 |
 |
|
|
|
|
DESCRIPTION
Warts are small growths on the skin that are caused by human papillomaviruses (HPV). There are at least sixty known types of HPV. Warts may appear singly or in clusters, and most are benign, although several types of warts have been linked to an increased likelihood of cancer. This page addresses three types of warts: Common Warts, Plantar Warts, and Genital warts.
COMMON WARTS
After acne, warts are the most common dermatological complaint. Three out of four people will develop a wart (verruca vulgaris) at some time in their lives. Children and young adults are more prone to getting warts because their defense mechanisms may not be fully developed, but it is possible to get a wart at any age.
Common warts can be found anywhere on the body, but are most common on the hands, fingers, elbows, forearms, knees, face, and the skin around the nails. Most often, they often occur on skin that is continually exposed to friction, trauma, or abrasion. They can also occur on the larynx (the voice box) and cause hoarseness.
Common warts may be flat or raised, dry or moist, and have a rough and pitted surface that is either the same color as or slightly darker than the surrounding skin. They can be as small as a pinhead or as large as a small bean. They can be mildly to highly contagious and the virus that causes common warts is acquired through breaks in the skin.
Digitate warts are horny and finger-like, with pea-shaped bases. They commonly appear on the scalp or near the hairline.
Filiform warts are thin and thread-like. They commonly appear on the face and neck.
Flat warts appear in groups of up to several hundred, usually on the face, neck, chest, knees, hands, wrists or forearms. They are slightly raised and have smooth, flat or rounded tops.
Periungual warts are rough, irregular and elevated. They appear on the edges of fingernails and toenails and may extend under the nails, causing pain.
It may be contracted by going barefoot in a locker room or other public area, or by using another person's comb or hair brush. Common warts can be spread if they are picked, trimmed, bitten, or touched. Warts on the face can spread as a result of shaving. Common warts typically do not cause pain or itching.
PLANTAR WARTS
Plantar warts occur on the soles of the feet and the undersides of toes. They are bumpy white, gray or brown and have a center with one or more dark pinpoints. These are tiny capillaries that supply blood to the wart. These growths may resemble calluses, except that they can be tender to the touch and often bleed if the surface is trimmed due to the capillaries feeding them. They also have an identifiable hard center. If left untreated, plantar warts may grow up to an inch in circumference and may spread into clusters (mosaic warts). A plantar wart is similar in structure to an iceberg. The part on the surface is a small fraction of the entire anomaly. Often, the portion of the wart under the skin is at least twice as big as the part you can see. Plantar warts can be very painful because the entire weight of the body presses against them continuously when standing or walking. Plantar warts do not usually tend to spread to other parts of the body.
GENITAL WARTS
Genital warts are soft, moist growths found in and around the vagina, anus, rectum, penis, groin, and/or scrotum. In men, they can grow in the urethra as well. These are more highly contagious than other warts. They are a sexually transmitted disease and can effect both sexes. Since the incubation period may be several months in duration (usually these warts do not appear until three months or more after an individual becomes infected with the HPV that causes them), the virus can be spread before the carrier is even aware that he or she has it. So someone can have the viral infection and have no signs or symptoms.
FREQUENT SIGNS AND SYMPTOMS
Genital warts have the following characteristics:
They appear on moist surfaces, especially the penis, entrance to the vagina and entrance to the rectum. May appear on vulval, vaginal and cervical walls and spread to perineum and perianal area.
Foul odor, if papillomas are infected.
Warts may be small, flat, pink, red or flesh-colored bumps, or tiny, cauliflower-like bumps.
Each wart measures 1 mm to 2 mm in diameter, but clusters may be quite large, up to 4 inches (10.2 cm) in diameter and become pendulated. They may be so small that you can't see them.
They may produce no symptoms, or cause itching, burning, tenderness or pain.
Genital warts in children may be a sign of sexual abuse.
CAUSES
Genital warts (termed condyloma acuminata) are caused by subtype of the same virus that causes other warts, the human papillomavirus (HPV), but they are more contagious. They spread easily on the skin of the infected person and are transmitted via sexual activity to other people. They have an incubation period of 1 to 6 months, but can take years to develop.
Two of the strains of HPV that cause genital warts have been associated with cancer of the cervix; five strains of HPV are seen in nearly all surface cancers of the cervix, vagina, vulva, anus, penis, and perianal area. An infant can contract warts by being exposed to genital warts during the birth process.
RISK INCREASES WITH
Presence of other sexually transmitted disease.
Multiple sexual partners; not using condoms.
Crowded or unsanitary living conditions; poor nutrition..
Poor hygiene.
Immunosuppression. People who take medications to suppress the immune system, such as those who have received organ transplants or who have certain autoimmune disorders, are more prone to develop warts.
Vitamin A or folic acid deficiency.
PREVENTIVE MEASURES
PLANTAR WARTS
Avoid walking barefoot, except on sandy beaches.
Change shoes and socks daily.
Keep feet clean and dry.
Check feet periodically.
Avoid direct contact with warts - from other persons or from other parts of the body.
Do not ignore growths on, or changes in, your skin.
Visit your health care provider and podiatrist as part of your annual health checkup.
GENITAL WARTS
Avoid having sex at all.
Have sex only with someone you know does not have genital warts and is having sex only with you.
Using condoms may help prevent transmission; however, condoms can't always cover all affected skin.
Practice good hygiene.
Adequate daily vitamin C intake is most important in maintaining effective immunity against the viruses that cause warts. A balanced diet high in vitamins C, A, and E will help boost your immune system.
Avoid stress, which can compromise your immunity, and learn to relax.
EXPECTED OUTCOME
These small warts usually cause no symptoms. If untreated some will disappear spontaneously. However, because the virus may be sexually transmitted, it is important to obtain medical and nutritional treatment. Warts themselves are not life-threatening. The warts may grow rapidly during pregnancy,but often resolve postpartum.
Recurrence is common.
POSSIBLE COMPLICATIONS
Female cervical disorders; in males, urinary obstruction.
In pregnancy, the warts can cause the skin of the vagina to tear more easily and make it more difficult to repair if an episiotomy or laparotomy procedure is performed. In addition, there is a small risk that the newborn can acquire the infection whether the birth is vaginal or by cesarean section. For this reason, the infection in a mother is not a special reason to do a cesarean section.
Through some types of HPV infection carry an increased risk of genital cancer, the type of HPV causing common genital warts is normally not implicated in this group. More than 60 distinct types of HPV have been identified to date.
TREATMENT GENERAL MEASURES
Nearly every health care provider says that the best treatment for warts is no treatment at all. Most people develop an immune response that causes warts to go away by themselves. One-fifth of all warts disappear within six months, and two-thirds are gone within two years. However, if your wart doesn't disappear, or if it's unsightly or uncomfortable, you can try self-treatment or seek help from your health care provider.
If you suspect you may have genital warts, see your health care provider promptly. This is especially important for women, because genital warts have been linked to cervical cancer. An immediate pap test is advised.
The genital warts can often be diagnosed with a physical examination. Scraping from wart shows marked vascularization of epidermal cells on dark-field examination. A vinegar-like solution placed on the skin turns the warts white for easier diagnosing. Sexual partners should be screened for the disorder also.
Other diagnostic tests may include biopsy of tissue; colposcopy, androscopy, anoscopy (all 3 involve use of a magnifying glass to view body parts); and Pap smear.
Treatment will be determined by size and location of the warts. Even though the warts can be removed, the viral infection can't be cured. This is why the warts often return. Pregnant women with genital warts require special treatment.
Small common warts may be treated with topical applications. Your first-choice remedy should be an over-the-counter medication in liquid, gel, pad or ointment form. Most of these contain a mild acid solution such as salicylic acid, the main constituent of aspirin, which softens and weakens the abnormal skin cells in the walls of the wart, dissolving them and allowing the virus to enter the bloodstream, causing a production of antibodies that eventually attack and destroy the warts. To use this type of medication, first, soak the wart in warm water for five minutes to help the medication to penetrate the skin. Then gently rub off dead skin cells with a washcloth or pumice stone. Before applying the medication, coat the area around the wart with petroleum jelly to keep the medication away from healthy or sensitive skin. Removal of the warts do not allow the body to build up immunity to the virus.
Plantar warts may not require treatment. However, if an wart is painful and interferes with walking, treatment is warranted. Several treatment sessions may be necessary to eliminate them, but health care providers can usually eradicate even the most stubborn plantar warts.
Some health care providers have achieved good results using the drug bleomycin (Blenoxane) to treat warts. It is injected or applied topically.
A commonly used medical treatment for common and plantar warts is fulgration (using electrical current to destroy wart tissue).
In some cases, application of liquid nitrogen to warts (cryotherapy) freezes the tissue. This treatment is used commonly for removing common and plantar warts.
There are a variety of treatments for genital warts, but none is a perfect cure and all have side effects. Treatment includes prescription topical preparations that destroy wart tissue, electrocoagulation or surgical excision to remove wart tissue, and biological approaches that target the virus. Removal does not allow the body to build up immunity to the virus.
Some larger warts require laser treatment. Laser treatment is proving more effective in treating genital warts than chemicals or conventional surgery. Lasers remove them completely (other treatments only reduce size). Treatment is performed on an outpatient basis, and usually prevents recurrences and transmission during sex.
Don't treat genital warts yourself with nonprescription drugs used for wart removal on the hands. They can make the genital area very sore.
NUTRIENTS Supplement Suggested Dosage Comments Very Important Vitamin B complex 50 mg 3 times daily Important in normal cell multiplication. Vitamin C 4,000-10,000 mg daily. Has powerful antiviral capacity. Important L-Cysteine 500 mg twice daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B6 and 100 mg vitamin C for better absorption. Supplies sulfur, needed for prevention and treatment of warts. Vitamin A 100,000 IU daily for 1 month, then 50,000 IU daily for 1 month, then reduce to 25,000 IU daily for 1 month or until warts disappear. If you are pregnant, do not exceed 10,000 IU daily. Needed for normalizing skin and epithelial membranes. Use emulsion form for easier assimilation and greater safety at higher doses. Vitamin E 400-800 IU daily. Can be applied topically; cut open capsule to release oil. Apply to warts daily. Improves circulation and promotes tissue repair and healing. Zinc 50-80 mg daily. Do not exceed a total of 100 mg daily from all supplements. Increases immunity against viruses. Use zinc gluconate lozenges for best absorption. Helpful Multiple vitamin and mineral complex As directed on label. Needed for normal cell division. Shiitake
Or
ReishiAs directed on label. Has antiviral properties. HERBS
Aloe vera gel; myrrh; oils of clove, tea tree, or wintergreen; and tinctures of black walnut, chickweed, goldenseal, and pau d'arco have all been used externally to treat warts. Place a small dab of one on the wart two or three times daily until the wart is gone. If irritation occurs, dilute the oil or extract with distilled water or cold-pressed vegetable oil. RECOMMENDATIONS
To remove warts, try one or more of the following remedies:
- Crush a garlic clove and apply the garlic directly on the wart. Cover it with a bandage and leave it in place for 24 hours. Blisters should then form and the wart should fall off in about a week. Do not use this remedy for internally located (vagina or cervix) warts.
- Apply a paste made from castor oil and baking soda to the wart. Put the mixture on each night and cover it with a bandage. This may remove the wart in three to six weeks.
- Increase the amount of sulfur-containing amino acids in your diet by eating more asparagus, citrus fruits, eggs, garlic, and onions. Desiccated liver tablets are also good.
- Keep genital warts dry. After bathing, use a hair dryer on a low setting to dry the area. Do not rub or irritate it. Wear only cotton underwear. Do not have sexual intercourse until the warts are completely healed.
- Do not cut or burn a wart off yourself. These are procedures that must be done by a qualified health care provider.
OTHER CONSIDERATIONS
Adequate daily vitamin C intake is most important in maintaining effective immunity against the viruses that cause warts.
People who take medications to suppress the immune system, such as those who have received organ transplants or who have certain autoimmune disorders, are more prone to develop warts.
Therapy may not be indicated, if warts do not cause discomfort. Warts may resolve themselves spontaneously.
MEDICATION
A topical medication may be prescribed for use at home. Apply carefully to avoid damaging surrounding healthy tissue. Use petroleum jelly on surrounding tissue first. Don't apply to large areas at one time. This may cause irritation or absorption of the drug. Wash off after 4 hours. Keep the medication out of eyes. A topical drug often used is 20% podophyllum in tincture of benzoin. This will remove small warts in 2 to 4 days. The tincture is to be washed off in 4 to 6 hours after application.
Alpha interferon (interferon alfa) injections directly into each wart with a very small needle may be recommended for some patients (usually considered if other treatment methods are unsuccessful or wart recur frequently). This treatment has been successful approximately 36% of the time. Interferon alpha (alfa) is a powerful antiviral substance, however, using this treatment for large numbers of warts may be too uncomfortable and expensive.
ACTIVITY
No restrictions, except to avoid sexual relations until treatment is completed.
DIET
No special diet restrictions. Use recommended nutritional supplements to assist with therapy. See Genital Warts for more information about genital warts.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of any type of warts. The following occur after treatment:
- Over-the-counter or home remedies don't work.
- You are a woman and develop genital warts, which in rare cases can be associated with cervical cancer.
- You are older than 45 and discover what looks like a wart. It may instead be a symptom of a more serious skin condition, such as skin cancer.
- Warts multiply and spread, causing embarrassment or discomfort.
- The treated area becomes infected (red, swollen, painful or tender).
- Signs of infection: fever, chills, headache, or muscle aches or a general ill feeling.
- You notice a change in a wart's color or size. This could indicate skin cancer.
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch
MoonDragon's Obgyn Information: Genital Warts & Graphics