Integrative Dermatology: What to know about Warts

Most Dermatologists can agree, warts are not always a well-received patient diagnosis. While they are one of the most common clinical diagnoses we make, the first impulse at hearing the clinical assessment is for a patient to make a disgusted face or even get offended. We see this reaction the most among adults, as opposed to pediatric patients, who the communal culture most likely EXPECTS to have warts. It’s inferred that being an adult with a wart holds a stigma. Whether they connect it with the idea of genital warts, caused by a sexually transmitted virus, or some subconsciously encoded knowledge that warts come from a virus and may be related to immunosuppressed, weakened states, it’s important for Dermatologists to set the record straight and re-educate our community about warts.

This is why I find it invaluable to explain to my patients that it’s actually estimated that 85% of people will get a human papilloma virus (HPV) infection in their lifetime.

Many will not even know it because of the work their immune system is doing to suppress the expression of the virus. In other words, your immune system is strong enough to prevent the virus from actually producing visible warts anywhere on the skin. Moreover, it’s important to clarify even further from here. When we hear the term HPV, we often lump this representation together with the phrases “high risk”, “low risk” and “genital warts.” This is actually misinformation in a lot of ways. While cutaneous warts, clinically known as “verrucae”, are a manifestation of infection with HPV, there are actually four different kinds of warts we commonly see as a result of the virus:

Condyloma Acuminatum - also known as genital warts, these are typical flesh colored bumps which begin to grow around the genitals. They can be found on testicles, labia, vulva, anywhere on the penis, perianally, in the vaginal canal, on the anus or in the rectal vault, on the inner thighs, or the suprapubic region (the mons). Often times, these little bumps don’t look like warts at all, and appear as little pigmented moles; however, biopsy (sampling) and pathology (looking under the microscope) prove otherwise.

Plantar Wart – These warts appear on the heels or balls of the feet, though they can also effect the toes. They can feel hard or grainy and produce pain with weight baring, giving the sensation of something pressing into the bottom of the foot when standing or walking. They can be very resistant to treatment due to the thicker character of skin that we see on the soles of the feet, and often, multiple treatments in addition to at-home therapy are needed to effectively clear them.

Flat Wart – Also known as verruca plana, we see these more commonly on the face, hands, arms and legs. They are incredibly common in more age advanced patients, seen dispersed throughout the lower legs. Shaving can cause these warts to bleed as well as spread, so we try to stay on top of treatment before they become too widespread.

Common Wart – Clinically referred to as Verruca Vulgaris, 3 in 4 people will grow one of these in their lifetime. Children and young adults are most familiar with these, as a result of their developing immune systems, but anyone at any age can present with this general and common presentation of a fleshy, often painless bump growing on the skin.

While these warts all look different, and present in unique ways on different parts of the body, the one thing they all have in common is the HPV virus. That being said, there have been more than 120 types of HPV recognized to date. Not every wart is spread by sexual contact. Skin to skin contact of any kind can transmit the virus, just as walking on an infected surface with bare feet can expose an individual to the virus.

So if your husband happens to grow a wart on his knuckle, spare yourself the paranoia and read on…

Instead, remember that majority of the population is silently carrying any of the 120 HPV viruses at any time, and it would be better to focus on:

TREATMENT

Visiting a Board Certified Dermatologist would be the quickest and most effective way to address any kind of wart. Treatment options can include cryotherapy to locally destroy the unwanted viral tissue, which can take a few treatments, optimally spaced about a month apart for most warts. Larger warts might be numbed and pared down, or even biopsied by a shave removal to expose the base. Special solutions can be applied topically or injected into warts to instigate the immune system and direct immune mediated destruction of the cells. Often times, a combination of treatments are recommended for larger, thicker warts, and depending on the age and status of the individual.

Retinoid and salicylic acid creams in various strengths can be prescribed for home treatment between appointments, to soften and “whittle down” the warts from the outside. And over the counter treatments, such as Cimetidine, which is an antacid and antihistamine, is also useful as an immune system “activator”, proving useful in studies beyond it’s typical clinical profile. This medication was found to be a safe and effective means for resolving warts in pediatric heart transplant patients over a twice a day course of treatment for 3-6 months. I recommend this often for my patients who recurrently return with warts, or experience distress from genital warts and frustration revolving around sexual activity. But be sure to talk to your dermatologist about the safety and efficacy of this medication for your own use before beginning a regimen on your own.

Lastly, homeopathic remedies are often utilized before a patient presents for a visit. The most common and effective remedy I have seen in 12 years of practice utilizes apple cider vinegar (ACV). It’s recommended to soak a cotton ball in ACV and then using a gentle paper tape, or well tolerated adhesive, to affix the cotton ball over the wart of concern for up to 5 days. Many patients report a decrease in the size and thickness of the wart in that time frame. Sometimes, these results can be seen with occlusive duct tape, alone. Nonetheless, these approaches can be irritating to sensitive skin. If irritation occurs, discontinue use immediately.

PREVENTION

An ounce of prevention is worth a pound of treatment. Avoiding skin to skin contact with anyone with raised lesions, wearing protective clothing to conceal warts on your own skin, avoidance of rubbing or shaving over existing warts, and prompt treatment are the best ways to prevent the spread of verruca.

Minding your immune system through attention to gut health, adequate and quality sleep, healthy physical activity, routine outlets for stress, and basic hygiene such as handwashing can go a very long way to maintain a more resilient immune system. Depending on your own personal medical history, allergies, medication use, and when not contraindicated by a physician, zinc supplementation, Vitamin D supplementation and herbal supplementation with immune supporting herbs such as Echinacea and Goldenseal can boost immune strength and fight viruses as well as the expression (symptoms) of viruses to help get ahead of the problem before it becomes too involved, limiting function or social comfort.

At the end of the day, the HPV virus is everywhere and warts are just a fact of life. They just don’t have to be a fact of YOUR life.

Your Favorite Integrative Dermatology Physician Associate,

Nicole Gentile, MMS, PA-C