Wart

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Warts
Classification and external resources
Dornwarzen.jpg
Warts on the big toe
ICD-10B07
ICD-9078.1
DiseasesDB28410
MedlinePlus000885
MeSHD014860
 
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For the Nintendo character, see Wart (character). For toad warts, see parotoid gland.
Warts
Classification and external resources
Dornwarzen.jpg
Warts on the big toe
ICD-10B07
ICD-9078.1
DiseasesDB28410
MedlinePlus000885
MeSHD014860
A filiform wart on the eyelid.

A wart is a small, rough growth resembling a cauliflower or a solid blister. It typically occurs on humans' hands or feet but often in other locations. Warts are caused by a viral infection, specifically by one of the many types of human papillomavirus (HPV). There are as many as 10 varieties of warts, the most common considered to be mostly harmless. It is possible to get warts from others; they are contagious and usually enter the body in an area of broken skin.[1] They typically disappear after a few months but can last for years and can reoccur.[2]

Types[edit]

A range of types of wart have been identified, varying in shape and site affected, as well as the type of human papillomavirus involved.[3][4] These include:

Cause[edit]

Micrograph of a common wart (verruca vulgaris) showing the characteristic features (hyperkeratosis, acanthosis, hypergranulosis, rete ridge elongation, and large blood vessels at the dermoepidermal junction, H&E stain.
Main article: Human papilloma virus

Warts are caused by the human papilloma virus (HPV). There are about 130 known types of human papilloma viruses.[5] HPV infects the squamous epithelium, usually of the skin or genitals, but each HPV type is typically only able to infect a few specific areas on the body. Many HPV types can produce a benign growth, often called a "wart" or "papilloma", in the area they infect. Many of the more common HPV and wart types are listed below.

  • High-risk: 16, 18 (cause the most cervical cancer); also 31, 33, 35, 39, 45, 52, 58, 59, and others.
  • Low-risk: 6, 11 (most common); also 13, 44, 40, 43, 42, 54, 61, 72, 81, 89, and others.

Pathophysiology[edit]

Common warts have a characteristic appearance under the microscope. They have thickening of the stratum corneum (hyperkeratosis), thickening of the stratum spinosum (acanthosis), thickening of the stratum granulosum, rete ridge elongation, and large blood vessels at the dermoepidermal junction.

Prevention[edit]

Gardasil is an HPV vaccine aimed at preventing cervical cancers and genital warts. Gardasil is designed to prevent infection with HPV types 16, 18, 6, and 11. HPV types 16 and 18 currently cause about 70% of cervical cancer cases,[8][9] and also cause some vulvar, vaginal,[6] penile and anal cancers.[7] HPV types 6 and 11 are responsible for 90% of documented cases of genital warts.[11] Unfortunately the HPV vaccines do not currently prevent the virus strain responsible for verrucas (plantar warts).

Treatment[edit]

There are many treatments and procedures associated with wart removal. A review of clinical trials of various cutaneous wart treatments concluded that topical treatments containing salicylic acid were more effective than placebo.[12] Cryotherapy appears to be as effective as salicylic acid, but there have been fewer trials.[12]

One complicating factor in the treatment of warts is that the wart may regrow after it has been removed.

Medication[edit]

Two viral warts on a middle finger, being treated with a mixture of acids (like salicylic acid) to remove them. A white precipitate forms on the area where the product was applied.

Another product available over-the-counter that can aid in wart removal is silver nitrate in the form of a caustic pencil, which is also available at drug stores. In a placebo-controlled study of 70 patients, silver nitrate given over nine days resulted in clearance of all warts in 43% and improvement in warts in 26% one month after treatment compared to 11% and 14%, respectively, in the placebo group.[18] The instructions must be followed to minimize staining of skin and clothing. Occasionally pigmented scars may develop.

Cryosurgery or cryotherapy devices using a dimethyl ether – propane mixture are inexpensive. A disadvantage is that the sponge applicator is too large for small warts, and the temperature achieved is not nearly as low as with liquid nitrogen. Complications include blistering of normal skin if excess freezing is not controlled.[citation needed]

Several randomized, controlled trials have found that zinc sulfate, consumed orally, often reduces or eliminates warts.[19][20][21] The zinc sulfate dosage used in medical trials for treatment of warts was between 5 and 10 mg/kg/day. For elemental zinc, a lower dosage of 2.5 mg/kg/day may be appropriate as large amounts of zinc may cause a copper deficiency.[19] Other trials have found that topical zinc sulfate solution[22] or zinc oxide[23] are also effective.

Procedures[edit]

Liquid nitrogen spray tank

Folk remedies[edit]

A variety of traditional folk remedies and rituals claim to be able to remove warts.

The acrid yellow sap of Greater Celandine is used as a traditional wart remedy.[31] The sap can be applied directly to the wart in a similar manner to concentrated salicylic acid solution, but in more modest quantities.

In The Adventures of Tom Sawyer, Mark Twain has his characters discuss a variety of such remedies. Tom Sawyer proposes "spunk-water" (or "stump-water", the water collecting in the hollow of a tree stump) as a remedy for warts on the hand. You put your hand into the water at midnight and say:

Barley-corn, barley-corn, injun-meal shorts,
Spunk-water, spunk-water, swaller these warts

and then "walk away quick, eleven steps, with your eyes shut, and then turn around three times and walk home without speaking to anybody. Because if you speak the charm's busted." This is held to be superior to Huckleberry Finn's preferred remedy which involved throwing a dead cat into a graveyard. Another remedy involved splitting a bean, drawing blood from the wart and putting it on one of the halves, and burying that half at a crossroads at midnight. The theory of operation is that the blood on the buried bean will draw away the wart.[32] Twain is recognized as an early collector and recorder of genuine American folklore.[33]

Similar practices are recorded elsewhere. In Louisiana, one remedy for warts involves rubbing the wart with a potato, which is then buried; when the "buried potato dries up, the wart will be cured".[34] Another remedy similar to Twain's is reported from Northern Ireland, where water from a specific well on Rathlin Island is credited with the power to cure warts.[35]

Despite their appearance, toads do not cause warts.

A longstanding tradition holds that touching toads will cause warts. The most common Northern Hemisphere toads have glands that protrude from their skin that superficially resemble warts. Warts are caused by a virus, and toads do not harbor it.[36]

See also[edit]

In other animals[edit]

References[edit]

  1. ^ "Warts Types, Causes, Symptoms, Treatments, Prevention". Webmd.com. 2010-09-02. Retrieved 2013-05-17. 
  2. ^ Warts. National institutes of Health.
  3. ^ Anderson, Keith,; Keith, Jeff; Novak, Patricia D.; Elliot, Michelle A. (2005). Mosby's Medical, Nursing, and Allied Health Dictionary (5th ed.). C.V. Mosby. ISBN 978-0-323-03736-5. 
  4. ^ "MedlinePlus: Warts". 2010. 
  5. ^ de Villiers EM, Fauquet C, Broker TR, Bernard HU, zur Hausen H (Jun 2004). "Classification of papillomaviruses". Virology 324 (1): 17–27. doi:10.1016/j.virol.2004.03.033. PMID 15183049. 
  6. ^ a b "FDA Approves Expanded Uses for Gardasil to Include Preventing Certain Vulvar and Vaginal Cancers". 2008-09-12. Retrieved 2009-08-04. 
  7. ^ a b Cortez, Michelle Fay and Pettypiece, Shannon (2008-11-13). "Merck Cancer Shot Cuts Genital Warts, Lesions in Men". Bloomberg News. Retrieved 2013-05-17. 
  8. ^ a b Lowy DR, Schiller JT (2006). "Prophylactic human papillomavirus vaccines". J. Clin. Invest. 116 (5): 1167–73. doi:10.1172/JCI28607. PMC 1451224. PMID 16670757. 
  9. ^ a b Muñoz N, Bosch FX, Castellsagué X, Díaz M, de Sanjose S, Hammouda D, Shah KV, Meijer CJ (2004-08-20). "Against which human papillomavirus types shall we vaccinate and screen? The international perspective". Int J Cancer 111 (2): 278–85. doi:10.1002/ijc.20244. PMID 15197783. 
  10. ^ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Mitchell, Richard (2007). "Chapter 19 The Female Genital System and Breast". Robbins Basic Pathology (8 ed.). Philadelphia: Saunders. ISBN 1-4160-2973-7. 
  11. ^ Steinbrook, Robert (March 16, 2006). "Perspective – The Potential of Human Papillomavirus Vaccines". 
  12. ^ a b Kwok CS, Gibbs S, Bennett C, Holland R, Abbott R (Sep 12, 2012). "Topical treatments for cutaneous warts". In Gibbs, Sam. The Cochrane database of systematic reviews 9: CD001781. doi:10.1002/14651858.CD001781.pub3. PMID 22972052. 
  13. ^ Barclay, Laurie (2011-06-04). "Short-Acting Imiquimod Cream Approved for Genital Warts". Medscape. Retrieved 10 August 2011. 
  14. ^ a b c Bacelieri R, Johnson SM (2005). "Cutaneous warts: An evidence-based approach to therapy". American family physician 72 (4): 647–652. PMID 16127954. 
  15. ^ Champion, R.H., et al. (1998) Rook's Textbook of Dermatology. Blackwell Science, p. 1044, ISBN 0-632-06429-3
  16. ^ "Treating Warts". British Medical Journal. 2002-08-31. Retrieved 2013-05-17. 
  17. ^ Salk, Robert et al. (May 2004). Exploring Alternative Treatment For Resistant Warts 17 (5). p. 56. 
  18. ^ Sterling JC, Handfield-Jones S, Hudson PM (2001). "Guidelines for the management of cutaneous warts". British Journal of Dermatology 144 (1): 4–11. doi:10.1046/j.1365-2133.2001.04066.x. PMID 11167676. 
  19. ^ a b Stefani M, Bottino G, Fontenelle E, Azulay DR (2009). "Efficacy comparison between cimetidine and zinc sulphate in the treatment of multiple and recalcitrant warts". An Bras Dermatol 84 (1): 23–9. PMID 19377755. 
  20. ^ Yaghoobi R, Sadighha A, Baktash D (April 2009). "Evaluation of oral zinc sulfate effect on recalcitrant multiple viral warts: a randomized placebo-controlled clinical trial". J. Am. Acad. Dermatol. 60 (4): 706–8. doi:10.1016/j.jaad.2008.09.010. PMID 19293025. 
  21. ^ Al-Gurairi FT, Al-Waiz M, Sharquie KE (March 2002). "Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebo-controlled clinical trial". Br. J. Dermatol. 146 (3): 423–31. doi:10.1046/j.1365-2133.2002.04617.x. PMID 11952542. 
  22. ^ Sharquie KE, Khorsheed AA, Al-Nuaimy AA (September 2007). "Topical zinc sulphate solution for treatment of viral warts". Saudi Med J 28 (9): 1418–21. PMID 17768472. 
  23. ^ Khattar JA, Musharrafieh UM, Tamim H, Hamadeh GN (April 2007). "Topical zinc oxide vs. salicylic acid-lactic acid combination in the treatment of warts". Int. J. Dermatol. 46 (4): 427–30. doi:10.1111/j.1365-4632.2006.03138.x. PMID 17442091. 
  24. ^ Warts at About.com
  25. ^ Stone KM, Becker TM, Hadgu A, Kraus SJ (1990). "Treatment of external genital warts: A randomised clinical trial comparing podophyllin, cryotherapy, and electrodesiccation". Genitourinary medicine 66 (1): 16–19. doi:10.1136/sti.66.1.16. PMC 1194434. PMID 2179111. 
  26. ^ Halasz CL (1994). "Treatment of common warts using the infrared coagulator". The Journal of dermatologic surgery and oncology 20 (4): 252–256. doi:10.1111/j.1524-4725.1994.tb01620.x. PMID 8163746. 
  27. ^ Wenner R, Askari SK, Cham PM, Kedrowski DA, Liu A, Warshaw EM (March 2007). "Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial". Archives of dermatology 143 (3): 309–13. doi:10.1001/archderm.143.3.309. PMID 17372095. 
  28. ^ Ringold S, Mendoza JA, Tarini BA, Sox C (Oct 2002). "Is duct tape occlusion therapy as effective as cryotherapy for the treatment of the common wart?". Archives of pediatrics & adolescent medicine 156 (10): 975–7. doi:10.1001/archpedi.156.10.975. PMID 12361441. 
  29. ^ Stubbings A, Wacogne I (September 2011). "Question 3. What is the efficacy of duct tape as a treatment for verruca vulgaris?". Archives of Disease in Childhood 96 (9): 897–9. doi:10.1136/archdischild-2011-300533. PMID 21836182. 
  30. ^ Kwok CS; Gibbs S; Bennett C; Holland R; Abbott R (12 Sep 2012). Topical treatments for cutaneous warts.. Cochrane Library PubMed. Retrieved June 6, 2014. 
  31. ^ http://www.botanical-online.com/english/celandine_for_warts.htm
  32. ^ Mark Twain, The Adventures of Tom Sawyer, ch. 6
  33. ^ LeMaster, J. R. (1993) The Mark Twain Encyclopedia (Taylor and Francis, pp. 293–294, ISBN 0-8240-7212-X.
  34. ^ Webb, Julie Yvonne (1971). "Louisiana Voodoo and Superstitions Relating to Health". HSMHA Health Reports 86 (4): 291, 296–297. doi:10.2307/4594154. PMC 1937133. 
  35. ^ Ballard LM (2009). "An approach to traditional cures in Ulster". The Ulster medical journal 78 (1): 26–33. PMC 2629017. PMID 19252727. 
  36. ^ Clark, Josh. "Do toads cause warts?". science.howstuffworks.com. p. 2. Retrieved October 20, 2012. 

External links[edit]