Wart…Away!

Ugh! Where the Heck Did That Come From?

Clustered, flat, pink warts on the fingers of a nail-biter

Common warts are a strange phenomenon. They come out of nowhere, have odd shapes and configurations, grow anywhere on the skin, may spread like wildfire, and frequently pose a demanding and lengthy treatment challenge. While they truly belong on witches and goblins, warts commonly afflict us humans, who, in response, tend to pick at them with our fingers, gnaw on them with our teeth (yes, this is common), or just let them go. More often than not, picking or gnawing makes it worse. The wart grows, recruits other warts to form a collective or disseminated troop, and wages an even greater assault on its host.

Why Me?

Wart surface dotted with capillaries

Common warts come from a viral infection of the top layer of skin (the epidermis), and the viral strains belong to the human papilloma virus [HPV] family. When the skin’s barrier is compromised, usually from a small scratch, the virus invades and rapidly replicates itself on the epidermis. There are 100 unique types of HPV. Some strains cause common warts, others cause genital warts, and some strains cause both.

The HPV responsible for common warts is omnipresent. All of us come in contact with HPV time and again throughout our lives from handshakes, keyboards, and doorknobs. And most of us will have at least one harmless but annoying common wart, typically on the hand. According to the American Academy of Dermatology [AAD], warts seek out and

Wart with finger-like projections

favor children and teens, nail-biters, and those with a weakened immune system. Common warts tend to favor (1) the hands and (2) the feet (called plantar warts; thicker and calloused), but they can crop up in obscure and hidden areas of the body, too. Typically, these warts are round, have a grey, brown, or skin-colored hue, and are speckled with tiny black dots within them (these are the clogged capillaries that “feed” the wart virus). Warts may also appear as smooth, flat, and pink bumps, or they may look almost animated and bizarre with finger-like projections on their surface.

HPV can spread from one body area to another and from person to person through direct contact with a wart. Each person’s immune system responds to the virus differently, which explains why some of us are more prone to growing warts than others. For example, when I practiced in dermatology, encountering – and sometimes inadvertently touching with bare hands – warts many times a day, I very rarely grew a wart to call my own. However, I had certain patients who were repeat wart warriors, chronically battling warts.

Now What?

While there is no absolute way to prevent the appearance or spread of warts, there are ways to decrease these risks. These tips improve one’s hygiene generally:

• Do not pick your skin or bite your nails. If you have a wart, avoid picking at or scratching it. Avoid directly touching someone else’ wart with bare hands.
• Wash your hands often, especially immediately after touching or treating warts.
• Wear flip-flops in public showers and pool areas. If you have a plantar wart (wart on the foot), this is particularly paramount.
• Keep warts on your hands and feet dry, as moisture tends to enhance the spreadability of the virus.

How to Treat

HPV usually self-resolves – the body’s immune system eventually and spontaneously resolves a wart. Oh happy day! But self-resolution can take up to two years – sometimes even longer. And, in the meantime, a wart can grow and replicate, which is a risk that some of us do not wish to take.

In order to expedite a wart’s demise, there exist in-home and in-office procedures that may help. There is no treatment that directly kills the HPV. Instead, treatment is intended to inflame the surrounding area around a wart, thus triggering the body’s immune system to send help to the irritated skin and fight off the virus.

Bear in mind that treatment measures are neither a “quick fix” nor can they guarentee success. All treatments for warts, in particular home treatments, take time and are done on a trial and error basis. What works for one person may not work for another. And the incidious nature of warts requires good stamina – with repeated injury to the wart structure.

Home Remedies:

The following tips come from the American Academy of Dermatology’s “Home Treatment for Warts” video.  The AAD’s Dermatology A to Z: Video Series features useful demonstrations on a variety of ways that we can care for our skin, hair and nails at home.

• Apply a wart product with a high amount of salicylic acid (look for 40%) directly to the wart. Examples include Dr. Scholl’s Plantar Wart Removal System, WartStick, and Curad Mediplast. Salicylic acid not only helps to cause physically peeling of the wart-ridden skin but it irritates the skin, which likely stimulates the immune system to respond.
• To improve your chances of success, soak the wart in warm water (or diluted vinegar) for several minutes and sand it down with an emery board (use a new one each time) or cuticle scissors (clean with alcohol before and after use) prior to painting on the salicylic acid. The thinner the wart, the more vulnerable it will become to the acid. Debridement (or thinning) of the wart is particularly important when treating a thick, or calloused, wart, such as a plantar wart.
• Repeat this procedure at least several times a week, and, ideally, on a daily or even twice daily (every 12 hours) basis. Frequency depends on one’s tolerance, diligence, and level of frustration! Even when done consistently and thoroughly, the regimen can take several months to see results.
• After applying treatment, immediately cover the wart with duct tape. Although studies conflict about its efficacy, duct tape sticks to the skin much better than bandages. Change the tape every two to three days before it gets too “gunky” around the edges, and keep the site occluded around the clock until it is visibly gone. The less oxygenation to and more occlusion of the wart, the better the results.
• Should the wart or surrounding skin became uncomfortably raw or bleed, you should stop treatment until the skin heals, or you may want to consider seeking dermatology care.

Dermatologist Treatments:

• Consider specialized dermatology care when home treatment does not work; the wart hurts, itches, or burns; you have many warts; you have a facial or genital warts; or you have a skin growth that you have trouble identifying — sometimes (although rarely) a skin cancer (usually a squamous cell carcinoma) can masquerade as a common wart. If you are not sure what you are dealing with or if your so-called wart persists for a longer duration than expected, you should seek medical care.
  

  Post-cryotherapy “white-out” before the thaw

  

  Post-cryotherapy – the wart becomes “whited out” and thaws within seconds

  

  Cryotherapy, or liquid nitrogen in spray form

   

• Dermatology and primary care providers routinely use the following treatments: (1) prescriptive medications that boost the immune system response or (2) in-office procedures, such as application of destructive, chemical topical agents, repeated and prolonged application of liquid nitrogen (cryotherapy), or a scrape and burn technique (electrodessication and curettage or “ED&C”).
• Surgical removal (dermatologist) and newer laser techniques (podiatrist) are usually reserved for refractory cases. The dermatologist or podiatrist likely will take a small biopsy to confirm the diagnosis and rule out skin cancer.

Persistence!

I’ll reiterate that there is no cure for the wart virus. Warts can replicate, even during treatment. A single wart may grow bigger before it shrinks/vanishes, or new warts may appear at any time, anywhere.