Warts- treatment, symptoms and cause of Warts

Warts are cutaneous neoplasms that are caused by papilloma viruses. Over 50 different human papilloma viruses (HPV) have been described, and this number will almost certainly continue to grow. Typical verruca vulgaris lesions are sessile, dome-shaped, usually about a centimeter in diameter, and their surface is made up of many small filamentous projections.

The HPV that cause typical verruca vulgaris also cause typical plantar warts, flat warts (or verruca plana), and filiform warts in intertriginous areas. Plantar warts are endophytic and are covered by thick keratin. Paring of the wart will generally demonstrate a central core of keratinized debris and punctate bleeding points. Filiform warts are most commonly seen on the face, neck, and skin folds and present as papillomatous lesions on a narrow base.

Flat warts are only slightly elevated and have a velvety, nonverrucous surface. They have a propensity for the face, arms, and legs and are often spread by shaving.

Multiple HPV types have been associated with genital tract lesions. They generally begin as small papillomas that may grow to form large fungating lesions. In women, they may involve either the labia, perineum, or perianal skin. Additionally, the mucosa of the vagina, urethra, and anus can be involved, as well as the cervical epithelium. In men, the lesions often occur initially in the coronal sulcus, but may be seen on the shaft of the penis, the scrotum, perianal skin, or in the urethra.

Within the past decade, appreciable evidence has accumulated that suggests HPV plays a role in the development of neoplasia of the uterine cervix and external genitalia. HPV types 16 and 18 have been most intensely studied, while recent evidence also implicates other types. Lesions may initially appear as small, flat, velvety, hyperpigmented papules occurring on the genitalia or perianal skin.

Histologic examination of biopsies from affected sites may reveal changes associated with typical warts and/or features typical of intraepidermal carcinoma (Bowen's disease). Squamous cell carcinomas associated with HPV infections have also been observed in extragenital skin. This is most commonly seen in patients immunosuppressed after organ transplantation.

Treatment of Warts

There are many modalities available to treat warts, but no single therapy is universally effective. Factors that influence the choice of therapy include the location of the wart, extent of disease, the age and immunologic status of the patient, and the patient's desire for therapy. Perhaps the most useful and convenient method for treating warts in almost any location is cryotherapy with liquid nitrogen. Equally effective, but requiring much more patient compliance, is the use of keratolytic agents such as salicylic acid plasters or combinations of lactic acid and salicylic acid.

For genital warts, application of podophyllin solution is moderately effective but may be associated with marked local reactions in certain individuals. Dilute preparations of purified podophyllin permit physician-directed by patient-applied use, facilitating treatment of mucosal warts. Topical imiquimod, a potent inducer of local cytokine release, has also been approved for use in genital warts. Other topical agents that are used include trichloracetic acid or cantharidin.

Electrodessication and curettage or CO2 laser excision are also effective therapies but require local anesthesia. Recurrence of warts appears to be common to all these modalities because viral genomic material is present in normal-appearing skin adjacent to the clinical lesions.

Treatment of warts should be tempered by the observation that an overwhelming majority of warts in normal individuals resolve spontaneously within 1 to 2 years. Also, only an extremely small proportion of warts is associated with neoplasia, and those are almost exclusively located on the genitalia or perianal skin.

Plantar Warts