Wart - symptoms and treatment

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

Disease definition. 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 children of school age - up to 10-20%.

Warts are very similar to other skin growths. Usually, a person cannot accurately determine the disease on his 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. Thus, each type of human papillomavirus infects tissue at the localization that is most characteristic 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's Warts
5, 8, 9, 12, 14, 15, 17, 19-24	Face, arms, front torso	Epidermodysplasia verruciform

Infection with the virus usually occurs through contact - with direct contact with infected and healthy skin (for example, when 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 - 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 inflammation of the skin, contribute to infection.

Also contributing 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 with which we are so often frightened in childhood, cannot be infected - this is one of the most popular myths about this disease, which has no basis.

If you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous to your health!

Wart symptoms

Symptoms will vary depending on the type of wart.

Common wart:

• Round dense 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 is distorted. The same goes for the palm drawing.
• Simple warts are located both singly and in several pieces - they 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: it can be used by a dermatologist to distinguish a wart from other similar diseases (for example, molluscum contagiosum and keratoma).

Plantar (horny) wart:

• The main symptom that usually causes a patient to see a doctor is pain when pressing and walking.
• Such warts are usually located on the feet.
• When contacting a doctor, as a rule, a keratinized, uneven plaque of the usual color is visible, although at the first stage you can see an even, smooth papule. With keratinization, the capillaries can be seen only if the keratinized layer of the skin is removed.
• The skin pattern of the sole 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 (juvenile) wart:

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

Epidermodysplasia verruciform (senile wart):

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

Wart pathogenesis

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

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 flaking.

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. Moreover, 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 thickening of the skin layers. Since 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:

• Common wartis the most common type (70% of warts are just them). Such neoplasms are not 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 due to uncomfortable, tight, chafing shoes contributes to the occurrence of such a wart.
• Flat warts- more often appear in young people, adolescents. This is due to the unstable hormonal background of young people, which affects the entire body. Usually flat warts are almost invisible.
• Senile warts- are typical for the elderly. They often appear on the part of the body that is 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 younger people, due to a slow metabolism.

Other authors distinguish several more from these types of warts:

• Mosaic warts(HPV 2, 4) - neoplasms on the palms and soles. They look like foci of hyperkeratosis, i. e. 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 outgrowths 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. Presented as hypertrophied neoplasms similar to cauliflower, but of normal color.

In addition, types of warts are distinguished depending on their location.

For example, anogenital warts - tumor-like neoplasms that appear on the genitals (especially in the places where the skin transitions to 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 patient's quality of life, his self-confidence and develop a lot of complexes. Complications include cracking of the surface of the wart and the addition of infection, and in some types of warts, soreness while 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 you try to remove the growth yourself. In this regard, inflammation and aesthetic 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 one 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 conduct a histological examination - the study of the cells of the neoplasm.

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

• Molluscum contagiosum- more often appears 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.

Palmar-plantar wartsmust be distinguished from the following diseases:

• Keratoderma- large areas of keratinization and inflammation of the skin. No clotted capillaries.
• Palmar-plantar syphilides- multiple painless neoplasms, 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 to viruses, CT or MRI).

Wart treatment

Warts are treated for aesthetic purposes and to improve the patient's quality of life. It can only be prescribed by a doctor after an examination and an accurately diagnosed diagnosis. Independent attempts to get rid of the wart are unacceptable, since a patient without medical education and the necessary equipment is not able to 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

Milk-salicylic collodion and salicylic patches are used to get rid of the wart. The percentage of drugs and the method of their use (long-term wearing of plasters, applications, etc. ) depend on the prevalence and localization of the neoplasm.

Solutions of zinc and 2-chloropropionic acid can also be used. In this case, a chemical composition is applied to the pre-treated 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, 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 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: a moistened swab is pressed against the damaged skin (with the capture of the surrounding tissue by a few mm) for 1-5 minutes. Some lesions require several treatments four weeks apart to destroy.

The main disadvantages of cryodestruction are its painfulness and delayed effect in comparison with other methods, in which only one procedure is often sufficient for removal.

Electrocoagulation

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

This method is more effective than cryodestruction, but it has a significant disadvantage: electrocautery often leaves behind scars at the site of wart removal. For those patients who seek to correct a cosmetic defect,this method will not be the most suitable.

Laser destruction

The laser also removes warts in layers. The light guide contacts the skin from several seconds to three minutes, depending on the size. Then the scab that appears is excised, and the bottom of the wound is treated with a laser again. The patient is then instructed on how to handle 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 passing waves, which is why molecular energy is released in the cells, which heats the skin. Under the influence of heat, the cells actually evaporate - a neat cut is obtained. At the same time, no mechanical forces are exerted on the affected tissue.

Pros of this method:

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

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

Which treatment method to choose

All of the above methods have several drawbacks:

• In the first couple of weeks, the operated area looks unattractive - crusts, darkening of 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 need to find out about at a preliminary consultation with a dermatologist.

But the main disadvantage is thehigh likelihood 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, since todayhuman papillomavirus is not curable.

Therefore, therapy is directed to:

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

Most often 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 any of the methods presented, the doctor usually prescribes the treatment of the removal site. It is forbidden to remove "crusts" 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 - 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, then the warts can go away on their own, but this will take a long time - from several months to several years. So, in 65% of cases, warts independently regress within two years. If after two years the wart is still in place, then 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 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 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 a possibility of skin injury and virus infection (swimming pools, public showers, gyms).
• Choose quality footwear, change it often. Try to keep your feet dry. Heat and moisture are excellent breeding grounds for human papillomavirus.
• To avoid periungual warts, only go to certified nail technicians 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 highly effective. There are currently no vaccines available to prevent other types of warts.

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