Warts: a Pesky Problem Requiring Persistence

Warts: a Pesky Problem Requiring Persistence

Warts are a very common but challenging skin problem. These pesky bumps, known in dermatological circles as "verrucae," have likely been around since the dawn of man, afflicting millions of individuals. They are caused by a virus called the Human Papilloma Virus, or HPV. There are many subtypes of HPV causing a variety of different warts. They are potentially contagious, spreading to other body areas on one person or to other individuals.

Warts can sometimes spontaneously resolve, but they often linger in many individuals for years while increasing in numbers or spreading to other individuals, siblings or family members.

There is no single, certain remedy or cure for warts. The wart virus resides at the base of the epidermis, which on the hands and feet can be over a half centimeter in depth with overlying reactive wart tissue. Destruction or regular removal of wart tissue until cells harboring the wart virus are removed is the most commonly utilized method of banishing warts.

Liquid nitrogen, acids, or blistering agents are often used. Persistent removal of wart tissue every few weeks is critical to achieve success in the removal of warts.

If more than several weeks pass between treatment and removal of layers of wart tissue, warts re-grow or regenerate causing us to "spin our wheels" in redundantly removing the same layers of tissue repetitively. Warts on the hands and feet require an average of 5-7 serial treatments every few weeks. Persistence is absolutely critical in getting rid of warts. Frustration is not allowed. We must be persistent in the regular removal of wart tissue, not allowing these pesky little warts to get the upper hand.

We generally avoid more painful techniques of wart removal in younger children. Cantharone, a blistering agent causing minimal discomfort, is often used repetitively in these individuals.

In older children and adults, liquid nitrogen cryosurgery is utilized to destroy layers of wart tissue. Acids or blistering agents are often added to achieve additional tissue destruction. Some discomfort is inevitable after wart treatment, as we have destroyed tissue and inflammation results. Often a blister results. If the blister breaks in the course of activities or a sore results, good local wound care should be initiated with either hydrogen peroxide or soap and water twice daily with subsequent antibiotic ointment such as bacitracin or Neosporin and a Band-Aid.

A large, tender blister can be decompressed in a sterile fashion with a needle cleansed in alcohol or hydrogen peroxide. Do not tear off the top of the blister. Tylenol (acetaminophen) can be given for pain or discomfort at an appropriate dose for the individual. If significant swelling or redness occurs, elevation of the affected part, cold ice compresses and Tylenol can be helpful. If symptoms persist or if other signs of infection are present, your doctor should be contacted or the ER visited, if after hours.

Additional means are taken in individuals with many warts where destructive means are prohibitive given the sheer number of warts. Tagamet, or cimetidine, is often used in these individuals in much higher doses than that used for stomach problems. A side effect of Tagamet at higher doses is the up regulation of the immune system responsible for identifying and ridding the body of viral infections. The typical course of treatment when Tagamet is deemed appropriate is 4-6 months. For very refractory warts, there are additional measures which can be taken. These can be considered and discussed as the need arises.

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