About Warts and Verrucas (Common Warts)
There are various strains of HPV that can lead to these growths on the skin and mucous membranes. The infection can occur through direct or indirect transmission, such as through minor trauma or interruption of the epithelial barrier.
Non-modifiable risk factors are factors that cannot be changed or controlled. Here are the non-modifiable risk factors for warts and verrucas:
- Age: Warts and verrucas are most prevalent in school-aged children, with a high prevalence in secondary school-aged children.
- Genetic predisposition: Positive family history of warts and verrucas or other related conditions can increase the risk.
Modifiable risk factors are factors that can be influenced or changed. These include:
- Occupational exposure: Certain occupations, such as meat handlers, may involve cutaneous injury that can increase the risk of warts and verrucas.
- Environmental factors: Softened skin from swimming pool exposure, nail-biting, habitual sucking of fingers, shaving, and sexual activities can also contribute to the transmission of warts and verrucas.
It's important to note that while these risk factors can increase the likelihood of developing warts and verrucas, they do not guarantee that someone will get them. Taking preventive measures, such as practicing good hygiene and avoiding direct contact with infected individuals or contaminated surfaces, can help reduce the risk of infection.
The main symptom of warts and verrucas are skin growths. Warts and verrucas are usually painless growths that occur on the skin and mucous membranes. They are caused by infection with different strains of the Human Papilloma Virus (HPV). They can be located in area including the feet and genitals. They may occur as one lesion but can also sometimes occur in groups.
As the condition progresses, other symptoms may occur. These include:
- Discomfort: Warts and verrucas can cause mild discomfort or pain, especially when they occur on the plantar surface of the foot (verrucae). This can interfere with daily activities and cause embarrassment.
- Spreading: Warts can spread and actually coalesce into larger plaques.
- Chronic condition: In some cases, warts can become a chronic condition, particularly in immunosuppressed adults. However, this is less common in immunocompetent adults.
- Resistance to treatment: Plantar lesions (verrucae) have been shown to be more resistant to treatment compared to warts on other areas of the skin. This can make treatment frustrating for individuals.
To diagnose warts and verrucas, healthcare professionals may perform the following examinations, tests, and procedures:
- Physical examination: Healthcare professionals usually diagnose warts and verrucas through a physical examination. They visually inspect the affected area to look for characteristic signs of warts, such as small, raised bumps with a rough or papillary surface.
- Vinegar solution application: To enhance visibility, healthcare professionals may apply a vinegar solution to the genital or anal area. This can make the warts turn white and become more visible.
- Biopsy: In certain situations, a healthcare professional may take a small sample of a visible wart for further analysis. This sample is sent for testing to confirm the diagnosis.
Additional examinations, tests, and procedures may include:
- Anoscopy: For anal warts, doctors may perform an anoscopy, which involves using a tool called an anoscope to examine the inside of the anal canal for any warts.
- Pelvic examination: In some cases, doctors may conduct a full pelvic examination to check for other forms of genital warts in women. This may include a Pap smear, which is a screening test used to detect abnormal changes in cervical cells.
- Colposcopy: In cases of genital warts in females, healthcare professionals may use a colposcope to look at the cervix. This is a special magnifying instrument that allows them to get a closer look at the warts.
- Sexual health checkup: If someone suspects they have genital warts or has had sexual contact with a new partner, it is recommended to go for a sexual health checkup. This can help identify any other sexually transmitted infections (STIs) and ensure comprehensive care.
It's important to note that while at-home tests for STIs are available, they do not specifically detect the types of HPV that can cause genital warts. Therefore, seeking guidance from a healthcare professional is crucial for an accurate diagnosis and appropriate management of warts and verrucas.
The goals of treatment for warts and verrucas are to remove the warts, improve symptoms, and relieve any psychosocial distress caused by their appearance. Treatment options for warts and verrucas include medications, therapeutic procedures, and self-care and health behavior changes. Treatment options include:
Medications
- Topical medications: These are applied directly to the warts and include creams, gels, or solutions containing ingredients like salicylic acid or imiquimod. These medications work by gradually breaking down the wart tissue or boosting the immune response against the virus.
- Prescription medications: In some cases, a healthcare provider may prescribe stronger medications like podophyllin resin or trichloroacetic acid for more stubborn warts. These medications work by destroying the wart tissue.
- Immunotherapy: Certain medications can be injected into the warts to stimulate the immune system's response against the virus, helping to eliminate the warts.
Therapies and Therapeutic Procedures
- Cryotherapy: This involves freezing the warts with liquid nitrogen. The extreme cold destroys the wart tissue, causing it to eventually fall off.
- Laser therapy: A laser is used to burn off or destroy the wart tissue. Laser therapy is often used for larger or more resistant warts.
- Photodynamic therapy: This involves applying a photosensitizing agent to the wart and then exposing it to a specific type of light. The combination of the agent and light destroys the wart tissue.
- Surgical removal: In some cases, surgical procedures like excision, curettage (scraping), or electrocautery (burning) may be used to physically remove the warts.
- Cantharidin treatment: Cantharidin is a substance derived from blister beetles that can be applied to the wart. It causes a blister to form underneath the wart, leading to its separation from the skin.
Self-care and Health Behavior Changes
- Avoiding picking or scratching at warts: Manipulating warts can cause inflammation and potentially lead to their rapid growth or spread.
- Maintaining good hygiene: Keeping the affected area clean and dry can help prevent secondary infections and promote healing.
- Duct tape occlusion therapy: This involves covering the wart with duct tape for several days at a time, followed by removal of dead skin layers. It is believed to stimulate an immune response against the virus.
- Home remedies: While not supported by scientific evidence, some people try home remedies such as applying apple cider vinegar or banana peels to warts.
It's important to note that there is no one-size-fits-all treatment for warts and verrucas. The choice of treatment depends on factors such as wart size, location, number, patient preference, cost, convenience, and provider experience. Shared decision-making between people and healthcare providers is encouraged to determine the most appropriate treatment approach for each individual case.
The natural progression of warts and verrucas can vary from person to person. However, it is well established that these growths may undergo spontaneous regression, meaning they can go away on their own without treatment. The exact mechanisms behind this regression are not fully understood, but several studies have reported cases of warts clearing up without any intervention. It is also important to know that some strains of the HPV are linked to certain cancers, in particular cervical cancer. Routine PAP smears are crucial to ensure early detection.
Complications of warts and verrucas can commonly occur. These growths can cause discomfort and be visually bothersome to individuals. There is also a risk of spreading the infection to other areas of the body or to other people if proper precautions are not taken.