Wart: Symptoms and Treatment

What is a wart? We will analyze the causes, diagnosis and treatment modalities in an article by a dermatologist with 37 years of experience.

Definition of the disease. Causes of the disease

Wartsare irregular, light-bodied benign skin lesions in the form of a localized overgrowth of the upper layer of the skin (epidermis) with papules (nodules) or plaques.

The incidence of warts in adults is 7-12%, in school-aged children - up to 10-20%.

Warts are very similar to other skin growths. Usually, a person cannot accurately determine the disease on their own, therefore, a dermatologist should be consulted to make a diagnosis.

Human papillomavirus is the cause of warts. The type of virus affects the type of warts that can develop. Therefore, each type of human papillomavirus infects the tissue in the most characteristic localization of it.

HPV type	Preferred localization	Types of warts
1	Feet, knees, palms, hands, fingers	Plantar and palmar warts, rarely simple warts
2, 4	Hands, fingers, knees, less often - feet	Simple warts, occasionally plantar, palmar and mosaic warts
3, 10	Shins, hands, face	Flat warts
7	Hands, fingers	Butcher warts
5, 8, 9, 12, 14, 15, 17, 19-24	Face, arms, front of torso	Verruciform epidermodysplasia

Virus infection usually occurs through contact - with direct contact between infected and healthy skin (for example, when shaking hands) or indirectly (through handrails, toys, etc. ). Therefore, you can be infected with the human papillomavirus, which causes warts, in a wide variety of places: in public transport, at school, at work, at home, in places with high contact and a humid environment (swimming pools, saunas, gyms). Small trauma to the epidermis, through which viruses enter, as well as skin inflammation, contribute to infection.

It also contributes to the appearance of warts:

• immunodeficiencies (including HIV infection);
• hot and humid environment;
• the need for professional contact with meat and fish ("butcher's warts").

Some types of human papillomavirus are passed on by parents.

But toads and frogs, despite the horror stories we are so often frightened with in childhood, cannot be infected: this is one of the most popular myths about this disease, which has no basis.

If you experience similar symptoms, consult your doctor. Do not self-medicate: it is dangerous for your health!

Wart symptoms

Symptoms vary depending on the type of wart.

Common wart:

• Dense round papule of normal color, 1-10 mm and more.
• The surface of the papule is covered with cracks, layers.
• If the papule is on the finger, the print disappears and becomes distorted. The same goes for the design of the palm.
• Simple warts are found singly or in several pieces: they usually appear in the points of greatest lesion (hands, fingers, knees).
• When viewed with a dermatoscope, the doctor may see small brown dots - thrombosed (blocked) capillaries. Patients often refer to these points as "roots". This is the main sign for a doctor - it is used by a dermatologist to distinguish a wart from other similar diseases (for example, molluscum contagiosum and keratoma).

Plantar wart (cornea):

• The main symptom that usually causes a patient to see a doctor is pain when pressing and walking.
• Such warts are usually found on the feet.
• When contacting a doctor, as a rule, keratinized and uneven plaque of the usual color is visible, although at the first stage, a smooth, uniform papule can be seen. With keratinization, the capillaries can only be seen if the keratinized layer of the skin is removed.
• The sole leather pattern is distorted.
• Plantar warts are usually solitary, but there are also 2-6 warts;
• these warts are often confused with corn (especially dry): this is the description of the problem that patients usually come to see.

Flat wart (juvenile):

• It has the appearance of a round, clear and smooth papule of normal color, pink or brownish, 1-5 mm in size.
• Appears on the hands, shins, very often on the face.
• There are always several of these warts - they are found in groups.

Verruciform epidermodysplasia (senile wart):

• Large, round, numerous confluent neoplasms of normal pink or brown color.
• Most often appears on the face, arms, front of the torso.
• May be confused with keratoma, shingles and skin cancer.

Pathogenesis of warts

When it enters the body, the human papillomavirus can remain in a latent state for a long time - a person usually does not even know about its existence. When factors favorable to the virus appear, it begins to "multiply" in the epithelium, leading to changes in the tissues.

Unlike other viruses, the human papillomavirus does not destroy the cells of the epithelium itself: they die on their own, naturally, in the process of keratinization and desquamation.

Local factors and the state of the immune system influence the spread of the infection. For example, people with HIV infection or a kidney transplant are more likely to develop warts. Furthermore, these neoplasms are often difficult to treat. With normal immunity, the virus does not affect the deep layers of the skin, so many people get warts on their own after a few months.

The main stage in the appearance of warts is the acceleration of the rate of cell division and growth with the help of the virus. This fast metabolism leads to the thickening of the skin layers. As the tissues grow in a certain small area, a tubercle appears, which is called a wart.

Classification and stages of development of the wart

There is no universally accepted classification for warts. However, there are several common varieties:

• The common wartis the most common type (70% of warts are just them). Such neoplasms do not make themselves felt and cause only aesthetic discomfort to a person.
• Plantar wart- appears on the soles of the feet, is painful, therefore requires treatment. Skin trauma from uncomfortable, tight and irritated shoes contributes to the occurrence of such a wart.
• Flat warts- appear more often in young people, adolescents. This is due to the unstable hormonal background of young people, which affects the whole body. Flat warts are usually almost invisible.
• Senile warts- are typical of the elderly. They often appear on the part of the body covered with clothing, but can occur on the face and hands. If there is no discomfort, such warts should not be treated: healing in older people can be much slower than in young people, due to a slow metabolism.

Other authors distinguish many more from these types of warts:

• Mosaic warts(HPV 2, 4) - neoplasms on the palms and soles of the feet. They look like foci of hyperkeratosis, that is, thickening of the stratum corneum (usually in the forefoot), covered with deep cracks.
• Cystic warts(HPV 60) are a very rare type of growth on the foot. It is a soft knot with cracks. Upon opening, a white-yellow discharge appears similar to curd.
• Filiform wartsare thin horny growths near the mouth, nose or eyes.
• "Butcher's" warts(HPV 7) - appear on the hands and fingers of people who are constantly in contact with meat and fish. It presents as hypertrophic neoplasms similar to cauliflower, but normal in color.

Furthermore, the types of warts are distinguished according to their location.

For example, anogenital warts - tumor-like neoplasms that appear on the genitals (especially where the skin passes to the mucosa) are a common disease. They are usually caused by HPV types 6 and 11.

Complications of the wart

The main reason why patients with warts go to the doctor is a cosmetic defect that can affect the patient's quality of life, self-esteem and develop many complexes. Complications can also include rupture of the surface of the wart and the addition of infections and, in some types of warts, pain when walking.

Skin warts usually do not degenerate into malignant neoplasms, they are quite harmless, however, in very rare cases, such a complication can still occur in people with suppressed immunity.

Other complications arise when trying to remove the growth on your own. In this regard, inflammation and cosmetic defects in the form of scars may occur, as well as the further spread of the virus through the skin, due to which, in the morning after self-removal of a wart, a person can wake up with several new ones.

Remember that under the guise of a wart, a completely different disease can be hidden, which cannot be determined without the advice of an experienced doctor.

Diagnosis of warts

An examination (clinical picture) and a history (anamnesis) are usually sufficient to make a diagnosis.

To confirm the diagnosis, the doctor may conduct a histological examination - the study of the tumor cells.

It is very important to make a differential diagnosis - to distinguish warts from other diseases. For example,common wartsmust be distinguished from the following diseases:

• Molluscum contagiosum- appears more often on the body and genitals, less often on the hands and feet. It is a hemisphere with an impression on the surface; when pressed from the sides, a whitish "gruel" is released.
• Epidermal warty nevus- more often solitary, a person has since birth. It rises above the surface of the skin, often covered with hair.
• Basalioma- a tumor in the form of a roller of nodules, covered with a crust in the center. Typical for the elderly.

Palm-plantar wartsmust be distinguished from the following diseases:

• Keratoderma- large areas of keratinization and inflammation of the skin. No coagulated capillaries.
• Palmar-plantar syphilides- multiple painless neoplasms, the skin exfoliates along the periphery. The reaction to syphilis is positive.
• Callus- usually painless, can only cause pain when pressed vertically.

The doctor must also differentiate other types of warts from a number of diseases. If another pathology is suspected, he may prescribe an additional diagnosis (for example, detection of antibodies to viruses, CT or MRI).

Treatment of warts

Warts are treated for aesthetic purposes and to improve the patient's quality of life. It can be prescribed by a doctor only after a carefully diagnosed examination and diagnosis. Independent attempts to get rid of a wart are unacceptable, since a patient without medical education and the necessary equipment is unable to accurately determine the disease, and complications after such "treatment" occur much more often than recovery.

There are several ways to treat warts. Usually they are all performed under the supervision of a doctor, and some of them - only in the treatment room of the clinic.

Chemical treatments

Milk salicylic collodion and salicylic patches are used to eliminate the wart. The percentage of drugs and the method of their use (prolonged use of patches, applications, etc. ) depend on the prevalence and location of the neoplasm.

Zinc and 2-chloropropionic acid solutions can also be used. In this case, a chemical composition is applied to the pretreated surface, which is left on the wart until the color changes (depending on the type of wart). The procedure is repeated several times after 7, 14 and 21 days. Before each procedure, the tissue is removed mechanically.

Another chemical method is a combination of nitric, acetic, oxalic, lactic acid and copper nitrate trihydrate. In this way, only relatively small neoplasms are treated - up to 5 mm. The solution is also left to change the color of the wart. After 3-5 days, the patient comes for a follow-up appointment, if necessary, he is prescribed a second procedure in 1-4 weeks.

Cryodestruction

This method consists in freezing the wart with liquid nitrogen: the moistened swab is pressed against the damaged skin (with the capture of the surrounding tissue by several mm) for 1-5 minutes. Some lesions require several treatments four weeks apart to destroy.

The main disadvantages of cryodestruction are its painful and delayed effect compared to other methods, where a single procedure is often sufficient for removal.

Electrocoagulation

Under the influence of an electric current, the wart is removed in layers. This operation is performed under local anesthesia.

This method is more effective than cryodestruction, but has one significant drawback: electrocautery often leaves scars at the wart removal site. For those patients seeking cosmetic repair,this method will not be the most suitable.

Laser destruction

The laser also removes warts in layers. The light guide makes contact with the skin for a few seconds to three minutes, depending on the size. Then the crust that appears is excised and the bottom of the wound is again treated with a laser. The patient is then instructed on how to manage the wound. The operation itself is performed under the influence of local anesthesia.

Radio wave surgery

Radio wave surgery is one of the most modern and gentle methods of removing some benign neoplasms, including warts.

The method is based on the generation of electromagnetic waves with different frequencies: from 100 kHz to 105 MHz. During the procedure, the tissues resist the passage of waves, which is why molecular energy is released in the cells, which heats theskin. Under the influence of heat, the cells actually evaporate - a clean cut is obtained. At the same time, no mechanical forces are exerted on the affected tissue.

Advantages of this method:

• security;
• rapid wound healing;
• good cosmetic effect - scars and scars excluded;
• relative painless: local anesthetic is applied before the mini-surgery;
• exclusion of secondary infection due to automatic disinfection of the electrode when the device is switched on.

The effectiveness of this method is recognized all over the world, however it is rather difficult to find a clinic that uses the radio wave surgery method.

Which treatment method to choose

All the above methods have several disadvantages:

• In the first two weeks, the operated area looks unattractive: scabs, darkening of the tissues. This should be taken into consideration if the warts are located on visible parts of the body (for example, on the face).
• Unpleasant odor and some degree of pain during surgery.

In addition, each of these methods has contraindications, which you need to know during a preliminary consultation with a dermatologist.

But the main drawback is thehigh probability of recurrence, especially if the warts were widespread, extensive. With each of these methods, doctors do not fight the root cause of the disease, but with its consequences, from todaythe human papillomavirus virus is not curable.

Therefore, therapy is directed to:

• or the destruction of neoplasms that appear at the site of introduction of the virus;
• to stimulate the antiviral immune response;
• or a combination of these approaches.

Most of the time destructive treatments are used. Their efficiency reaches 50-80%.

Childhood is usually not a contraindication for surgical treatments. Therefore, many of them (including radio wave surgery) are also used to treat warts in children. An exception is the chemical removal of warts due to the possibility of adverse reactions to the substance.

What to do after the

operation

Be sure to follow your doctor's advice after any of these operations.

After removal of the tumor by one of the methods presented, the doctor usually prescribes treatment of the removal site. It is forbidden to remove the "scabs" on your own, wet the wound and expose it to direct sunlight.

If a patient is constantly suffering from warts, he should consult an immunologist - perhaps drug therapy will be required, which will increase the resistance of immunity to the manifestations of the human papillomavirus.

Forecast. Prevention

If the patient does not have immunodeficiencies, the warts can go away on their own, but this will take a long time, from several months to several years. Then, in 65% of cases, warts independently regress within two years. If after two years the wart is still in place, it is recommended to remove it. It is recommended to remove multiple growths immediately.

With normal immunity and the correct method of removal (depending on the size and type of wart), it is possible to remove the pathogenic tissue and achieve a good cosmetic effect. With reduced immunity and other predisposing factors, the human papillomavirus remaining in the body causes relapses.

There is no specific disease prevention. But is infection inevitable?

You can reduce the likelihood of a virus if you follow a few rules:

• Avoid walking barefoot in public places where there is the possibility of skin injuries and virus infections (swimming pools, public showers, gyms).
• Choose quality footwear, change them often. Try to keep your feet dry. Heat and humidity are excellent breeding grounds for the human papillomavirus.
• To avoid periungual warts, only go to a nail technician and make sure they use sterile tools.

For the prevention of anogenital warts, according to the WHO (World Health Organization), the quadrivalent vaccine against human papillomavirus is also highly effective. There are currently no vaccines available to prevent other types of warts.

If you find a wart, don't try to cauterize, cut, or remove it yourself - this can contribute to inflammation and further spread of the virus through the skin. After such "removal", instead of a wart in the morning, you can wake up with ten.