What is a wart? We will analyze the causes, diagnosis and treatment methods in an article by a dermatologist with 37 years of experience.
Definition of the disease. Causes of the disease
Wartsare irregular mild body benign lesions in the form of localized adhesions of the upper layer of the skin (epidermis) with papules (nodules) or plaques.
The incidence of warts in adults is 7-12%, in school-age children - up to 10-20%.
Warts are very similar to other skin growths. Usually a person cannot accurately diagnose the disease on their own, so a dermatologist should be consulted to make a diagnosis.
Human papillomavirus is a cause of warts. The type of virus affects the type of warts that can develop. In this way, each type of human papillomavirus infects tissue at the site that is most characteristic of it.
| HPV type | Preferred localization |
Types of warts |
|---|---|---|
| 1 | Legs, knees, palms, hands, fingers |
Plantar and palmar warts, rarely simple warts |
| 2, 4 | Hands, fingers, knees, less often - feet |
Simple warts, occasionally plantar, palmar and mosaic warts |
| 3, 10 | Thighs, arms, face | Flat warts |
| 7 | Hands, fingers | Brothers' warts |
| 5, 8, 9, 12, 14, 15, 17, 19-24 |
Face, arms, front torso |
Epidermodysplasia verruciform |
Infection with the virus usually occurs through contact - in direct contact between infected and healthy skin (for example, when trembling hands) or indirectly (through railings, toys, etc. ). Therefore, you can become infected with the human papillomavirus, which causes warts, in a wide variety of places - on public transport, at school, at work, at home, in places with high contact and humid environments (swimming pools, saunas, gyms). . Minor trauma to the epidermis through which viruses enter, as well as inflammation of the skin, contribute to infection.
Also contributes to the appearance of warts:
- immunodeficiencies (including HIV infection);
- warm and humid environment;
- the need for professional contact with meat and fish ("warts warts").
Some types of human papillomavirus are transmitted by parents.
But frogs and toads, despite the horror stories we so often fear in childhood, cannot be infected - this is one of the most popular myths about this disease, which has no basis.
If you find such symptoms, talk to your doctor. Do not self-medicate - this is dangerous for your health!
Symptoms of warts
Symptoms will vary depending on the type of wart.
Common wart:
- Round dense papule with normal color, 1-10 mm and more.
- The surface of the papule is covered with cracks, layers.
- If the papule is on the finger, the imprint disappears and is distorted. The same goes for the palm drawing.
- Simple warts are located in several pieces at the same time - they usually appear at the sites of the greatest injury (hands, fingers, knees).
- On examination with a dermatoscope, the doctor may see small brown spots - thrombosed (clogged) capillaries. Patients often refer to these points as "roots. "This is the main sign for a doctor: it can be used by a dermatologist to distinguish a wart from other similar diseases (for example, a contagious mollusk and keratoma).
Plantar (excited) wart:
- The main symptom that usually makes a patient see a doctor is pain when pushing and walking.
- Such warts are usually located on the legs.
- Contact with a doctor usually shows a keratinized, uneven plaque of the usual color, although in the first stage you may see a uniform, smooth papule. With keratinization, capillaries can only be seen if the keratinized layer of the skin is removed.
- The sole skin pattern is distorted.
- Plantar warts are usually solitary, but there are 2-6 warts;
- These warts are often confused with corn (especially dry) - this is the description of the problem that patients usually come in.
Flat (juvenile) wart:
- Appears as a round, clear, smooth papule of normal, pink or brownish color, measuring 1-5 mm.
- Appears on the hands, shins, very often on the face.
- There are always a few such warts - they are arranged in groups.
Epidermodysplasia verruciform (senile wart):
- Large, round, numerous merging neoplasms of normal pink or brown color.
- Most commonly appears on the face, arms, front of the torso.
- It can be confused with keratoma, shingles and skin cancer.
Pathogenesis of warts
Once in the body, the human papillomavirus can be dormant for a long time - one usually doesn't even know it exists. When factors favorable to the virus appear, it begins to "multiply" in the epithelium, leading to tissue changes.
Unlike other viruses, the human papillomavirus does not destroy the cells of the epithelium itself - they die on their own, naturally, in the process of keratinization and scaling.
Local factors and the state of the immune system affect the spread of the infection. For example, people with HIV infection or kidney transplantation are more likely to develop warts. In addition, these neoplasms are often difficult to treat. With normal immunity, the virus does not affect the deep layers of the skin, so many people get warts on their own after a few months.
The main stage in the appearance of warts is the acceleration of the rate of cell division and growth with the help of the virus. This rapid metabolism leads to thickening of the skin layers. As the tissue grows in a specific, small area, a tubercle called a wart appears.
Classification and stages of wart development
There is no generally accepted classification for warts. However, there are several common varieties:
- The common wartis the most common type (70% of warts are just them). Such neoplasms are not felt and cause only aesthetic discomfort to a person.
- Plantar wart- appears on the soles of the feet, is painful, so it requires treatment. Skin trauma due to uncomfortable, tight, tangled shoes contributes to the appearance of such a wart.
- Flat warts- more common in young adolescents. This is due to the unstable hormonal background of young people, which affects the whole body. Usually flat warts are almost invisible.
- Senile warts- are characteristic of the elderly. They often appear on the part of the body that is covered with clothing, but can appear on the face and hands. If there is no discomfort, such warts should not be treated - treatment in the elderly may be much slower than in younger people due to a slow metabolism.
Other authors distinguish several more of these types of warts:
- Mosaic warts(HPV 2, 4) - neoplasms of the palms and soles. They resemble foci of hyperkeratosis, ie thickening of the stratum corneum (usually in the front leg) covered with deep cracks.
- Cystic warts (xx / strongxx) (HPV 60) are a very rare type of foot growth. This is a soft knot with cracks. When opened, a white-yellow curd-like secretion appears.
- Filiform wartsare thin, aroused growths near the mouth, nose, or eyes.
- Butcher warts(HPV 7) - appear on the hands and fingers of people who are in constant contact with meat and fish. Presented as hypertrophied neoplasms, similar to cauliflower, but of normal color.
In addition, the types of warts differ depending on their location.
For example, anogenital warts - tumor-like neoplasms that appear on the genitals (especially in places where the skin transitions to the mucosa) are a common disease. They are usually caused by HPV types 6 and 11.
Wart complications
The main reason for patients with warts to go to the doctor is an aesthetic defect that can affect the quality of life of the patient, his self-confidence and develop many complexes. Complications include cracking of the surface of the wart and the addition of infection, and in some types of warts, pain when walking.
Warts do not usually degenerate into malignant neoplasms, they are quite harmless, but in very rare cases such a complication can still occur in people with suppressed immunity.
Other complications occur when you try to remove the growth yourself. In this regard, inflammation and aesthetic defects in the form of scars can occur, as well as the further spread of the virus through the skin, so that in the morning after self-removal of a wart a person can wake up with several new ones.
Remember that under the guise of a wart can hide a completely different disease, which can not be determined without the advice of an experienced doctor.
Diagnosis of warts
Examination (clinical picture) and medical history (history) are usually sufficient for diagnosis.
To confirm the diagnosis, the doctor may perform a histological examination - examination of the cells of the neoplasm.
It is very important to make a differential diagnosis - to distinguish warts from other diseases. For example,common wartsmust be distinguished from the following diseases:
- Molluscum contagiosum- occurs more often on the body and genitals, less often on the arms and legs. It is a hemisphere with an imprint on the surface; when pressed from the side, a whitish "slurry" is released.
- Epidermal wart nevus- more often lonely, a person has from birth. It rises above the surface of the skin, often covered with hairs.
- Basal cell carcinoma- a tumor in the form of a roller of nodules covered with bark in the center. Typical for older people.
Palmar-plantar wartsmust be distinguished from the following diseases:
- Keratoderma- large areas of keratinization and inflammation of the skin. No clotted capillaries.
- Palmar-plantar syphilis- many painless neoplasms, exfoliating the skin on the periphery. The reaction to syphilis is positive.
- Corn- usually painless, can cause pain only when pressed vertically.
The doctor must distinguish other types of warts from a number of diseases. If another pathology is suspected, he may prescribe additional diagnostics (eg detection of antibodies against viruses, CT or MRI).
Treatment of warts
Warts are treated for aesthetic purposes and to improve the patient's quality of life. It can be prescribed by a doctor only after examination and accurate diagnosis. Independent attempts to get rid of a wart are unacceptable, as a patient without medical education and the necessary equipment is not able to accurately diagnose the disease, and complications after such "treatment" occur much more often than recovery.
There are several ways to treat warts. All of them are usually performed under the supervision of a doctor, and some of them - only in the medical department of the clinic.
Chemical treatments
Milk-salicylic collodion and salicylic patches are used to get rid of the wart. The percentage of drugs and the method of their use (long-term use of plasters, applications, etc. ) depend on the distribution and location of the tumor.
Zinc and 2-chloropropionic acid solutions may also be used. In this case, a chemical composition is applied to the pre-treated surface, which is left on the wart until the color changes (depending on the type of wart). The procedure is repeated several times after 7, 14 and 21 days. Before each procedure, the tissue is removed mechanically.
Another chemical method is a combination of nitric, acetic, oxalic, lactic acid and copper nitrate trihydrate. In this way, only relatively small neoplasms are treated - up to 5 mm. The solution is also allowed to change the color of the wart. After 3-5 days the patient comes for a follow-up appointment, if necessary, he is prescribed a second procedure after 1-4 weeks.
Cryodestruction
This method consists of freezing the wart with liquid nitrogen: a moistened swab is pressed against the damaged skin (capturing the surrounding tissue by a few mm) for 1-5 minutes. Some lesions require several treatments for four weeks to resolve.
The main disadvantages of cryodestruction are the pain and the delayed effect compared to other methods, in which only one procedure is often sufficient for removal.
Electrocoagulation
Under the influence of electric current, the wart is removed in layers. Such an operation is performed under local anesthesia.
This method is more effective than cryodestruction, but has a significant drawback: electrocautery often leaves scars at the site of wart removal. For those patients seeking cosmetic repairs,
this method will not be the most appropriate.
Laser destruction
The laser also removes warts in layers. The light guide contacts the skin for a few seconds to three minutes, depending on the size. The scab that appears is then excised and the bottom of the wound is treated again with a laser. The patient is then instructed on how to treat the wound. The operation itself is performed under the influence of local anesthesia.
Radiowave Surgery
Radiowave surgery is one of the most modern and gentle methods for removing some benign tumors, including warts.
The method is based on the generation of electromagnetic waves with different frequencies: from 100 kHz to 105 MHz. During the procedure, the tissues resist the passing waves, due to which the cells release molecular energy, which heats the skin. Under the influence of heat, the cells actually evaporate - a clean incision is obtained. At the same time, no mechanical forces are applied to the affected tissue.
Pros of this method:
- security;
- rapid wound healing;
- good cosmetic effect - scars and scars are excluded;
- relative painlessness - local anesthesia is applied before mini surgery;
- exclusion of secondary infection due to automatic disinfection of the electrode when the device is turned on.
The effectiveness of this method is recognized worldwide, but it is quite difficult to find a clinic that uses the method of radiowave surgery.
Which treatment method to choose
All of the above methods have several drawbacks:
- During the first few weeks, the operated area looks unattractive - crusts, darkening of the tissues. This should be kept in mind if warts are found on visible parts of the body (such as the face).
- Unpleasant odor and some pain during surgery.
In addition, each of these methods has contraindications, which you should find out in consultation with a dermatologist.
But the main drawback isthe high probability of recurrence, especially if the warts are widespread, extensive. With each of these methods, doctors do not fight the root cause of the disease, but its consequences, because todayHuman papillomavirus is not curable.
Therefore, therapy is aimed at:
- or destruction of neoplasms that appear at the site of virus introduction;
- or to stimulate an antiviral immune response;
- or a combination of these approaches.
Destructive treatments are most commonly used. Their efficiency reaches 50-80%.
Childhood is usually not a contraindication to surgical treatment. Therefore, many of them (including radiowave surgery) are also used to treat warts in children. An exception is the chemical removal of warts due to the possibility of side effects on the substance.
What to do after operation
Remember to follow your doctor's advice after any of these operations.
After removing the tumor by one of the presented methods, the doctor usually prescribes treatment at the site of removal. It is forbidden to remove the "crusts" yourself, wet the wound and expose it to direct sunlight.
If the patient is constantly suffering from warts, then he should consult an immunologist - he may need drug therapy, which will increase the resistance of the immune system to the manifestations of human papillomavirus.
Forecast. Prevention
If the patient does not have immunodeficiencies, then the warts may disappear on their own, but this will take a long time - from a few months to several years. So in 65% of cases, the warts regress independently within two years. If after two years the wart is still in place, then it is recommended to remove it. It is recommended to remove multiple growths immediately.
With normal immunity and the correct method of removal (depending on the size and type of wart) it is possible to remove pathogenic tissue and achieve a good cosmetic effect. With reduced immunity and other predisposing factors, the remaining human papillomavirus in the body causes relapses.
There is no specific prophylaxis of the disease. But is infection inevitable?
You can reduce the likelihood of a virus by following a few rules:
- Avoid walking barefoot in public places where there is a possibility of skin injury and viral infection (swimming pools, public showers, gyms).
- Choose quality shoes, change them often. Try to keep your feet dry. Heat and moisture are excellent breeding grounds for the human papillomavirus.
- To avoid multilingual warts, only go to certified nail technicians and make sure they use sterile instruments.
To prevent anogenital warts, according to the World Health Organization (WHO), the tetravalent vaccine against human papillomavirus is also highly effective. There are currently no vaccines available to prevent other types of warts.
If you find a wart, then do not try to catheterize, cut or pick it up yourself - this way you can contribute to the inflammation and further spread of the virus through the skin. After such a "removal", instead of one wart in the morning, you can wake up with ten.