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Warts and verrucae
Warts and verrucae

 


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Condition
Warts and verrucae
Class
Skin
Description
Warts are small growths on the skin caused by an infection with a virus known as the human papilloma virus (HPV).

There are a number of different types of warts and their name and appearance varies depending where on the body they occur.

Common warts are round with a rough surface and are usually the same colour as the skin or brown in colour. They can occur on all areas of the body but most commonly occur on the fingers and knees.

Plane or flat warts are smaller and flatter than common warts and tend to occur on the face and back of the hands.

Warts on the soles of the feet or around the toes are called plantar warts or verrucae.

Genital warts are pink in colour and often look like a small cauliflower. They are found in and around the genital and rectal areas. (see separate article on genital warts)

Sometimes, a number of small warts may clump together to form what is known as a mosaic wart.

Warts are extremely common. Most people will develop warts at some time during their life and at any one time an estimated 1 person out of every 10 will have warts. Males and females are affected equally, children and adolescents between 12 to 16 years of age being particularly susceptible.

In most cases, warts are harmless but they can be painful if they occur on sensitive parts of the body such as the feet or genitals. If the wart is visible, for example appearing on the hands or face, it may be a cause of embarrassment.

Causes
All types of warts are caused by infection with HPV. When HPV invades the skin it stimulates the cells of the skin to divide rapidly resulting in an over-production of a protein called keratin in the top layer of the skin. As more and more keratin is produced, the top layer of skin gets progressively bigger to produce the characteristic appearance of the wart.

HPV is highly contagious and can be passed on by direct contact between people, or indirectly through contact with infected surfaces and towels. If the skin is broken, the risk of picking up the virus is increased. People with a poor immune system are less able to defend themselves against the virus and so are more likely to develop warts than those with a fully functioning immune system.

Verrucae are easily picked up by walking barefoot in damp, communal areas such as swimming pools and showers.

Genital warts are contracted through sexual contact and are the most common sexually transmitted infection (STI) in the UK.
Symptoms
The size, shape and colour of warts vary depending on the area of the body where they develop.

Common warts tend to be round with a raised rough surface. They are usually a few millimetres in diameter and the same colour as the skin. They can occur on all areas of the body but most commonly occur on the fingers and knees. As these areas are visible, the unsightly appearance of the wart may cause embarrassment, particularly in school children. The warts may itch, but the desire to scratch should be resisted as this may spread the virus.

Verrucae or plantar warts develop on the soles of the feet. A verruca starts as a tiny pink area speckled with black dots but can become dark with a rough crumbly layer of skin with a 'pepper pot' appearance. Verrucae vary in size and can be as big as 1.25cm. Verrucae on the soles of the feet can make walking very painful.

Genital warts are pink in colour and often have a cauliflower appearance. They may grow on the penis, in or on the outside of the vagina, and in or around the anus. Most genital warts do not produce any symptoms, but some may itch.

Treatment
Gels, liquids, ointments or paints containing salicylic acid are among the most widely used preparations to remove common warts. When applied directly to the wart, the salicylic acid softens and destroys the hard skin which can then be gradually removed by rubbing with an emery board or pumice stone. It may take up to 3 months to remove the wart completely. Normal, healthy skin around the wart should be protected during treatment, which may prove difficult if there are a large number of warts.

Preparations containing formaldehyde or glutaraldehyde act in a similar way to salicylic acid, but because these ingredients tend to be more irritant than salicylic acid they are mainly used for the treatment of verrucae on the soles of the feet where the thick layer of normal skin provides protection against the irritation.

Creams or lotions containing imiquimod or podophyllotoxin are used for the treatment of genital warts. Imiquimod acts by stimulating the body's immune system to attack the virus, while podophyllotoxin prevents the virus from multiplying.

There is a vaccine, called Gardasil, normally used to provide protection against cervical cancer in adult females aged 16 to 26 years, that also provides protection against genital warts. However, although Gardasil provides protection against the types of HPV responsible for 90% of cases of genital warts, it does not provide protection against all types of HPV. Therefore, it is still possible to get genital warts. The vaccine has not been tested in males and so cannot be used to provide protection for men.

If treatment fails, or if there are a large number of warts that make treatment difficult, the warts can be removed by freezing or by cauterisation. Freezing or cryotherapy involves spraying the wart with liquid nitrogen. This kills the virus and, after about a week, the wart will drop off. Cauterisation involves burning the wart off either with an electric current or laser. Both cryotherapy and cauterisation can be painful and usually require the use of a local anaesthetic to dull the pain in the area around the wart.

When to see your pharmacist
Treatments for common warts and verrucae are available from your local pharmacy without the need for a prescription. However, wart treatments sold at your local pharmacy do not work for genital warts. If your pharmacist decides that you may have genital warts you will be referred to your doctor or to a clinic that specialises in genital problems. The clinics are called 'Departments of Genito-Urinary Medicine', but are often referred to as GUM clinics. You do not need a referral from your doctor to visit a GUM clinic and you can be assured that your consultation would remain strictly confidential.

Condoms, available through your local pharmacy, provide some protection against genital warts but are not 100% effective as they do not cover the entire genital skin. However, condoms are very good at protecting against other sexually acquired infections such as chlamydia, gonorrhoea and HIV.

When to see your doctor
Always seek advice before self-treatment if you have diabetes, you are pregnant or taking long-term medication, such as steroids. Any lump in the genital or anal skin that fails to clear after a few days should be examined by a doctor. If your wart changes colour or shape or starts to bleed, seek medical advice. If you are worried that you have had a wart or verruca for too long, see your doctor.

If the wart is unsightly and causing embarrassment, or if it is painful, then see your doctor about getting it removed

Talk to your doctor if you want to protect yourself against cervical cancer and genital warts. The vaccine, Gardasil, is not available on NHS prescription, but it may be obtained on a private prescription if your doctor thinks it is necessary.
Living with common warts and verrucae
If you do get a wart, most warts will disappear without treatment within a couple of years. While you have warts, there are a number of simple precautions that can be taken to reduce the risk of getting more warts or spreading them to others. Try to avoid direct contact with other people's warts, do not share towels and do not pick or scratch the wart. To avoid picking up verrucae or spreading them to others, wear protective footwear in changing rooms and swimming pools.
Living with genital warts
Left untreated, genital warts may disappear or they may grow larger in size. Even if the warts do disappear, it does not mean that HPV has been totally eliminated from the body. There is still the risk that genital warts will appear again (called recurrent infection), and there is still the risk that HPV may be spread to your partner. Using a condom will reduce the risk of spreading the infection, but it will not totally eliminate the risk as skin areas may still come into contact during sexual activity.

Treatment of genital warts can be painful and it may leave scarring if large areas need to be treated. It is generally accepted that treatment of genital warts reduces, but does not eliminate, the risk of spreading HPV. The virus may remain in the body even though visible signs of the genital warts have gone. There is also the risk that genital warts will reappear. If this does happen, the genital warts can be treated again, possibly using a different form of treatment.

Genital warts can cause problems if you become pregnant. The genital warts may appear for the first time, reappear or they may grow larger in size. There is also a risk that the virus may be spread to the baby during childbirth. It is therefore considered better to have genital warts removed, but you should always tell the doctor or nurse removing the genital warts that you are pregnant in case any of the treatments being used could affect your unborn baby. It is always better to tell your partner that you have or have had genital warts, so that you may make decisions about your love-making together.
Useful Tips
  • Help to prevent verrucae by washing your feet regularly
  • Take sensible precautions in communal changing areas, such as using flip-flops or verrucae socks
  • Cover your verrucae when swimming
  • Avoid sharing towels
  • If you have a wart on your hand you should wear washing-up gloves
  • Try not to scratch your wart
  • Condoms reduce, but do not eliminate the risk of spreading genital warts


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