Warts

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What are warts?

Warts are very common benign skin growths caused by at least seventy (70) types of human papilloma virus (HPV). The lesions are papules (raised skin lesions) that are usually skin-colored and feel rough to the touch, but they can be dark, flat and smooth. Most commonly found in hands and feet, warts can also appear on almost any part of the body, face, neck, chest, back, and even on the skin of the genitals (known as genital warts).

What are the types of warts?

The three types most often seen are Common Warts (veruccae vulgaris), Foot (Plantar) Warts and Flat warts. Common warts involve the fingers, around the nails and on the backs of the hands. Plantar warts affect the soles (plantar area) of the feet. When plantar warts grow in clusters they are known as mosaic warts. Plantar warts can be painful, feeling like a stone in the shoe. Flat warts are smaller, smoother, and tend to grow in large numbers, even up to 100 at any one time.

How prevalent are warts?

The prevalence in the United States is cited at 0.84%, and in Russia, 12.9%. The incidence is highest among children and young adults (12% among 4-6 year olds in the United Kingdom and 24% among 16-18 year olds in Australia).

How does one get warts?

Warts are transmitted from person to person, usually when there is a break or damaged skin of the "recipient", where the shed virus is inoculated. It takes several months from the time of exposure to the development of warts that are visible to the naked eye. The risk of spread of hand, foot, or flat warts from one person to another is small.

Can touching frogs cause warts?

This is a popular old wives' tale and without any scientific basis. Playing with frogs does not cause warts. Touching a patient with warts can transmit it only when the one touching has an open wound in the finger. The inoculation of the virus has to be onto the damaged skin or open skin sore of the second person in order to get the infection from the patient.

Why do some people get warts and others don't?

The difference in the immune system might account for this. Also, the frequency or degree of exposure contribute to the spread. The transmission occurs from carrier to an individual with damaged skin, as stated earlier, like children or people who bite their nails or who have cuts and wounds. Otherwise, it is not easy to catch it from another person. Auto-inoculation (spread to other parts of the body on the same person) is more common.

Do warts need to be treated?

Most common warts spontaneously go away without treatment within two years. If they persist beyond that time, or if they are painful or multiplying fast, they should be treated. Among some children, warts can vanish without any therapy.

What are the treatments for warts?

There are a variety of treatments, depending on the age of the patient, the kind of warts, and their location. Common warts among younger children can be treated (under a medical prescription) at home by their elders by applying salicylic acid gel, solution or plaster on a daily basis. This may take 6-12 weeks to obtain results. Some experts use cantharidin to "paint" the warts. Cantharidin causes a blister to form under the wart, and in a week or so this blister roof may be clipped away. Cryotherapy (freezing) is generally preferred for older children and adults. In some clinical trials, Salicylic Acid application has been found to be as equally effective as cryotherapy. Electro-cautery (burning) is another good alternative treatment. Laser treatment can be used as a last resort for larger lesions or resistant and recurrent ones, although this modality causes more scarring.

What are the other therapies?

Injection of each wart with an anti-cancer drug called bleomycin is one form of treatment, but reports of a bad side-effects, like Raynaud's phenomenon and vascular damage to the treated fingers, have been reported following its use. Contact Immunotherapy (with dinitro-chlorobenzene), using the person's own immune system to fight warts, is another. Interferon alpha injection into the wart to boost the immune reaction and cause rejection of the wart has also been utilized effectively. Retinoic acid 0.05% cream (commonly used as facial cream for a younger-looking complexion), and 5% benzoyl peroxide, another irritant, have also been used to peel off warts, alone, or in combination (applied sequentially) with salicylic acid cream.

How about X-Ray therapy?

X-ray treatment is not used because it can make warts more invasive.

Can I treat my own warts?

While there are non-prescription, over-the-counter, drug for warts, it is very dangerous to treat skin lesions on your own without initial medical consultation. The correct diagnosis is essential because one could be erroneously treating a skin condition that is more serious (like skin cancer) with medications for warts. The mistake could be deadly. Skin lesions should be examined by a trained physician for proper evaluation.

Which specialist takes care of warts?

Dermatologists (skin specialists) treat warts. There are a few derma clinics in Cebu. My family and I go to Dr. Dana Ruiz-Sesante, a cosmetic surgeon, at the Ruiz Derma & Spa on the second floor at SM, one of the four Ruiz derma clinics in Cebu. We are particularly impressed with their competence, modern facilities and equipment, and their clean, comfortable and soothing environment.

Are hypnosis and "folk" remedies effective?

No, they are not. Some warts in some children spontaneously disappear, and if a folk remedy or hypnosis was used on these children, the "believers" will swear these techniques work because the warts "were cured."

What about recurrent warts?

Old warts shed virus into the surrounding skin, if not treated. New "baby" warts grow around the original "mother" warts. In view of this, the warts must be treated as soon as they develop to prevent shedding, contaminating surrounding skin areas, and auto-inoculation.

Is there any vaccine for warts?

None at this time, otherwise these bothersome warts could have been eliminated. But science never sleeps and laboratory researches around the world are ongoing to formulate new and more lasting treatment, and hopefully, in a not-too- distant future, a vaccine will be developed to wipe these annoying warts from the surface of the earth.

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Update on another viral infection: SARS

As of last Friday, June 6, 2003, ten of the original 12 cases of SARS in the Philippines have recovered, the other 2 had died. There has been no new reported cases in the Philippines since May 15th, according to the World Health Organization data, making ours a SARS-free country once more. But we can't afford to have our guards down as yet. We must continue to be cautious and vigilant because inbound travelers can still (again) bring in SARS to the Philippines. The worldwide cumulative total number of cases is 8404, with 779 deaths, with new cases still being reported in mainland China, Hong Kong, Taiwan, Canada, etc. as late as June 6th. Clearly, our battle with SARS is far from over.

©2003Raoul R. Diez, M.A.O.D.