Wart: symptoms and treatment

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

Definition of disease. Causes of the disease

Wartsare benign, light-bodied irregular 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-age children, up to 10-20%.

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

The 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 tissue in the most characteristic location.

HPV type	Preferred location	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	Pimples, hands, face	Flat warts
7	Hands, fingers	Butcher warts
5, 8, 9, 12, 14, 15, 17, 19-24	Face, arms, front torso	Verruciform epidermodysplasia

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

Also contributes to the appearance of warts:

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

Some types of human papillomavirus are transmitted from parents.

But toads and frogs, despite the horror stories that so often frighten us in childhood, cannot be infected; This is one of the most popular myths about this disease, which is unfounded.

If you find similar symptoms, see your doctor. Don't self-medicate, it's dangerous for your health!

Symptoms of warts

Symptoms will 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 impression disappears and becomes distorted. The same goes for the palm drawing.
• Simple warts are located individually or in several places; usually appear in the places of greatest injury (hands, fingers, knees).
• When viewed with a dermatoscope, the doctor may see small brown dots - thrombosed (clogged) capillaries. Patients often refer to these points as "roots. "This is the main sign for a doctor: a dermatologist can use it 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 go to the doctor is pain when pressing and walking.
• These warts are usually found on the feet.
• When contacting a doctor, as a general rule, a keratinized and irregular plaque of the usual color is seen, although in the first stage you may see a uniform and smooth papule. With keratinization, the capillaries can only be seen if the keratinized layer of the skin is removed.
• The leather pattern on the sole is distorted.
• Plantar warts are usually solitary, but there are also 2 to 6 warts;
• these warts are often mistaken for corn (especially dry) - this is the description of the problem that patients often see.

Flat wart (juvenile):

• Looks like a round, transparent, smooth papule of normal pink or brown color, 1 to 5 mm in size.
• Appears on hands, pimples, very often on the face.
• There are always several warts of this type: they are located in groups.

Epidermodysplasia verruciform (senile wart):

• Numerous large, round, pink or normal brown confluent neoplasms.
• They appear most frequently on the face, arms, and 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 be in a latent state for a long time; a person generally does not even know of its existence. When factors favorable to the virus appear, it begins to "multiply" in the epithelium, causing 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 affect the spread of 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 rapid metabolism leads to thickening of the layers of the skin. Since the tissues grow in a certain and small area, a tuber 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 warts). Such neoplasms are not felt and only cause aesthetic discomfort to a person.
• Plantar wart- appears on the soles of the feet, is painful and therefore requires treatment. Trauma to the skin from uncomfortable, tight and rubbing shoes contributes to the appearance of such a wart.
• Flat warts: they appear more frequently in young people, adolescents. This is due to the unstable hormonal background of young people, which affects the entire body. Flat warts are usually almost invisible.
• Senile warts: they are typical of the elderly. They often appear on the part of the body covered with clothing, but can appear on the face and hands. If there is no discomfort, these warts should not be treated; healing in older people can be much slower than in younger people due to a slow metabolism.

Other authors distinguish several more of these types of warts:

• Mosaic warts(HPV 2, 4): neoplasms on the palms of the hands 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 smooth knot with cracks. When opened, a yellowish-white discharge appears similar to curd.
• Filiform wartsare thin horny outgrowths near the mouth, nose or eyes.
• "Butcher" warts(HPV 7): appear on the hands and fingers of people who are in constant contact with meat and fish. Presented as hypertrophied neoplasms similar to cauliflower, but normal in color.

Also, wart types are distinguished based on their location.

For example, anogenital warts, tumor-like neoplasms that appear on the genitals (especially in places where the skin passes the mucous membrane) 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 an aesthetic defect that can affect the quality of life of the patient, their self-confidence and develop many complexes. Complications can also include cracking of the wart surface and the addition of infection, and in some types of warts, pain when walking.

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

Other complications arise when you try to remove the growth yourself. In this regard, inflammation and cosmetic defects in the form of scars can occur, as well as further spread of the virus through the skin, so that in the morning after self-expression of a wart, a person may 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.

Wart diagnosis

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

To confirm the diagnosis, the doctor may perform a histological examination - the study of the cells of the neoplasm.

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

• Molluscum Contagiosum: Appears most 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 "mush" is released.
• Epidermal warty nevus- most often solitary, a person has it from birth. Rises above the surface of the skin, often covered with hair.
• Basalioma- a tumor in the form of a roll of nodules, covered with a crust in the center. Typical for the elderly.

Palmar-plantar wartsmust be distinguished from the following diseases:

• Keratoderma: large areas of keratinization and inflammation of the skin. No coagulated capillaries.
• Palmoplantar syphilides: multiple painless neoplasms, the skin exfoliates along the periphery. The reaction to syphilis is positive.
• Corn- 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 additional diagnostics (for example, detection of antibodies against viruses, CT or MRI).

Wart treatment

Warts are treated for cosmetic purposes and to improve the patient's quality of life. It can only be prescribed by a doctor after an examination and a precisely diagnosed diagnosis. Independent attempts to get rid of the wart are unacceptable, since a patient without medical education and without the necessary equipment cannot accurately determine the disease, and complications after such "treatment" occur much more often than recovery.

There are several ways to treat warts. All of them are usually carried out under the supervision of a doctor, and some of them, only in the treatment room of the clinic.

Chemical treatments

Salicylic collodion with milk and salicylic patches are used to remove the wart. The percentage of drugs and the method of use (prolonged use of plasters, 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 pre-treated surface, which is left on the wart until it changes color (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 acids, and copper nitrate trihydrate. In this way, only relatively small neoplasms, up to 5 mm, are treated. 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, a second procedure is prescribed in 1-4 weeks.

Cryodestruction

This method consists of freezing the wart with liquid nitrogen: a moistened swab is pressed against the damaged skin (capturing the surrounding tissue a few mm) for 1-5 minutes. Some injuries require multiple treatments four weeks apart to destroy.

The main disadvantages of cryodestruction are its pain and delayed effect compared to other methods, where only one procedure is usually sufficient for extraction.

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 a significant disadvantage: electrocautery often leaves scars at the wart removal site. For those patients seeking a cosmetic repair,this method will not be the most suitable.

Laser Destruction

The laser also removes warts in layers. The light guide comes into contact with the skin from several seconds to three minutes, depending on the size. The scab that appears is then removed and the lower part of the wound is treated again 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 to remove 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 the waves, so molecular energy is released in the cells, whichwarms the skin. 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 are excluded;
• relative painless: local anesthesia is applied before mini surgery;
• exclusion of secondary infection due to automatic electrode disinfection when the device is switched on.

The efficacy of this method is recognized throughout the world, however, it is quite difficult to find a clinic that uses the radio wave surgery method.

Which treatment method to choose

All the above methods have several drawbacks:

• In the first weeks, the operated area seems unattractive: scabs, darkening of the tissues. This should be taken into account if warts are found 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 should be aware of in a preliminary consultation with a dermatologist.

But the main disadvantage is thehigh probability of recurrence, especially if the warts were generalized, extensive. With each of these methods, doctors are not fighting against the root cause of the disease, but against its consequences, since todaythe human papillomavirus is not curable.

Therefore, therapy targets:

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

Destructive treatments are used most of the time. Its efficiency reaches 50-80%.

Childhood is not usually 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 tumor removal by any 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 constantly suffers from warts, then he should consult an immunologist; Drug therapy may be required, increasing resistance of immunity to manifestations of human papillomavirus.

Forecast. Prevention

If the patient does not have immunodeficiencies, warts may disappear on their own, but this will take a long time, from several months to several years. So, in 65% of cases, warts independently return 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 removal method (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 remaining human papillomavirus in the body causes relapses.

There is no specific prevention of diseases. But is infection inevitable?

You can reduce the probability of a virus by following some rules:

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

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

If you find a wart, do not try to cauterize, cut, or remove it yourself; In this way, it can contribute to inflammation and further spread of the virus through the skin. After such a "removal", instead of one wart in the morning, you can wake up with ten.