What is a Wart?
A wart (verruca) is a painful skin lesion a caused viral infection. The virus is a strain of the Human Papillomavirus (HPV). It is an infection that cannot be cured. Once the virus has infected the patient, it cannot be removed or killed from the blood stream. However, the actual wart that lies within the skin can be treated.
Warts can be found on any area of the skin of the body. It is most notably found on the top of the foot or the bottom of the foot, commonly called a “plantar” wart.
What Are the Symptoms of a Wart?
When a wart shows up in the skin, the body’s reaction is to build a callus (layers of dead skin). As the callus gets larger the area can become painful to touch or when walking. Warts can appear as a single lesion or a cluster of many lesions.
What are the Causes of a Wart?
Warts are caused by the Human Papillomavirus (HPV). This virus is contracted by close contact with another individual with an exposed viral lesion. Some patients will contract the virus from a parent from birth. The virus is contagious if an individual with open skin comes in contact with another individual with an active wart lesion on the skin.
How is a Wart Diagnosed?
An examination of the skin is the most common way to verify the presence of a wart. Warts have a very specific appetence within the skin. They will usually have read or black dots within the lesion, which are the ends of tiny blood vessels that supply the virus. The “fingerprint” of the skin will not pass through the lesion. There is pain when the lesion is squeezed from side to side more than direct pressure. The skin under the wart will be white and irregular. In rare cases, a biopsy of the wart may be needed to confirm the diagnosis.
How is a Wart Treated?
Over the Counter Medications:
Most of these products are acid based materials that attempt to kill the virus cells on the surface of the skin. They come in the form of topical solutions or adhesive pads. They can work well with warts that are very small or on the skin of the top of the foot or toes. The success of these products is limited because they cannot penetrate deep enough to the source of the virus cells. When they do work, multiple treatments are needed.
These medications are topical based materials that work to kill the virus cells within the skin. One of the main products is called Efudex (5-Flurouracil). These work better than the OTC products, but are also limited to working well for those warts on the top of the foot or toes, and smaller lesions.
Cimetadine (Tagament) Pills:
You have seen it advertised on TV many times. It cuts down of over production of stomach acid. Many people do not know it, but it also stimulates cell-mediated immunity, the branch of the immune system that fights off warts. I have found it helpful for grown ups with warts to take the 400 mg Tagamet pill twice a day during the wart treatment period and for about a month after the wart is gone. Tagamet, in my experience, works best for little kids. The dose is 1/2 of a 200 mg table twice a day for about 1-2 months. Several little kids with large numbers of warts have gotten rid of all the warts with just Tagamet alone and no other treatment.
Liquid Nitrogen / Cautery:
These therapies rely on their ability to penetrate the first layers of skin containing the wart, and killing the cells. Each of these types of procedures is more effective than the above treatments. They are only offered in a doctor’s office setting. The limit of the therapies is that many multiple painful treatments are needed to eradicate the wart.
A laser used to treat plantar warts can be very effective. The laser is used to penetrate through the skin’s surface to kill the virus and the surrounding affected skin. The custom temperature and wavelength of the laser is specific for killing the virus and stopping is multiplication capabilities. The treatment is perfumed in the office by a state-of-the-art laser. Multiple treatments may be needed. There are no restrictions on activities after the treatments. Dr. Soomekh offers this service in his office
In stubborn cases and most warts on the bottom of the foot, Dr. Soomekh offers a more predictable treatment option with a single injection therapy. Bleomycin is a anti-cancer medication used for skin lesions. It is an antibiotic produced by a specialized bacteria. The therapy works by injecting the medication just into the wart lesion. The medication then will kill all the wart cells and the surrounding poor skin. The patient returns to the office 10 days later to have the wart completely removed. A small wound is created that heals with healthy normal skin within 2 to 3 weeks. This procedure is more effective and has more predictable results and returns the patients to pain free and wart free activity sooner than other therapies.
In some cases the lesion is too large or resistant to treatment. In these situations the patient may need to have surgical removal of the wart. This would be performed in an operating room under light sedation. The wart is completely cut with additional healthy skin. The wound may be closed with stiches. In some cases, the wound needs to close over a 2 to 3 week period of time.