Warts- not harmful but embarrassing!

Warts are small growths on the skin caused by a virus known as human papillomavirus (HPV). The virus resides in the bottom layer of the epidermis and replicates into almost normal-looking skin. Different sub-types of HPV cause different types of warts. Warts can be disfiguring and embarrassing, and occasionally they itch or hurt. Warts do not have "roots". They only grow in the top layer of skin, the epidermis. When they grow down, they displace the second layer of skin, the dermis. They do not grow into the dermis. Warts normally grow out of the skin in cylindrical columns. These are actually blood vessels that have grown rapidly and irregularly into the wart and have clotted off.

Types of Warts: There are 6 clinically different types.

Common warts have a rather bumpy surface called papules or plaques and appear commonly on the hands, elbows, knees and fingers (of children, in particular). They have a rough surface and frequently will have small tiny spots which are from blood vessels that have clotted.

Flat or plane warts are small, smooth warts appearing in clusters on the back of the hands, face, or legs. They are brown or skin colored. They are most commonly seen on the face of women. They are spread easily by shaving.

Plantar warts are those appearing on the soles of the feet. They are thickened. They can be confused with corns or calluses. They will frequently have thrombosed blood vessels causing black dots. They can sometimes be uncomfortable if they are in weight-bearing areas. Occasionally they can be quite widespread involving large surfaces. They tend to grow into the skin rather than coming outwards as most other warts.

Filiform warts form long, thin projections around the eyes, face, and neck.

Periungual warts (common in people who bite their nails) occur under and around the fingernails.

Genital (venereal) warts appear in the genital peri-anal skin. They have a variety of appearances. They can look like common warts or sometimes they are skin colored, small papules. They vary in size from tiny papules to much larger typically warty growths. Occasionally they are pigmented. There is a subgroup of these warts caused by HPV 16 and 18 which have been named bowenoid papulosis. They have a small chance of becoming cancerous. Some of the genital warts have been associated with carcinoma of the cervix, Bowenoid papulosis and Bowen's disease.

Keep in mind that some warts can become cancerous, and some skin cancers can look like warts, so always get them checked by your doctor.

Causes of Warts:

Warts can be caused by 70 different strains of HPV.
These viruses exist naturally on human skin, so when a person's immune system is weak (i.e., from illness or medications) he or she is at a higher risk of contracting the virus.
Common, plantar, or plane warts can be acquired through something as simple as a cut.
Walking barefoot in public areas is also a high-risk activity for contracting warts.
Genital warts are more serious and also the most contagious. They are transmitted through direct sexual contact and may take from 1 to 24 months to appear.

Symptoms: More specifically, plantar and genital warts have very distinct symptoms and are more serious types of warts.

Plantar: These warts sometimes resemble calluses. They are flat in appearance, deep-rooted in the skin, and can cause pain when you walk. They may be yellow or brown in color and may also be dotted with tiny grey-black nodules.
Genital: These warts are often small and flat. They can be pink, white, or grey in color. They can also join together, forming cauliflower-like growths. These warts are able to grow on both the external and internal genitalia, including the anus, vagina, urethra, and cervix. Genital warts can also appear in the throat if oral sexual contact occurs with an infected person.

Treatment: There are many effective treatments for warts, ranging from creams to laser treatment.

Common Warts: Liquid nitrogen cryotherapy is most commonly used in those who can tolerate the pain. Repeat treatments are frequently required. Excising or scraping off these warts is less desirable as it will scar. The use of pulse dye laser or very occasionally the Co2 laser can be used in resistant lesions. Cantharone can be used particularly in children as it is more easily tolerated. Other treatments involve the use of immune therapy. Substances such as DNCB involve painting the substance on the warts in order to develop an allergic reaction. This immune allergic reaction will be useful for destroying the wart.
Flat Warts: Flat warts frequently occur on the face and on the legs. Care needs to be taken not to use a treatment that will have a high risk of scarring. Very light liquid nitrogen cryotherapy can be used. It is important that shaving is done very carefully or is stopped for a while as this is known to spread these warts. Treatments such as Aldara have been used. Topical treatments such as vitamin A acids (Tretinoin) can sometimes be of benefit. Efudex cream has also been used.

Plantar Warts: Plantar warts can be stubborn. Because of their location aggressive use of liquid nitrogen cryotherapy is difficult in that it can not only be painful but swelling and soreness can prevent walking for a number of days. Often paring the warts by thinning them down can be helpful. The use of salicylic acid preparations that are applied daily and cover the affected area will eat away at the surface of the wart allowing it to be pared down. This may make it more responsive to liquid nitrogen. The use of duct tape to soften the lesions in some individuals can be in itself curative. It appears that changing the water content and making the skin mushy enhances the patient's ability to eradicate these warts. A treatment such as surgery and scraping of these warts is discouraged as scars can sometimes be painful on the weight-bearing parts of the foot. The pulse dye laser can be used once the wart has been thinned as it does not produce scarring. Occlusion combining these therapies with Aldara cream in some individuals is helpful.
Genital Warts: Genital warts are usually sexually transmitted. It is important that woman be checked to rule out any atypical changes on the cervix. Small warts can be treated with liquid nitrogen although this is uncomfortable. Podophyllin or podophyllotoxin can be applied every few days and this can be helpful.

Apart from genital or plantar warts, many warts will disappear on their own, without any treatment.

Important Points:

Warts are local growths in the skin that are caused by human papillomavirus (HPV) infection.
Types of warts include common warts, flat warts, plantar warts, periungual warts, and filiform warts.
Warts typically disappear on their own with time, but it may take years.
Warts respond variably to treatment measures.
Over-the-counter treatments for warts include salicylic-acid preparations and freezing kits.
Warts may recur following treatment.

Warts can occur in people of all ages, but occur most commonly in children and young adults. They spread by direct contact, simply by touching the wart. Warts normally resolve spontaneously but the time it takes for this resolution is variable. People who have immune-related diseases such as AIDS and lymphoma, or who are taking chemotherapy tend to have more warts that last longer.

(Sources: chealth.canoe.ca, skincareguide.ca, dermatology.about.com, medhelp.org, medicinenet.com)