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Warts, viral warts

What is it?

Warts are viral lesions caused by human papillomavirus (HPV). They are self-inoculable (can spread by contact of the lesions with areas not affected) and may be transmitted by direct contact with infected persons.

Characteristics and symptoms

Viral warts may present themselves in various ways, according to their location and format:

Vulgar warts: lesions are elevated, hardened, with rough surface and whitish. Some present very small dark spots. Isolated or coalescing, can range from millimeters to centimeters in diameter. The areas most affected are the limbs, being very common on the hands, elbows and knees. More easily found in children and adolescents.

Periungual wart: common warts that are located around the nails. Because they extend into the nail fold, its treatment may be more difficult.

Juvenile wart or flat wart: lesions are small, with flat surface and appear in large number. The regions most affected are the face and limbs. More frequent in adolescents.

Plantar wart: located in the soles, these lesions grow into the skin because body weight impedes its growth out. They are often mistaken for calluses, but lesions show irregular surface and dark spots on the inside, what differentiates from the callus. Big lesions tend to cause pain while walking.

Filiform wart, facial wart: more frequent on the face and neck, this type of wart present a fingerlike shape protruding from the skin surface. It is most easily found in the elderly.

Genital warts or condyloma acuminata: found in the genital or peri-anal area. Lesions are softer and, when located in the mucous membranes, can be humid. The color varies from white to dark and the size range from tiny dots to large vegetating lesions (cauliflower appearance). More common in adults, may be acquired by sexual transmission. The finding of genital warts in children should raise suspicion of sexual abuse.

Treatment

The treatment of warts consists of their destruction, which can be done through surgical procedures (electrocoagulation and curettage), by chemical cauterization (use of caustics), by cryosurgery (destruction of lesions by freezing with liquid nitrogen) or the local use of substances known as immunomodulators, used to treat warts which are resistant to conventional treatments.

Below is an example of plantar wart treated with one session of cryosurgery. Besides the effect of freezing, it seems that the inflammatory process resulting from this treatment favors the recognition of the virus as a pathogenic agent, with consequent formation of antibodies against it.

When the lesions occur in large numbers, it may be needed to stimulate the patient's immune system to fight against the virus. The appropriate treatment for each case should be defined by a dermatologist.

Associating psychological stimulus to treatment may be helpful, especially for children. What happens is that, being a viral illness, the stimulation of organic defense by the subconscious may help the body to develop immunity against the virus.

Related articles

- Genital warts, condyloma acuminatum
- Molluscum contagiosum


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