soapy water for a few minutes. * Gently rub away dead skin with an emery board or pumice stone before applying wart remover. * Drop the wart paint on accurately with a toothpick or matchstick (commercial applicator tips often spread the chemical too far). Petroleum jelly (Vaseline) put around the wart can stop the solution from irritating the surrounding skin. * If the wart becomes painful or if after 12 weeks of self-applied wart treatment it isn’t gone, seek advice from a family doctor or dermatologist. * Never use over-the-counter wart paints, liquids or plasters on the face or genitals.

Two harmless but unproven home wart cures

A couple of wart cures, recently reported in medical literature, claim high success rates without harmful effects: * Taping. Completely cover the wart and surrounding skin by binding it (but not so tightly that it cuts off circulation) with plain surgical adhesive tape. Leave the tape on for seven days in all, removing it after the first 12 hours, and then rebinding for a further six days. This process can be repeated until the wart disappears. The method supposedly works well for finger warts. * The Banana Cure. Cut pieces of fresh banana skin no bigger than the wart and secure with surgical tape. Apply fresh banana skin every morning. After a few weeks to three months, the wart should vanish.

Modern wart treatments

* Salicylic acid is the first line of attack for warts and promises success for up to 80 per cent of common warts. Used regularly, salicylic acid will often cure common warts on the hands and feet within 10-12 weeks. It is also useful for eradicating flat, filiform and small foot warts. Salicylic acid is usually marketed in a collodion base that hardens and “covers” the area to be peeled. As a solution or paste it is applied nightly from a dropper or applied as a plaster (stronger form). The peeling action and slight irritation release some wart virus, activating the immune defenses. Since these paints or solutions can destroy not just the wart but also damage the surrounding skin, they must not be lavishly splashed on but applied to the wart with a toothpick, match, or cuticle stick (many supplied applicators are too large). Wart paints are most effective if applied after the wart has been soaked in water and gently rubbed with a pumice stone or emery board to remove the loose, top skin layer allowing the solution better entry. If the skin gets rough, cracked or painful, salicylic acid treatment should be stopped for a day or two until the skin heals. * Cryotherapy involves freezing (with liquid nitrogen) over a period of weeks to months, repeating the freezing treatment every one to three weeks. If too long a gap intervenes between freezings the warts may regenerate. Cryotherapy is a simple process and done correctly should not leave scars. It may be used in conjunction with home salicylic acid therapy and is often the treatment of choice. It can be safely used during pregnancy. * Cantharidin, available by prescription, is a mitochondrial cell poison that causes cell membranes to break down and form blisters which may help to get rid of some especially resistant warts around the nail and other areas, usually producing no scarring. It should be used with extreme caution, especially in children, and not on the face as it can damage the mucous membranes of the nose, mouth and eyes. * Interferon and other immune-system stimulants have been tried for difficult warts with good reported cure rates. However, the cost, risk of skin reactions and other side effects limit their usefulness. * Enucleation (blunt paring) to remove bulk may be useful for resistant plantar and other warts to get rid of a big wart but needs great care on pressure-bearing surfaces and remains a controversial method. * Electrocautery is sometimes used to destroy large warts, done under local anesthetic, to burn off the wart – but never on the weight-bearing surfaces of the feet. * Laser treatment is highly successful in eradicating resistant genital and common warts, sometimes used as an adjunct to other wart remedies – but not on weight-bearing surfaces as it can produce a scar similar to those left by electrocautery or surgery. * Surgery. Many experts feel that there is no place for surgery in the treatment of warts, particularly since the wart virus may spread around the cutting area, leading to recurrence. Surgery may also leave a lasting scar or painful lump, particularly uncomfortable on the foot. It’s not a good idea to pare off or remove warts with a razor! * New approaches include the use of retinoid (vitamin A) creams and inosine pranobex, but these chemicals are only suitable for a selected few, used under close medical surveillance. * Vaccines against HPV wart viruses are being developed but will be a long time coming because of the many viral subtypes (as with flu) which make production difficult.

Genital warts can be removed by:

* Podophyllin, a natural extract of plants such as the Wild Flower May Apple, arrests cell division and is used in a 25-50 per cent solution. Petroleum jelly is put onto the surrounding skin to protect it from the solution, which is precisely painted onto the wart once a week, left on two to six hours, then washed off. As treatment proceeds, podophyllin solution may be left on for progressively longer periods but some blistering may occur and occasionally severe swelling and inflammation if too much is used. Podophyllin should not be used in pregnant women because it affects fetal development, nor should it be put on the vagina because it can be absorbed into the bloodstream causing vomiting and nausea. Self-treatment is not recommended. If four to six podophyllin treatments fail to get rid of genital warts, other methods such as freezing with liquid nitrogen, laser treatment or electrocautery may be tried. (A biopsy is recommended before starting treatment to check for cancer-causing viral strains.) * Trichloracetic acid treatment may help to remove genital warts. * Cryotherapy or freezing is a popular, easy way to remove genital warts. Multiple freezing sessions may be needed and there is occasionally some local discomfort although the genital area generally heals easily and fast. * Electrocautery can be useful in removing large areas of genital wart infection leaving little or no scarring in this area. * Laser treatment is increasingly used to remove genital warts that resist other treatment. * Fluorouracil cream (containing an anti-cancer drug which blocks cell division) is a “last-ditch” method occasionally used for widespread stubborn genital warts in women but requires great care.

COPYRIGHT 1989 Strategic Inc. Communications Ltd.

COPYRIGHT 2004 Gale Group