What is Wart?
Warts are harmless growths that appear on the skin and slimy layer inside the body, also known as mucosa. They are caused by the human papillomavirus (HPV), and there are over 100 types of HPV. These growths can occur anywhere on the body. The most common types of warts caused by HPV include common warts, genital warts, flat warts, thick and rough warts on hands and feet (Myrmecia), tiny bumps on the skin (focal epithelial hyperplasia), a skin disorder causing wart-like growths (Epidermodysplasia verruciformis), and painful lumps on the bottom of the feet (Plantar cysts).
Warts can be passed from person to person through direct touch or even by contact with something that has been touched by a person with the virus. Situations that break or damage the skin surface increase the chances of getting warts. Treating warts can be challenging. In many cases, they disappear on their own after a few years.
However, some types of HPV are more harmful and can lead to cancer. These include types 6, 11, 16, 18, 31, and 35. The risk of warts turning into cancer is usually seen in people with genital warts and those with a weakened immune system. Moreover, HPV types 5, 8, 20, and 47 also have the potential to cause cancer, leading to the condition known as epidermodysplasia verruciformis.
What Causes Wart?
The Human Papillomavirus (HPV) has over 100 different types, but only a handful of these are capable of causing skin warts; these warts tend to appear in specific areas of the body. Nevertheless, with skin-to-skin contact, HPV can end up on any part of the body. HPV is known for causing genital warts, flat warts, and warts on palms or soles of the feet (palmoplantar warts).
Warts can easily spread through direct touch, or indirectly through objects touched by someone with the virus. This is especially true if the protective outer layer of skin is broken. Along with skin, warts can also develop on mucous membranes which are the moist linings of certain parts of the body like the nose, mouth, and lungs.
Generally, HPV only affects the outer layer of the skin, called the epithelium, and it doesn’t usually spread through the body. The virus multiplies mainly in the upper part of this skin layer, but virus particles can also be found in the lower part.
Different HPV types are linked with different kinds of warts:
– Common warts are usually due to HPV types 2 and 4, followed by types 1, 3, 27, 29 and 57.
– Flat warts are mostly caused by types 3, 10, and 28.
– Warts found deep on the palms or soles are mainly caused by type 1, followed by types 2, 3, 4, 27, and 57
– Cystic warts, which have a softer surface than common warts, are caused by type 60.
– Focal epithelial hyperplasia, a condition causing benign growths in the mouth, is caused by types 13 and 32.
– Butcher’s warts, common in people who handle raw meat and fish, are caused by type 7.
Risk Factors and Frequency for Wart
Warts are a common medical condition that affect people around the world. They are particularly prevalent in certain demographics and have varying rates based upon age, race, and occupation.
- Warts affect about 10% of the population globally.
- In children of school age, warts can occur in 10-20% of the population.
- They are particularly common in people who have weakened immune systems or work with meat.
- While warts can appear at any age, they are rare in babies and young children.
- The rate of warts increases in school-aged children, reaching its peak in people aged 12 to 16.
- Warts are twice as common in white individuals compared to black or Asian individuals.
- Focal epithelial hyperplasia (or Heck disease) is more common in Inuit and American Indian populations.
- Warts occur in both men and women at similar rates.
Signs and Symptoms of Wart
Warts usually do not cause any symptoms apart from affecting one’s appearance. In some rare cases, they might cause localized pain. Plantar warts, found on the underside of the foot, can be uncomfortable due to their location, which can be subject to friction and pressure, leading to bleeding. If large, they can disrupt walking and make it difficult to fit into shoes.
On examination, a regular wart may look like a raised bump with an uneven texture and shape. It can be as small as 1 mm or as large as several centimeters, and are typically found on the hands and legs.
Warts around the lips and eyelids may appear thin and long, while plantar warts may be mistaken for hardened skin or a callous due to their depth and can be painful when touched. Flat warts are flesh-colored and can range from 1 to 7 mm in size. In some cases, a person may have hundreds of these.
- Butcher’s warts occur in those who work with raw meat. These warts usually have a cauliflower-like appearance and can be quite large.
- Focal epithelial hyperplasia is a type of wart that appears in the mouth. These small white bumps are usually 1-5 mm in size and appear in groups.
- Cystic warts are usually found on weight-bearing areas like the soles of the feet and have a smooth texture.
Testing for Wart
Your doctor can usually identify a wart through a simple physical examination. However, to completely confirm its presence and understand more about it, some lab tests might be needed.
In some cases, laboratory studies are conducted to detect specific proteins which would confirm the presence of Human papillomavirus (HPV), a virus that usually causes warts. However, this method might not always be accurate. Another technique, known as Southern blot hybridization, can be more precise and can also identify the specific type of HPV. A different test, the polymerase chain reaction, can increase the amount of viral DNA to make it easier to analyze. It’s important to note though that HPV might not always be found in older warts.
In situations where the diagnosis is unclear, your doctor might need to get a tissue sample, or a biopsy, from the wart. By reducing the size of the wart, or paring it down, tiny black dots might be revealed. These dots represent small blood vessels that have clotted, which are common in warts.
Treatment Options for Wart
Once a doctor has confirmed you have warts, the course of treatment will depend on a variety of factors. These include the severity of your symptoms, your personal treatment preferences, and the cost of treatment. Sadly, there isn’t a guaranteed cure for warts. All available treatments have a risk of the wart returning. Ideally, a less expensive and less painful treatment is tried first.
Costly and invasive treatments are usually kept for stubborn warts that keep coming back. But in some cases, doing nothing can also be a valid form of treatment, because around two-thirds of warts will naturally disappear on their own within two years. The only downside to this is that some warts may get larger or spread to other areas of the body.
Initially, creams and ointments that can be applied directly to the wart are typically used. For example, salicylic acid is a frequently used treatment that doesn’t require a prescription, so you can use it yourself at home. It has been found to completely cure warts in about half to two-thirds of cases. Other similar treatments include cryotherapy, which is freezing the wart; using retinoic acid, podophyllin, topical 5-fluorouracil, interferon, and imiquimod.
Cidofovir, a medication mainly used to treat a type of infection in HIV patients, has also been reported to be useful in treating persistent warts. 5-Fluorouracil, another drug, is usually used to treat a certain skin condition known as actinic keratosis, but can also be used on warts. For flat warts specifically, a vitamin A derivative called tretinoin has seen some success.
In cases where the wart is more stubborn, injections directly into the wart with immunotherapy (candida), bleomycin, or interferon alfa have shown some effectiveness. Systemic treatments, which work throughout your entire body, like cidofovir, cimetidine, and retinoids are also sometimes tried.
There are also a variety of non-drug treatments used to treat warts. These include adhesive therapy (using a sticky substance to remove the wart), hypnosis, heat therapy (hyperthermia), propolis (a type of resin), and various plant extracts. However, it’s difficult to judge their effectiveness, since warts do often disappear on their own without needing treatment.
If warts persist despite these treatments, sometimes it might be necessary to resort to surgical treatments. Options include using low temperature (cryotherapy), laser treatment, electrodesiccation (using electrical current to dry out the wart), or traditional surgical removal.
What else can Wart be?
Here are some medical conditions that might be considered during a diagnosis:
- Molluscum contagiosum: a viral infection of the skin
- Seborrheic keratosis: a common, harmless, pigmented, noncancerous growth on the skin
- Lichen planus: a condition that can cause swelling and irritation in the skin, hair, nails and mucous membranes
- Squamous cell cancer: a type of skin cancer that begins in the squamous cells
- Keratoacanthoma: a low-grade, non-invasive skin tumor that occurs primarily in sun-exposed skin
What to expect with Wart
About two-thirds of warts naturally go away on their own over several years, which makes it difficult to determine the effectiveness of treatments. Warts usually do not leave behind any scarring when they disappear on their own. However, almost all types of topical treatments – the creams or gels that you apply directly to the skin – have the potential to cause varying degrees of scarring, from moderate to severe.
Another thing to keep in mind is that treatment failures, where the warts don’t respond to the treatment, are common. This can lead to pain and severe changes to the appearance of the skin, which may affect how someone feels about their looks.
Additionally, it’s very rare, but common warts can sometimes turn into a type of skin cancer called verrucous carcinoma. This is most common on the bottom of the foot, also known as the plantar surface.