WARTS

A wart (also known as a verruca when a plantar wart occurs on the sole of the feet or on
toes) is generally a small, rough tumor, typically on hands and feet but often other
locations, that can resemble a cauliflower or a solid blister. These warts are common, and
are caused by a viral infection, specifically by human papillomavirus 2 and 7. There are
as many as 10 varieties of warts with the most common being considered largely
harmless. It is also possible to get warts from others, they can be contagious, but
transmission from person to person is rare. They typically disappear after a few months
but can last for years and can recur.[1]

Types
A range of types of wart have been identified, varying in shape and site affected, as well
as the type of human papillomavirus involved.[2][3] These include

• Common wart (Verruca vulgaris), a raised wart with roughened surface, most
common on hands, but can grow anywhere on the body;
• 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;
• Plantar wart (verruca, Verruca pedis), 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;
• Mosaic wart, a group of tightly clustered plantar-type warts, commonly on the
hands or soles of the feet;
• 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.

[edit] Cause
Main article: Human papilloma virus

Warts are caused by the human papilloma virus (HPV). There are about 130 known types
of human papilloma viruses [4]. HPV infects the squamous epithelium, usually of the skin
or genitals, but each HPV type is typically only able to infect only a few specific areas on
the body. Many HPV types can produce a benign growth, often called a "wart" or
"papilloma", in the area they infect. Many of the more common HPV and wart types are
as follows:
 • Common warts - HPV types 2 and 4 (most common); also types 1, 3, 27, 29, and
57 and others.
• Genital dysplasia - These are classified as "high-risk" or "low-risk" according to
their association with cancers of the cervix[5][6], and can also cause some vulvar,
vaginal,[7] penile, and anal cancers.[8]

• High-risk: 16, 18 (most common); also 58, 33, 45, 31, 52, 35, 39,
59, and others.
• Low-risk: 6, 11 (most common); also 13, 44, 40, 43, 42, 54, 61, 72,
81, 89, and others.

• Plantar warts (myrmecia) - HPV type 1 (most common); also types 2, 3, 4, 27, 29,
and 57 and others.
• Anogenital warts (condylomata acuminata or venereal warts) - HPV types 6 and
11 (most common); also types 42, 44 and others[9].
• Flat warts - HPV types 3, 10, and 28.
• Butcher's warts - HPV type 7.
• Heck's disease (Focal epithelial hyperplasia) - HPV types 13 and 32.

[edit] Prevention
Gardasil is a 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,[5][6] and also cause some vulvar,
vaginal,[7] penile and anal cancers.[8] HPV types 6 and 11 are responsible for 90% of
documented cases of genital warts.[10]

[edit] Treatment
There are many different treatments and procedures associated with wart removal. One
review of 52 clinical trials of various cutaneous wart treatments concluded that topical
treatments containing salicylic acid were the best supported, with an average cure rate of
75%, compared with 48% for the placebo in six placebo-controlled trials including a total
of 376 participants.[11] The reviewers also concluded that there was little evidence of a
significant benefit of cryotherapy over salicylic acid or duct tape.[11]

One complicating factor in the treatment of warts is that the wart may regrow after it has
been removed.
Prescription medications

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.

Treatments that may be prescribed by a medical professional include

• Application of podophyllum resin paint [podophyllum resin I.P.'66 (20% w/v),

benzoin I.P. (10% w/v), aloes I.P. (2% w/v), isopropyl alcohol I.P. to make (100%
v/v)]
• Imiquimod, a topical cream that helps the body's immune system fight the wart
virus by encouraging interferon production. Not approved by the U.S. Food and
Drug Administration (FDA) for common warts. The drug is very expensive.
• Cantharidin, a chemical found naturally in many members of the beetle family
Meloidae which causes dermal blistering. Either used by itself or compounded
with podophyllin. Not FDA approved, but available through Canada or select US
compounding pharmacies.
• Bleomycin, not US FDA approved. One or two injections used. It can cause
necrosis of digits and Raynaud syndrome.[12][13] This drug is expensive, USD
$200–300 per vial.
• Dinitrochlorobenzene (DNCB), like salicylic acid, this is applied directly to the
wart. Studies showed this method was effective with a cure rate of 80% compared
to 38% for a placebo. But DNCB must be used much more cautiously than
salicylic acid; the chemical is a known mutagen, able to cause genetic mutations.
So a physician must administer DNCB. This drug induces an allergic immune
response resulting in inflammation that wards off the wart-causing virus.[14]
• Fluorouracil, which inhibits DNA synthesis, is being used as an experimental
treatment. It is applied directly to the wart (especially plantar warts) and covered
(for example: with tape). This treatment is combined with the use of a pumice
stone, but tends to work very slowly.[15]
• Salicylic acid can be prescribed by a dermatologist in a higher concentration than
that found in over-the-counter products. Examples include a topical solution
marketed by Elorac, Inc. under the trade name Durasal.
• Apple Cider Vinegar - Natural treatment
• Chelidonium majus (European tetterwort) tincture - Natural treatment
Filiform wart on the eyelid:

Plantar Wart

Genital Wart