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SKIN DISEASES: Warts



Dermatlas: Planar Warts
Planar warts

Dermatlas: Genital Warts
Genital warts


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Common warts
Location: common warts usually develop on the extremities.

Symptoms: Some types of HPV (e.g. HPV-1) cause common skin warts, such as those found on the hands and soles of the feet (plantar wart). These types of HPV do not cause genital warts. The shape of the wart depends on the body surface affected. Facial warts appear filiform, and warts in areas subject to abrasion appear as a flattened mosaic of multiple warts.

Treatments: Detectable warts can be removed using local treatments: cryosurgery which involves freezing the wart, after which the wart and surrounding dead skin falls off by itself; application of fluorouracil cream; application of chemical compounds, containing salicylic acid, blistering agents, or immune system modifiers, sharp curettage, radiofrequency resection and laser ablation. There are certainly other therapies in use, and experienced clinicians recognize that no one of them is uniformly effective. Scientists are doing research on prevention of HPV using two types of HPV vaccines: one would be used to prevent infection or disease (warts or pre-cancerous tissue changes), but the other would be used to treat cervical cancers.


Planar warts (Verruca Pedis; VP)
Location: planar warts appear on the sole of the foot. Plantar warts on the heel and sole are surrounded by hyperkeratotic, callus-like skin.

Symptoms: generally small, rough, cauliflower-like growth that may have small black specks within it. Plantar warts may be quite painful when they occur on weight-bearing surfaces. Multiple plantar warts may combine to become a large "mosaic wart". Flat warts are small, 1- to 4-mm papules, often occurring on the face and legs of children and adolescents. While inconspicuous at first, they propagate rapidly, often into the hundreds.

Treatments: some health professionals recommend the application of small amounts of banana or banana skin pulp to the wart (eg under a sticking plaster) which may kill the wart in 1-12 weeks. Options to treat planar warts include freezing (cryotherapy), burning with an electric current (electrosurgery), burning with stronger acids, laser and surgical excision.

Note: plantar warts can often be differenciated from Helomas (Corns) by close observation of skin striations. Feet, like hands, are covered in skin stria which are more commonly called fingerprints. Where verrucae pedis are present, the skin stria can be observed as going around the lesion; where the lesion is not verrucae pedis, the cell DNA are not altered and the striations continue across the top layer of the skin. Furthermore, VPs tend to be painful on application of pressure from either side of the lesion rather than direct pressure. Helomas tend to be the opposite and are painful on direct pressure rather than pressure from either side.



Genital warts (Condylomata Acuminata)
Location: mostly affect moist skin of the genital tract.

Symptoms: genital warts, technically called condylomata acuminata, are soft and often occur in clusters. The lesions begin as small papules, which often become whitish with maceration as they grow. Vulvar and anogenital condylomata generally exhibit a cauliflower-like appearance. The lesions may become quite large and, rarely, may cause destruction of surrounding tissues. They are most commonly associated with two HPV types, HPV-6 and HPV-11.

The warts may appear internally or externally, within several weeks after sexual contact with a person who is infected with HPV, or they may take months or years to appear, or they may never appear. Even in the absence of warts the virus may be present and transmittable. HPVs may also cause flat, abnormal growths in the genital area and on the cervix (the lower part of the uterus that extends into the vagina). However, HPV genital infections usually cause no symptoms. Problems can result from untreated warts, which can grow quite large, or, in rare cases, from infection of an infant during delivery. In most cases, papillomaviruses do not cause malignant change leading to cancer.

Some types of HPVs are referred to as "low-risk" viruses because they rarely cause cancer. HPVs that are more likely to lead to the development of cancer are referred to as "high-risk". Both low- and high-risk types of HPVs can cause the growth of abnormal cells, but generally only the high-risk types of HPVs may lead to cancer.

Sexually transmitted, high-risk HPVs include types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, and possibly a few others. These high-risk types of HPVs cause growths that are usually flat and nearly invisible, as compared with the warts caused by types HPV-6 and HPV-11.

Such types of papilloma viruses as HPV-16, HPV-18, HPV-31 may play a role in cancers of the cervix, vulva, vagina, anus, some cancers of the oropharynx (the middle part of the throat that includes the soft palate, the base of the tongue, and the tonsils). Infection with these HPV is also a risk factor for penile cancer(cancer of the penis). These viruses have also been associated with cancers of the head and neck. HPV-16 has been shown to be associated with some forms of Kaposi's sarcoma. HPV-30, HPV-40 cause Laryngeal Carcinoma.

Prevention and Treatments: If one's sexual partner has warts that are visible in the genital area, one should avoid any sexual contact until the warts are treated. Male latex condoms can not prevent transmission of HPV itself, but condom use may reduce the risk of developing diseases linked to HPV, such as genital warts and cervical cancer. Genital HPV infections are particularly difficult to treat because of the location of the lesions. The use of cryotherapy or podophyllin for external lesions or cryotherapy or laser ablation for any genital lesion has found favor with most clinicians. Intralesional alpha interferon has also been effective in the treatment of genital warts.


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