Wart

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Template:Short description Template:Other uses Template:Use dmy dates Template:Infobox medical condition (new)

Warts are non-cancerous viral growths usually occurring on the hands and feet but which can also affect other locations, such as the genitals or face.<ref name="Loo2014" /><ref name="IQ2014" /> One or many warts may appear.<ref name="IQ2014" /> They are distinguished from cancerous tumors as they are caused by a viral infection, such as a human papillomavirus, rather than a cancer growth.<ref name="IQ2014">Template:Cite web</ref>

Factors that increase the risk include the use of public showers and pools, working with meat, eczema, and a weak immune system.<ref name="Loo2014">Template:Cite journal</ref><ref name="IQ2014" /> The virus is believed to infect the host through the entrance of a skin wound.<ref name="Loo2014" /> A number of types exist, including plantar warts, "filiform warts", and genital warts.<ref name="IQ2014" /> Genital warts are often sexually transmitted.<ref name="Hen2010">Template:Cite journal</ref>

Without treatment, most types of warts resolve in months to years.<ref name="Loo2014" /> Several treatments may speed resolution, including salicylic acid applied to the skin and cryotherapy.<ref name="Loo2014" /> In those who are otherwise healthy, they do not typically result in significant problems.<ref name="Loo2014" /> Treatment of genital warts differs from that of other types.<ref name="IQ2014" /> Infection with a virus, such as HIV, can cause warts. This is prevented through careful handling of needles or sharp objects that could infect the individual through physical trauma of the skin, plus the practice of safe sex using barrier methods such as condoms. Viruses that are not sexually transmitted, or are not transmitted in the case of a wart, can be prevented through several behaviors, such as wearing shoes outdoors and avoiding unsanitized areas without proper shoes or clothing, such as public restrooms or locker rooms.

Warts are very common, with most people being infected at some point in their lives.<ref name="PubMed2016">Template:Cite web</ref> The estimated current rate of non-genital warts among the general population is 1–13%.<ref name="Loo2014" /> They are more common among young people.<ref name="Loo2014" /> Before widespread adoption of the HPV vaccine, the estimated rate of genital warts in sexually active women was 12%.<ref name="Hen2010" /> Warts have been described as far back as 400 BC by Hippocrates.<ref name="Bo2012">Template:Cite book</ref>

Types

A filiform wart on the eyelid.

A range of types of warts have been identified, varying in shape and site affected, as well as the type of human papillomavirus involved.<ref>Template:Cite book</ref><ref>Template:Cite web</ref> These include:

  • Common wart (verruca vulgaris),<ref>Template:Cite web</ref> a raised wart with a roughened surface, most common on hands, but can grow anywhere on the body. Sometimes known as a Palmer wart or junior wart.
  • Flat wart (verruca plana), a small, smooth, flattened wart, flesh-coloured, which can occur in large numbers; most common on the face, neck, hands, wrists, and knees.
  • Filiform or digitate wart, a thread- or finger-like wart, most common on the face, especially near the eyelids and lips.
  • Genital wart (venereal wart, condyloma acuminatum, verruca acuminata), a wart that occurs on the genitalia.
  • Periungual wart, a cauliflower-like cluster of warts that occurs around the nails.
  • Plantar wart (verruca, verruca plantaris), a hard, sometimes painful lump, often with multiple black specks in the center; usually only found on pressure points on the soles of the feet and between toes.
  • Mosaic wart, a group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet.

Causes

Template:Main article Warts are caused by the human papillomavirus (HPV). There are about 130 known types of human papillomaviruses.<ref name="deV2004">Template:Cite journal</ref> HPV infects the squamous epithelium, usually of the skin or genitals. Each HPV type is typically only able to infect a few specific areas of the body. Many HPV types can produce a benign growth, often called a "wart" or "papilloma", in the area they infect.<ref>Template:Cite journal</ref> Many of the more common HPV and wart types are listed below.

Pathophysiology

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.Template:Cn

Diagnosis

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

On dermatoscopic examination, warts will commonly have fingerlike or knoblike extensions.<ref>Template:Cite journal</ref>

Prevention

Gardasil 6 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,<ref name="pmid16670757" /><ref name="Muñoz2004" /> and also cause some vulvar, vaginal,<ref name="VulvarCA" /> penile and anal cancers.<ref name="Bloomberg" /> HPV types 6 and 11 are responsible for 90% of documented cases of genital warts.<ref name="NEJM">Template:Cite journal</ref>

Gardasil 9 protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.<ref>Template:Cite web</ref>

HPV vaccines do not currently protect against the virus strains responsible for plantar warts (verrucae).<ref>Template:Cite journal</ref>

Disinfection

The virus is relatively hardy and immune to many common disinfectants. Exposure to 90% ethanol for at least 1 minute, 2% glutaraldehyde, 30% Chlorhexidine, and/or 1% sodium hypochlorite can disinfect the pathogen.<ref name="phac">Human Papillomavirus Template:Webarchive. Public Health Agency of Canada</ref>

The virus is resistant to drying and heat, but killed by Template:Convert temperature and ultraviolet radiation.<ref name="phac" />

Treatment

Template:Further There are many treatments and procedures associated with wart removal.<ref name="pmid17210977">Template:Cite journal</ref> A review of various skin wart treatments concluded that topical treatments containing salicylic acid were more effective than placebo.<ref name="Cochrane 2011">Template:Cite journal</ref> Cryotherapy appears to be as effective as salicylic acid, but there have been fewer trials.<ref name="Cochrane 2011" />

Medication

  • 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.
    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.
  • Throat warts before and after carbon dioxide laser treatment.
    Throat warts before and after carbon dioxide laser treatment.

Procedures

Liquid nitrogen spray tank
This image shows throat warts (papillomas) before treatment and during the treatment process. Left to right: warts before treatment, warts on the day of silver nitrate treatment, warts two days after treatment, warts four days after treatment, warts six days after treatment, and warts remaining nine days after treatment.

Alternative medicine

Despite their appearance, toads do not cause warts

Daily application of the acrid yellow latex of Chelidonium majus (greater celandine) is a traditional treatment.<ref>Template:Cite journal</ref><ref>Template:Cite web</ref>

A variety of traditional folk remedies and rituals claim to be able to remove warts. According to English folk belief, touching toads causes warts; according to a German folk belief, touching a toad under a full moon cures warts.<ref name="ley196312">Template:Cite magazine</ref> 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.<ref>Template:Cite web</ref>

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. In his version, one puts one's hand into the water at midnight and says:

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One would 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 given as an example of Huckleberry Finn's planned remedy, which involves throwing a dead cat into a graveyard as a devil or devils comes to collect a recently buried wicked person. Another remedy involved splitting a bean, drawing blood from the wart and putting one of the bean halves against the wart, 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.<ref>Twain, Mark. "Chapter VI". The Adventures of Tom Sawyer.</ref> Twain is recognized as an early collector and recorder of genuine American folklore.<ref>LeMaster, J. R. (1993) The Mark Twain Encyclopedia (Taylor and Francis, pp. 293–94 Template:Webarchive, Template:ISBN.</ref>

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".<ref>Template:Cite journal</ref> 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.<ref>Template:Cite journal</ref>

History

A ~7 mm plantar wart surgically removed from the sole of a person's foot after other treatments failed.

Surviving ancient medical texts show that warts were a documented disease since at least the time of Hippocrates, who lived Template:Circa – c. 370 BC. In the book Template:Lang by the Roman physician Aulus Cornelius Celsus, who lived c. 25 BC – c. 50 AD, different types of warts were described. Celsus described Template:Lang, today recognized as plantar wart, and categorized the acrochordon (skin tag) as a wart. In the 13th century, warts were described in books published by the surgeons William of Saliceto and Lanfranc of Milan. The word verruca for a wart was introduced by the physician Daniel Sennert, who described them in his 1636 book Template:Lang.<ref name="link.springer.com">Template:Cite journal</ref>

The cause of warts was initially disputed in the medical profession. In the early 18th century, the physician Daniel Turner, who published the first book on dermatology, suggested that warts were caused by damaged nerves close to the skin. In the mid-18th century, the surgeon John Hunter popularized the belief that warts were caused by a bacterial syphilis infection. The surgeon Benjamin Bell documented that warts were caused by a disease entirely unrelated to syphilis, and established a causal link between warts and cancer. In the 19th century, the chief physician of Verona Hospital established a link between warts and cervical cancer in particular. But in 1874, it was noted by the dermatologist Ferdinand Ritter von Hebra that while various theories were advanced by the medical profession, the "influences causing warts are still very obscure".<ref name="link.springer.com" />

In 1907, the physician Giuseppe Ciuffo first demonstrated that a viral infection causes warts. In 1976, the virologist Harald zur Hausen was the first to discover that warts were caused by the human papillomavirus (HPV). His continuous research established the evidence necessary to develop an HPV vaccine, which first became available in 2006.<ref name="link.springer.com" />

See also

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References

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Template:Medical condition classification and resources Template:Diseases of the skin and appendages by morphology Template:Viral cutaneous conditions Template:Skin tumors, epidermis Template:Human papillomavirus Template:Authority control

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