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Warts

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Warts are small overgrowths on skin that commonly occur due to a viral infection. They can occur on any part of the skin. These may range in size, color, texture, and severity. A viral infection that results in warts is contagious and can easily spread from an infected person to another by different modes. The majority of the warts cases are recovered well on their own, with or without medication. Some viruses may cause cancerous warts, a serious condition that needs immediate medical attention. 

Causes

The most common cause of warts is the Human Papillomavirus (HPV). This virus enters the outer layer of the skin and triggers your immune response. It can penetrate the skin by any breach in the skin caused by cuts, bruises, abrasion, or previous infection. There are almost 150 different types of human papillomavirus. The most common types that cause skin warts are HPV 2 and HPV4. Skin warts are contagious and can spread from one part of the body to another by scratching the lesion and touching other parts. You may develop warts around your fingers or nails by consistent scratching. They can also spread from one person to another by direct contact with the lesion or by sharing clothes, towels, etc. 

Another common type of wart is the one that affects anal and genital regions. HPV6 and HPV11 are the causative pathogens in most cases. This infection can spread through sexual contact from an infected person to their partner. Few types of human papillomavirus are capable of causing cancerous lesions. The most common types include HPV 16 and HPV18. These types can cause cervical, anal, vaginal, or penile cancer. 

Types

Warts can be divided into multiple types based on their location of occurrence. 

Common warts (Verruca Vulgaris) usually occur on hands but can appear elsewhere on your skin. These are small-sized overgrowths and may resemble your skin color. 

Flat warts (Verruca Plana) can be present on your neck, knees, face, or elsewhere on your body. As the name indicates, these are flattened warts with a smooth texture. 

Filiform warts (Digitate Warts) are small-sized overgrowths usually present around your eyelids and lips region. 

Genital warts appear as multiple raised bumps on genital and anal regions.

Plantar warts (Verruca Plantaris) are most commonly observed on the soles of feet. They can be painful and cause extreme discomfort during walking and other activities. 

Mosaic warts are similar to plantar warts as they are usually present on hands and feet. They appear a bunch of clustered warts on the affected region.

Periungual warts are cauliflower-shaped warts that are present around nails or the tips of fingers. 

Risk Factors And Epidemiology

The occurrence of warts is highly linked with the strength of your immune system. Children, young adults, and older people are at high risk for this reason. A weakened immune system can also result from certain systemic diseases, medication, or treatment. Patients with HIV/AIDS are at the highest risk of contracting this infection. Excessive use of corticosteroids, especially in organ transplantation, can also increase the risk because of a suppressed immune system. Chemotherapy or radiotherapy can also decrease the immunity of a person hence raising the risk for this infection. You may also be at risk if you share clothes, towels, or other items of personal use with an infected person. Sharing a shower or swimming pool with an infected person may increase the risk of its spread. 

Warts can occur at any age if you come in contact with an infected person. However, its prevalence is high among children due to their lower immunity. About 10% to 20% of children are affected worldwide by skin warts. Genital warts are more common among sexually active adults. There is no gender prevalence associated with this condition.

Signs And Symptoms

Warts can vary in size, color, and texture depending on the type of HPV virus you are infected with. Most warts appear as little growths on the skin that can be skin-colored, pinkish, white, grey, or black. They are rough in texture and can be felt as small bumps on the skin that may or may not be accompanied by pain. The skin surrounding a wart lesion can be darker or lighter than your regular skin color. These warts can be present on the face, limbs, oral or genital regions. 

Diagnosis

Warts can be diagnosed based on clinical presentation alone. Your doctor may require history about the onset, duration, and severity of symptoms. This is followed by a clinical examination of the skin region affected by warts. Your doctor can shave a small sample from the area and examine it under a microscope for a conformational diagnosis. A biopsy is recommended in a few cases where a cancerous lesion is suspected. 

Differential Diagnosis

Signs and symptoms of warts may resemble other skin or genital conditions. Some of these conditions include lichen planus, lichen nitidus, seborrheic dermatitis, actinic keratosis, squamous cell carcinoma, syphilis, herpes simplex infection, familial benign pemphigus, etc.

Treatment

Treatment of warts depends on the severity of the condition. Small, painless warts generally do not require any treatment and can heal by themselves in a certain period of time. If you have warts that cause cosmetic issues or discomfort, treatment begins with the least invasive measures, such as the use of salicylic acid or topical medications. Cryotherapy is the next option of treatment. In this procedure, liquid nitrogen is applied to the wart lesion to freeze it off from the rest of the skin. The wart may fall off after one or more applications. If these treatment options are not successful, other options are considered, including surgical curettage, laser therapy, electrodesiccation, and a few other techniques. It is recommended to avoid scratching a wart lesion and limit contact with other individuals to limit the spread of this infection.  

Medication

Salicylic acid is the most commonly prescribed medication for warts. It removes the layer of warts or dead skin cells with consistent use and increases immune response to fight off the virus. Trichloroacetic acid can be used as an alternative to salicylic acid. Topical ointments with imiquimod, podofilox, or sinecatechins can be used in given prescriptions for genital warts. 

Prognosis

The majority of warts cases recover well even if they are not treated. Medication and other techniques can help with the early disappearance of warts without waiting for months or years. The prognosis of cancerous lesions depends on their severity and stage of diagnosis. 

Prevention

Warts can occur at any time without any preceding factors. There are vaccines available for certain types of papillomavirus, which should be received if possible. However, you may still develop warts if you get infected by other types. Prevention methods are used to limit the spread of warts. Avoid scratching your warts or shaving over them. You need to be extra careful if you have a habit of nail-biting. Sharing clothes, towels, razors, and other personal items should be avoided until warts have been treated.