If you polled a group of dermatologists and asked about a common skin condition that is easy to diagnose, but difficult to treat, there’s a good chance a few of us would quickly groan “warts!”
What Are Warts?
Warts are benign skin growths that result from infection of the upper layers of skin with human papillomavirus (HPV). They often appear as rough, skin-colored bumps with black dots and can be solitary or numerous. While benign, warts are contagious and can be passed directly from person to person or via transfer from contaminated surfaces. You can even spread them to yourself, from one part of the body to another, in a process called autoinoculation.
There are many types of warts caused by different strains of HPV:
- Common warts (most commonly HPV strains 1, 2, and 4) are typically found on your hands, feet, and knees.
- Plantar warts (most commonly HPV strains 1, 2, and 4) are typically found on the palms and soles of your feet.
- Flat warts (most commonly HPV strains 3, 10, 28, and 49) can be found anywhere, but are typically found on your face, arms, hands, and feet.
- Oral mucosal warts (caused by 40+ strains of HPV) are typically found on the inside of your lips, cheeks, gums, tongue, or hard palate.
- Genital warts (also known as condyloma acuminata) are often found in your groin folds, pubic area, around the anus, as well as external and internal genitals. Two groups of HPV strains are responsible for genital warts and are distinguished by their association with HPV-related cancers, such as cervical cancer. HPV types 6 and 11 are considered low-risk subtypes; types 16, 18, 31, 33, and 35 are considered high-risk.
Skin that has been traumatized or broken in some way (from cuts, scratches, scrapes, shaving, or picking at hangnails) is more likely to be affected. Warts can affect all ages but are particularly common in children and those with suppressed immune systems.
What Are Some Ways to Treat Warts?
Luckily, warts are benign and do not absolutely require treatment. In fact, warts often resolve themselves without treatment, especially in children – thanks to our immune systems. However, this can take up to 2 years. Treatment is recommended if the warts are causing pain, are cosmetically bothersome, or are spreading quickly. There are many ways to rid yourself of these pesky growths, depending on the type of wart, the location of the wart, and the age of the patient.
An effective treatment available without a prescription or in-office procedure is salicylic acid. Salicylic acid can be purchased as a gel, ointment, solution, or medicated pad. I typically recommend soaking the wart in warm water, applying the 40% salicylic acid product directly to the wart, and covering it with a strong adhesive tape such as duct tape.
A popular in-office treatment is cryotherapy. The wart is first scraped to remove the dead upper layers of skin; this helps to make the treatment more effective. The wart is then frozen with liquid nitrogen for a few seconds for one to three cycles. It may take a few appointments to fully clear the wart (remember, they’re stubborn!), and is not suitable for small children due to associated discomfort.
Topical prescription medications, such as fluorouracil, imiquimod, cidofovir, and retinoids like tretinoin or tazarotene, can be added for widespread warts or those that have been resistant to prior treatments. Podophyllotoxin solution may be used for genital warts. Make sure you discuss appropriate use with your dermatologist, as these topicals are known to cause irritation and should only be used as directed.
Laser or injectable treatments are also utilized and must be administered by a dermatologist. Examples of medications that can be injected locally into the skin to eradicate warts include:
- Candida antigen: A form of immunotherapy that uses your immune system to help fight the warts
- Bleomycin: A chemotherapeutic agent
- Cidofovir: An antiviral agent
You can reduce your risk of getting warts by frequently washing your hands; not sharing items such as towels, socks, or razors; not biting your cuticles and nails; and wearing footwear in public, shared spaces. The HPV vaccine is also available and offers protection against many types of HPV associated with cancer.
How can a condition so common be so difficult to conquer? That’s a question many of us dermatologists ask ourselves day in and day out as we tackle the toughest warts most resistant to treatment. When warts do not resolve with at-home remedies, don’t hesitate to schedule an appointment with a dermatologist to review what treatment options are best for you.
Photo Credit: iStock / Getty Images
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