Warts are a viral disease characterized by the appearance of small rounded protruding growths on the skin. There are several types of warts: ordinary – localized on the fingers, face, scalp; plantar, flat (juvenile) – located on the face, the back of the hands, pointed – more often occur in the anogenital region. Warts are prone to spread, relapse and rapid growth; when injured, they bleed, can change shape, color, become painful; when self-medication causes the appearance of scars and scars, malignant degeneration.
General information
Warts are a viral disease characterized by the appearance of small rounded protruding growths on the skin. There are several types of warts: ordinary – localized on the fingers, face, scalp; plantar, flat (juvenile) – located on the face, the back of the hands, pointed – more often occur in the anogenital region. Warts are prone to spread, relapse and rapid growth; when injured, they bleed, can change shape, color, become painful; when self-medication causes the appearance of scars and scars, malignant degeneration.
Etiology and pathogenesis
The human papillomavirus (HPV), which causes the formation of warts, is widespread in all age groups and the most common are simple, plantar and flat warts. HPV is affected not only by the skin, but also by the mucous membranes of the mouth, nose, bladder, vocal cords, etc.
Infection with the HPV virus occurs as a result of contact with an infected or sick person, as well as through contact with sick animals. There are frequent cases of infection by household means, through things, toys and common items. After penetration into the human body, the virus begins to actively multiply in the surface layers of the skin.
Autoinoculation (self-infection) is quite common; warts in the periarticular area are associated with the habit of biting nails or biting fingers, and the appearance of flat warts on the face is associated with shaving, peeling and other cosmetic procedures, as a result of which damage to the skin is possible.
The papilloma virus enters the human body through microtrauma of the skin; people who actively visit swimming pools, gyms, baths and saunas are most susceptible to infection. Poultry farm workers and those engaged in cutting meat or fish also fall into the risk group, warts affect their hands and forearms.
The incubation period is usually from one and a half to five months, but even with infection, there may be no external manifestations of the virus.
The most common are simple warts, juvenile (flat) and plantar; pointed warts are also called condylomas.
Common (vulgar) warts. Common warts are localized on the palms, the back of the hands and on the fingers, rarely appear on the face and even less often on the mucous membranes; externally they look like rounded dense nodules, the skin color is not changed, but pink or yellow shades may be present. Such warts are multiple in nature and have a tendency to merge. The affected areas of the skin are rough and uneven to the touch. Among the total mass of warts, one is usually the largest, it is also called maternal, after the removal of which the rest often disappear on their own.
Vulgar warts account for 70% of all skin warts; they are most common in children and schoolchildren.
Plantar warts. They are localized on the soles and cause painful sensations when walking, outwardly they are similar to ordinary warts.
Palmar-plantar warts are widespread among young people and older people. These warts look like dense formations with a thickened stratum corneum of the skin. They need to be differentiated from the usual skin scuffs and calluses, as well as a differential diagnosis with plantar papules in syphilis. Uncomfortable shoes and excessive sweating contribute to the spread of infection.
Periarticular warts are a variant of ordinary warts, most often found in children biting their nails and the skin around them. After their removal, relapses occur quite often.
Flat or juvenile warts occur in 4% of cases, affect the skin of the hands, face, mucous membranes. Flat warts can be localized on the head of the penis, the cervix and on the mucosa of the rectum. The age category from 10 to 25 years falls into the risk group.
Threadlike warts are located on the neck, the skin of the eyelids, in the armpits, on the mammary glands and in the groin area. Outwardly they look like soft papules, sometimes on a leg, which often leads to their traumatization. The color of filamentous warts varies from flesh to dark brown.
The viral nature of filamentous warts is confirmed by their tendency to autoinoculation, and hormonal conditioning is associated with diabetes mellitus, the onset of menopause and other conditions in which a hormonal shift is observed.
Pointed warts because of the lobular structure and the dough consistency look like cauliflower or cock’s comb. The color of the warts is pink or flesh, however, when they are rubbed, they turn bright red, and when injured, they bleed easily. They have a narrow leg and are prone to the formation of extensive conglomerates. They are localized on the genitals and in the perineum, nasolabial folds are more often affected in children.
Diagnostics
The diagnosis is made on the basis of external signs. But warts need to be differentiated from red lichen planus, which is characterized by a waxy sheen and purple-red color of papules. Warts differ from warty tuberculosis of the skin in the absence of inflammatory infiltrate and a red-purple corolla on the periphery.
When the central part of the plantar wart is removed, the delicate papillary layer is exposed, and a dense horny ring remains on the periphery. When taking a biopsy, such a picture is a confirmation of the correctness of the diagnosis.
Treatment of warts
The main method of treatment is to remove or destroy warts using medications or mechanically. Antiviral ointments prevent the spread of infection to unaffected areas of the skin. Oxoline, tebrofen and other ointments are prescribed in the desired percentage concentration.
Cryodestruction and electrocoagulation have a good therapeutic effect in most patients. Laser removal, depending on the type of beam, gives the effect of evaporation or coagulation of the affected skin. After local anesthesia, a layer-by-layer removal of the wart is performed, the depth of penetration and the time of exposure depend on the size and localization of the formation. This type of treatment leaves almost no scars, and the pigmentation of the skin does not change. A depression remains in place of the wart, which is tightened after 10-14 days.
Electrocoagulation is also performed under local anesthesia, the principle of operation consists in the ability of a high-frequency current to coagulate tissues, a metal loop simply cuts off the wart, and short-term exposure to high temperature prevents bleeding and the spread of infection by hematogenic means. A small crust remains in place of the wart, which disappears after a week. If the wart was large, then an inconspicuous scar may remain.
Surgical treatment is carried out if a large area of tissue is affected by warts. Excision of tissues is carried out under local anesthesia, with the imposition of intradermal cosmetic sutures, which are removed after 7-10 days; after treatment, a light inconspicuous scar remains. Cryodestruction with liquid nitrogen is similar in principle to electrocoagulation, only tissue death does not occur due to heating, but due to deep freezing.
Depending on the course of the disease, mechanical and drug therapy can be combined. Histological examination of the removed material is mandatory. The effectiveness of treatment ranges from 50 to 94%, relapses occur in a quarter of patients. The earlier treatment is started, the more effective it is, and it is also advisable to conduct general antiviral and anti-relapse therapy. The prognosis and probability of recurrence depends on the timeliness of treatment and on the state of the immune system.