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Warts result from skin infection with human papillomavirus (HPV). Warts can be cosmetically bothersome and occasionally a source of pain. HPV is a DNA virus, with more than 60 types identified. It is epitheliotropic and causes tumors of the epidermis. At least five types are potentially oncogenic, with two implicated in cervical carcinoma and three in squamous cell carcinoma. Warts can be transmitted by direct contact or by autoinoculation. Young people have a high frequency of warts. Healing can occur spontaneously, presumably through immunologic mechanisms. Approximately two-thirds of warts disappear spontaneously within 2 years of their appearance, but if they are left untreated, additional warts may develop from the human papilloma virus.
Clinical presentations vary according to site and viral strain involved. The common wart (verruca vulgaris) is associated with HPV-2 and HPV-4 infection and appears flesh-colored or grayish white with a papillated hyperkeratotic surface. It may be punctuated with black dots due to thrombosis of superficial
The plantar wart (verruca plantaris) results from HPV-1 or HPV-4 infection of the plantar surface of the foot and appears as a small skin nodule that produces grayish or yellow interruptions in the skin lines of
Anogenital warts (condylomata acuminata) result from sexual transmission of HPV-6 and HPV-16.
Verrucae vulgaris should be differentiated from squamous cell carcinoma and also from a cutaneous
Appearance is usually sufficient for diagnosis, but early genital warts can be difficult to identify. Typically, a...
Warts are benign tumors that often regress spontaneously. Treatment should not be so aggressive as to produce permanent scarring. Simple and safe treatments should be employed. Location, discomfort, cosmetic effect, and therapies available influence the decision to treat. Larger warts of long duration.
Freezing the lesion with cotton-swab application of liquid nitrogen is convenient, well tolerated, often effective, and associated with a low risk of serious scarring. Solid freezing of the lesion is usually achieved by 5 to 10 minutes of repeated application of the liquid nitrogen from a cotton swab dipped into a Styrofoam cup containing the supercold liquid. The freezing injury leads to the wart's separating.
Nonsurgical methods are preferred to surgical removal because scarring in this location can cause permanent discomfort. The lesion should be pared and then treated with application of 40% salicylic acid plasters , taped in place for 1 to 3 days, followed by scraping off of the macerated skin. This procedure is used for 2 to 3 weeks and can be performed by the patient. A salicylic acid preparation suspended in a...
Topical 5-fluorouracil cream or solution and retinoic acid cream or gel are used effectively for flat warts, especially those on the face. With both of these topical agents, patients will probably experience irritation...
A preparation of 20% to 40% podophyllin in compound tincture of benzoin is used to treat macerated genital warts . It must be applied sparingly, only to the wart, and allowed to dry thoroughly before the
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Sublesional bleomycin , diluted to 10 U/mL, has a distinct role in the treatment of refractory warts, both those on the hands and the plantar variety. Usually one or two units injected beneath the verruca is..
Interferon-alpha (both type 2a and type 2b) has been approved for treatment of refractory genital warts. Lesions are injected intralesionally three times a ..
Immunostimulation is sometimes tried. Dinitrochlorobenzene (DNCB) sensitization followed by repeated applications of diluted DNCB has been used to treat resistant warts. This form of immunotherapy is.... Autogenous wart vaccines appear no more effective than...
The carbon dioxide laser has become an increasingly popular method for treating warts, although in many
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