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Warts (verrucae) are benign, small-area and sharply defined growths of the epidermis. They arise from an infection with Human Papillomavirus (HPV). Warts are harmless and the body can usually fight the triggering viruses alone. However, this can take weeks to months. The exact duration of the healing process varies from case to case and depends on the causative virus type and the state of the immune system of the person concerned. Warts often affect children and adolescents. But warts can also occur in other age groups.
Types of warts and their causes
In general, doctors distinguish between real and fake warts. Real warts include common warts, thorny warts, brush warts, flat warts and genital warts. Real warts are due to infection with Human Papillomavirus (HPV). The viruses usually penetrate through small skin cracks or injuries, in order to subsequently cause uncontrolled cell growth. In addition, the host cells are made to produce further viruses.
Common warts are mostly caused by HPV types 1, 2, 4 or 7. Thorny warts can primarily be attributed to HPV types 1, 2 and 4. HPV type 3 mainly causes flat warts, while genital warts are mainly caused by HPV types 6 and 11. In addition, skin growths can appear that look like real warts, but have causes other than infection with HPV. Dell warts, age warts and stem warts are fake warts. Dell warts are caused by infection with a specific pox virus. The causes of age and peduncle warts have not yet been clarified.
No increased risk of cancer from warts
Certain types of HPV are associated with the development of tumor diseases (especially cervical cancer). The HPV types that cause warts usually do not belong to these so-called high-risk types. There is only a potential risk with genital warts, which are triggered in part by the high-risk HPV types 16 and 18. However, experts estimate the risk that a malignant tumor will develop from these skin changes as extremely low.
The risk factors for the development of warts
The development of warts can be favored by various factors. These include:
- Wounds in the skin,
- a weakened immune system,
- excessive sweating (hyperhidrosis),
- Circulatory disorders in the fingers and toes (acrocyanosis),
- general allergy tendency,
- existing atopic eczema (neurodermatitis),
- physical and mental stress,
Depending on which type of HPV has led to infection in which area of the body, different types of warts develop morphologically.
Types of warts
A basic distinction is made between the types of warts listed below.
Common warts (Verrucae vulgares)
The most common warts are the common warts (also vulgar warts or spiked warts). They can develop in any area of the body, but mostly occur on the fingers, under the nail plate and on the face. In many cases, common warts are not isolated (solitary), but in large numbers. The warts are usually the size of a pinhead to a pea.
At the beginning, the raised and hemispherical skin growths are characterized by a smooth surface. It corners with age and growth and finally appears rugged, rough and scaly. The skin growths at this stage are often reminiscent of cauliflower. The warts also change color. At first they appear skin-colored, but gradually show a dirty yellowish color. Common warts usually cause no discomfort and do not cause itching or tenderness. They often recede on their own. Various methods can be used to accelerate this regression process. These include in particular freezing with liquid nitrogen (cryotherapy), acid therapy with salicylic acid or laser treatment.
Brush warts (Verrucae filiformes)
Brush warts are a subspecies or special form of the common warts. They are characterized by an elongated, thread-like or spike-like stem. This is why these warts are reminiscent of small brushes. Older people are often affected. The warts form on them especially in the face area, especially on the eyelids, lips or nose. This type of warts can also often be observed on the neck. Due to their location and stem-like morphology, the warts can easily become irritated during washing or shaving. In some cases, the warts also cause itching. Many find the warts annoying and have them removed as part of cryotherapy, acid or laser treatment.
Foot warts (Verrucae plantares)
In the case of foot warts (skin growths on the feet), a distinction is made between thorn and mosaic warts. Thorny warts usually develop on the sole of the foot or heel. They are therefore not raised, but pressed into the subcutaneous tissue by the weight of their body. Thorny nipples can become comparatively large and cause severe pain, making it difficult for those affected to walk.
Mosaic warts, on the other hand, mostly appear like beds on the ball of the foot or under the toes. They are smaller than pin warts and do not grow as deep. Therefore, they usually do not cause any complaints. In many cases, soles of the feet develop in people who move barefoot in swimming pools, gyms or shared showers. By walking barefoot, the skin of the feet comes into contact with the triggering HPV viruses. In most cases, thorny warts are treated with the help of acidic plasters (including salicylic acid). Thorns can also be removed as part of cryotherapy or electrocoagulation.
Flat warts (Verrucae planae juveniles)
Flat or planar warts are only slightly raised. In most cases, they develop on the face or on the hands, but can also occur on other parts of the body. Flat warts mostly show up in children and adolescents, which is why they are also called juvenile warts.
Like all real warts, flat warts are triggered by HP viruses. An infection is promoted by a weakened immune system. Children often scratch the warts and thus promote the spread of the viruses and thus the warts along the scratch mark.
The harmless planar warts usually recede alone. However, medical treatment may be necessary if the spread is severe. The warts are treated with the help of vitamin A or salicylic acid. If necessary, acid therapy can be combined with UV radiation. Cryotherapy, electrocoagulation and laser treatment are also available. The warts can also be removed with the help of curettage (scraping).
Genital warts (Condylomata acuminata)
Genital warts (including genital warts or condylomas), like all real warts, are caused by an HPV infection. The skin nodules, which are usually the size of a pin, are among the most common venereal diseases. The viruses enter the organism primarily through unprotected sexual contacts and settle in the upper layers of the skin. With a weakened immune system, the viruses trigger cell proliferation and warts develop. The red, brown or gray-white nodules mainly form in the genital and anus areas. They usually occur close together and in large numbers (wart beds).
They are usually not accompanied by any complaints. Itching can develop on sensitive skin areas. External genital warts are treated with active substances that inhibit virus growth, such as podophyllotoxin (obtained from the rootstock of the petal), epigallocatechin (obtained from the leaves of green tea) or imiquimod (antiviral). The active ingredients are applied to the warts in the form of solutions or creams for several weeks.
Internal genital warts are treated as part of an acid treatment with trichloroacetic acid or cryotherapy. The two methods are particularly suitable for small warts on the mucous membranes of the vagina, urethral mouth or the anal canal. With bed-like and strong growth and recurrences (recurrence after successful treatment), the warts are surgically removed with a curette or destroyed under the influence of heat (laser treatment, electrocoagulation).
Dell Warts (Mollusca contagiosa)
Dell warts (also molluscs or Mollusca contagiosa) - unlike real warts - are caused by the so-called Poxvirus mollusci and are therefore assigned to the fake warts. About two to seven weeks after the infection, pinhead to pea-sized skin nodules with a wart-like appearance form. The skin-colored to light red skin changes show a dent in the center.
They usually appear in groups on one or more parts of the body. Occasionally, however, they can develop distributed over the body. In adults, Dell warts often form in the genital area. In children who are most often affected by dell warts, they can also develop on other areas of the body such as the eyelids, armpits or on the neck.
Dell Warts contain a whitish, mushy and highly infectious secretion. Contact with this secretion leads to infection with the virus (smear infection). The penetration of the viruses is favored by softened skin. This is particularly evident when visiting swimming pools and saunas. In addition, disorders of the skin barrier caused by wounds, neurodermatitis or fungal infections can increase the risk of infection. Adults also often become infected with dell warts during intercourse.
The warts are usually not accompanied by pain. In some cases, symptoms such as itching, a feeling of sore, reddening of the skin or swelling may appear. In most cases, Dell warts regress independently. However, this can take up to several years. Those affected who find Dell warts annoying or unaesthetic can have them treated by a doctor. In the case of dell warts, acid therapy with vitamin A or salicylic acid and surgical-mechanical removal are possible. So-called irritation treatment can also contribute to faster healing. Here, a liquid that is very irritating to the skin, such as potassium hydroxide, is applied to the Dell wart. This corrodes the wart tissue and thus causes it to die. The method is mainly used for occasional warts.
Age warts (Verrucae seborrhoicae)
Despite their wart-like appearance, age warts also belong to the fake warts. Since they are not caused by viruses, these skin growths are not contagious. The exact causes have not yet been clarified. They occur primarily from the age of 50. Age warts often form on the face, chest, back, back of the hand and on the front of the arms and legs.
They can be round or oval and are the size of lentils to beans. They are characterized by a gray-brown to black color and a jagged surface and usually do not cause any complaints. Therefore, the harmless skin growths don't really need to be treated. However, removal may be desirable for cosmetic reasons. Age warts can be surgically removed using a curette or a sharp spoon. Pedunculated warts (subspecies of old age warts) are removed with an electric snare. Laser treatment is also available.
Pedicle warts (fibromas)
Stick warts are also fake warts. The small petioles on the skin are caused by the growth of certain skin cells. They are soft and skin-colored. For this reason, they also refer to doctors as soft fibromas. The causes of the development of stalk warts are still unknown. However, since they occur increasingly in some families, a genetic predisposition is suspected. Stem warts are harmless and not infectious, but can be perceived as unsightly or mechanically. For example, necklaces or fine silk scarves can get caught on stem warts. In these cases, they can be removed using laser treatment, electrocoagulation or with the help of surgical scissors.
General treatment for warts
As already described, warts are usually harmless and often resolve on their own. Therefore, there is usually no medical reason for treatment. However, many find the skin growths unattractive and would like to have them removed. For that there are different possibilities:
- Cryotherapy (freezing with liquid nitrogen),
- Electrocoagulation (killing with the help of electric current),
- Acid treatment in the form of ointments or plasters,
- Laser treatment,
- surgical removal (using a scalpel, a sharp spoon or a curette).
Removal of warts by acid treatment
Various acids dissolve the horny layer of the warts and thus promote removal. Salicylic acid is mostly used in the form of solutions, tinctures, creams or plasters. Lactic acid can also help dissolve the horny layer. Vitamin A acid is often used for flat warts on the face. However, the affected skin areas usually have to be treated with the acidic solution, tincture or cream several times a day for several weeks. However, plasters are only worn for a few days. Here, however, the treatment may have to be repeated.
Cryotherapy: icing of warts
Cryotherapy is another treatment method. The doctor applies liquid nitrogen to the warts to be removed. The nitrogen then evaporates and so-called evaporative cooling occurs. This destroys the top layer of skin on the wart and thus accelerates its death. The cryotherapy is carried out in several sessions at intervals of at least one week. With existing circulatory disorders, cryotherapy is often contraindicated and must not be carried out. For example, icing warts on a diabetic foot can additionally impair blood circulation and lead to further nerve damage and poorly healing wounds.
Surgical wart removal
If non-invasive methods such as acid or cryotherapy do not lead to the desired success, surgical removal of the warts may be indicated. Warts can be removed as part of a so-called curettage (scraping). The wart tissue, which is mostly pretreated with acid, is removed with a special instrument - the curette. The method can be used, for example, in the case of pronounced infestation of genital warts. On the other hand, pincer warts are usually surgically removed with the help of a scalpel. The wound resulting from the procedure is then closed by electrical current (electrocoagulation) or with a suture. The surgery is associated with an increased risk of infection and scarring. Therefore, this method is only used in isolated cases today.
Conventional treatment measures
In addition, the wart can also be removed as part of a laser treatment. The wart tissue is heated so much with the help of a laser that the cells die. As part of a photodynamic treatment, an active ingredient-containing gel is applied to the wart to be treated. After an exposure time of several hours, the wart tissue is irradiated with light to activate the active ingredients. These ultimately destroy the wart tissue. In addition, solutions and ointments with active substances that inhibit viral cell growth (including 5-fluorouracil, acyclovir) are offered. However, the effectiveness of these antiviral agents has not been clearly demonstrated in warts.
Herbal wart treatment
Various herbal remedies can speed up the healing of warts. These include the milk juice of celandine or dandelion. A solution from rootstocks or thuja tincture (tincture from tree shoot tips) may also be helpful. As with acid treatment, the herbal active ingredients must be applied to the warts to be removed several times a day. Tea tree oil is also recommended in naturopathy. This has an antiviral effect and can inhibit the multiplication of the viruses that cause warts. Slices of garlic that are fixed on the wart overnight can also accelerate the healing process. However, the effectiveness of the described phytopharmaceuticals is not considered to be guaranteed.
When to the doctor?
Warts should always be examined by a doctor if they occur in the genital area or cause symptoms. A visit to the doctor is also advisable in the following cases:
- bleeding and / or inflamed warts,
- Warts that are caused by other skin problems (including neurodermatitis)
- rapid spread of warts.
Age warts can possibly be mistaken for skin cancer. Here, too, a doctor's visit may be useful for precise clarification. (fp)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters
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