How To Get Rid Of Warts Verruca Vulgaris

What Is A Viral Wart?

A viral wart is a very common benign lesion caused by infection with human papillomavirus (HPV). Viral warts can be classified by site as cutaneous or mucosal, as the HPV types are quite distinct. A cutaneous wart is also called a verruca or papilloma, and lesions resembling warts, regardless of the cause, may be described as verrucous or papillomatous.

Warts Symptoms

Skin growths that appear most commonly on hands and feet, but can grow anywhere on the body and last months to years.

What Causes Plantar Warts

Warts are caused by infection with the human papillomavirus (HPV), a double-stranded DNA virus. There are more than 150 known HPV types, with only some of them infecting the skin and leading to various clinical presentations. Infection typically begins in the basal layer of the epidermis, causing proliferation of keratinocytes (skin cells), hyperkeratosis, and the production of infectious virus particles, resulting in the formation of a wart. The most common HPV types infecting the skin include types 1, 2, 3, 4, 10, 27, 29, and 57.

HPV spreads through direct skin-to-skin contact or autoinoculation. If a wart is scratched or picked, a wart may develop under the fingernail (known as a subungual wart), or the virus may spread to another area of the skin. Autoinoculation of the virus through a scratch can result in a line of warts (known as pseudo-koebnerisation). The incubation period can be as long as twelve months, depending on the amount of virus inoculated.

Common Warts Verruca Vulgaris
Warts Verruca Vulgaris

What Are The Clinical Features Of Viral Warts?

Cutaneous viral warts have a hard, keratinous surface. Tiny red or black dots visible in the wart are papillary capillaries.

Common wart:

Common warts (verruca vulgaris) present as cauliflower-like papules with a rough, papillomatous, and hyperkeratotic surface ranging in size from 1 mm to 1 cm or more. They may be solitary or multiple. Common warts are found most often on the knees, backs of fingers or toes, and around the nails (periungual).

Plantar Wart:

Plantar warts (verruca plantaris) include tender inwardly growing myrmecia on the sole caused by HPV 1 and clusters of superficial, less painful mosaic warts due to HPV 2. Myrmecial warts are typically tender with lateral and direct pressure and are surrounded by yellow hyperkeratotic callus-like skin showing accentuated skin markings, but with discontinuation of the skin lines through the actual wart.

Plantar epidermoid cysts are associated with HPV 60 infection of the eccrine ducts.

Plane Wart:

Plane warts are typically multiple small flat-topped skin-colored papules located most commonly on the face, hands, and shins. On the shins and beard area of the face, the virus is often spread by shaving, resulting in numerous warts. Plane warts are mostly caused by HPV types 3 and 10.

Filiform and Digitate Warts:

A filiform wart is a cluster of fine fronds emerging from a narrow pedicle base usually found on the face. They are also described as digitate (finger-like).

Butcher’s Wart:

Butcher’s warts are specifically caused by HPV 7 infecting the hands of butchers and others whose occupation involves chronic exposure to a cold, moist environment. They clinically resemble common warts and tend to be numerous.

Epidermodysplasia Verruciformis:

Epidermodysplasia verruciformis is a rare autosomal recessive condition susceptible to skin infection with specific HPV types that cause flat pityriasis versicolor-like lesions and squamous cell carcinoma.

How to Treat Warts

Treatment may not be necessary in all cases, as most warts resolve spontaneously, especially in children. Indications for active treatment include:

Immunosuppression Presence of complications Patient preference

Treatments do not kill the virus but work by removing virus-containing skin. Persistence with treatment and patience are essential! Remember, HPV infects the basal cell layer of the epidermis, so warts recur rapidly if the virus has not been eradicated.

Topical treatment:

Topical treatment includes wart paints, pastes, or patches containing salicylic acid, podophyllin, or similar compounds, which work by removing the surface skin cells.

It is applied once daily to the wart. Treatment with wart paint usually makes the wart smaller and less uncomfortable, with 70% of warts resolving within twelve weeks of daily applications.

Steps for topical treatment:

Soften the wart by soaking in a bath or bowl of hot soapy water. Rub the wart surface with a piece of pumice stone or emery board. Apply wart paint or paste accurately and include a rim of normal skin. Allow the paint to dry before covering with plaster or duct tape. Next day remove the old paint and dead surface skin layer with a pumice stone and reapply the paint or paste. If the wart paint makes the skin sore, stop treatment until the discomfort has settled, then recommence as above.

Cryotherapy:

Cryotherapy with liquid nitrogen is repeated at one to two-week intervals to cause peeling of the surface layer. It is uncomfortable and results in blistering for several days or weeks. Treatment is required frequently to prevent the wart from regrowing between appointments. Success is around 70% after 3-4 months of regular freezing.

A hard freeze using liquid nitrogen might leave a permanent white mark and can also cause temporary numbness if performed over a superficial nerve, such as on the side of a finger.

Electrosurgery:

Electrosurgery (curettage and cautery) has been used for large and resistant warts. Under local anaesthetic, the growth is pared away and the base burned. The wound heals in two weeks or longer (depending on the site); even then, 20% of warts can be expected to recur within a few months. This treatment leaves a permanent scar, which can be painful to walk on if located on a pressure site. Recurrent wart in a scar is very hard to treat.

Other treatments:

Other treatments for recurrent, resistant, or extensive warts include:

The immune modulator, imiquimod cream – approved for treating anogenital warts but is usually ineffective for cutaneous warts Bleomycin injections Pulsed dye laser destruction of feeding blood vessels Photodynamic therapy Laser vaporisation Diphencyprone, dinitrochlorobenzene, or squaric acid to cause localised allergic contact dermatitis over the wart Microwave treatment for plantar warts.

How To Prevent Warts

Avoid spreading existing warts to other parts of the body by treating warts promptly and not using a razor on wart-infected skin. Do not pick, pull, or bite the wart. If you use public showers at gyms or public swimming pools, protect your feet by wearing waterproof footwear.

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