Warts usually affect the skin of the extremities, the genital skin and mucosa, larynx and the oral mucosa. Warts can occur at any age, though peak incidence is during the adolescence and early adulthood. Both sexes are equally affected. Various studies have stated that about three to 20% of school children have warts.
What are Warts?
Warts, also known as verrucae, are skin growths caused by various types of HPV (Human Papilloma Virus). Usually they are harmless and resolve by themselves, though it could take up to two years for complete resolution in some cases.
The hard, thick (hyperkeratotic) and cauliflower like protuberance gives them the name "warts." Similar growths are called warty, which need not be warts in the real sense.
What is HPV?
HPV stands for human papilloma virus, a double stranded DNA virus without the surrounding envelop. It is ubiquitous and is highly infective.
There are more than 120 genetic types of HPV causing different types of clinical lesions in human beings. For example, HPV 1 causes thick palmoplantar warts, HPV 6 & 11 causes anogenital warts and laryngeal papillomas while HPV 16, 18, 30, 31, 35 etc. have more predilections for the genital mucosa and are also responsible for cervical cancers.
Are Warts Dangerous?
Most warts are benign and harmless growths which resolve by themselves after a few months to two years, when the body develops immunity against them. Certain types of warts, especially those affecting the genital skin and mucosa, have been shown to cause cancers in the cervix in females and glans in males.
Other skin cancers including squamous cell carcinoma, cancers of the larynx etc are also reported to be caused by the human papilloma virus.
What is the Incubation Period of Warts?
Incubation period means the time taken by the infectious agent to produce clinical signs and symptoms after entering the host body. Genital warts are usually the earliest to make a clinical appearance. Subclinical infections without any visible lesions have also been demonstrated in the skin and mucous membranes of the affected persons. The usual incubation period of HPV can vary from three weeks to one year.
What are the Different Types of Warts?
Depending upon the clinical appearance and area of involvement, warts have been classified into different types. The common types of warts include plane warts, common warts, filiform warts, palmar warts, plantar warts and anogenital warts.
A special types of wart, known as epidermodysplasia verruciformis present as generalized flat warts resembling pityriasis versicolor, especially on the trunk. These may become cancerous later on. The bumps may resemble seborrheic keratosis and actinic keratosis as well. Incidence of squamous cell carcinoma, in situ and invasive, is very high in EV patients.
Should Warts be Treated?
Some authorities are of the opinion that as most warts are self-limiting, they are best left alone rather than opting for costly, potentially scarring treatments. But others, justifiably, feel that for cosmetic, hygienic and preventive reasons warts should be treated as soon as they appear. This approach could reduce chances of transmission and also reduce the frequency of malignant changes in affected individuals and their partners.
No solid research has been carried out yet to prove that treatment of warts reduces the incidence of cancer, especially that of the genitals in both sexes. Common sense and hygienic reasons, though, calls for early treatment of anogenital warts.
What are the Treatments Available for Warts?
Many medical and surgical treatment options are available to get rid of the warts. Some of them, like the application of keratolytic agents such as salicylic acid or antiviral such as imiquimod could be carried out by the patient at home, under the directions of a dermatologist.
Dermatologist applied treatments in the clinical settings include surgical pairing, cryocautery, electrosurgery, laser, and so on. Treatments which could cause scars on the skin, like the electocautery and laser are best avoided on area like the face, palms and the soles.
Can Warts be Prevented?
Preventive and therapeutic vaccines are available against human papilloma virus. Teenage girls are now advised to take three injections of HPV vaccine at 0, one and six months' intervals as a preventive measure against cervical cancers. Other preventive measures include avoidance of unprotected sex, close and intimate contact with infected persons, avoidance of scrubbing of the feet on public toilet floors and sharing of towels and sandals.
Newer modalities of diagnosis of HPV like the DNA hybridization and immunohistochemistry have revealed higher incidence of warts than thought to be present, especially in the genital areas. Anogenital warts have emerged as the commonest sexually transmitted disease of the modern age.
Reference:
- Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Sixth Ed, 2009
- Virus Infections in IADVL Textbook of Dermatology, 3rd Ed, 2008
- Sterling JC. Virus Infections, in Rook’s Textbook of Dermatology, 7th Edition, 2004
Disclaimer
The information given in this article is for educational purposes only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the Dr.Hanish Babu, MD or Suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...
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