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Skin infections: warts SKIN INFECTIONS: WARTS
Warts are small, hard swellings which sometimes appear on the skin and the mucous membranes. There are many different types of warts, all of them caused by the Papova virus; there is the common wart, usually on the fingers, and most unsightly; the plane or flat wart, often on the back of the hand or on the face; the plantar wart, on the soles of the feet, sometimes known a papilloma or verruca; and the venereal wart, which is confined to the anal or genital areas.
Warts are caused by infection of abraded skin by the human wart virus (Papova virus). They spread most rapidly under warm, moist conditions, at sites of trauma. It is estimated that about one quarter of all warts spontaneously disappear within six months. The mechanism of spontaneous resolution is not fully understood, but is certainty related to the resistance or immune response of the person. The development of immunity is related to the person's make-up, and to the amount of virus present, which varies in warts of different kinds. Plane and plantar warts, which contain little virus, are the most persistent and difficult to cure.
There are many ways of treating warts. This multiplicity indicates that there is no one effective treatment for all warts. The aim of treatment must always be to remove the wart without hazard to the patient, with minimal discomfort and absence of scarring. Effective treatment not only destroys the wart but activates the immune system winch hopefully will prevent further infection.
Common warts are probably best treated, at least initially, with local applications of either formalin, salicylic acid, cantharadin, or combinations of these. This treatment has the advantage of being painless and can be done at home. If they prove resistant, then cryotherapy is the next choice. This entails freezing the wart, either with carbon dioxide snow at — 79°C or liquid nitrogen at — 196°C. It is frequently necessary to repeat this treatment three or four times with, ideally, no longer than a three-week interval between treatments. Occasionally, warts may be resistant to cryotherapy, or too large for freezing to be effective. Patients then have the option of undergoing diathermy with curettage under local anaesthesia. This is sometimes known as 'burning the warts out'. The disadvantage of this form of treatment is that it is rather painful and occasionally leaves scars. Curettage or 'spooning out' of the wart, without diathermy, is frequently more effective.
Plane warts are usually responsive to local applications. Since they commonly occur on the face, this is also a more appropriate mode of treatment. Various preparations may be used.
including topical 5-Fluorouracil, a preparation used for some skin cancers and solar keratoses. If they persist, then cryotherapy is the logical and only other mode of treatment.
Plantar warts are frequently most difficult to treat. Once again local preparations containing salicylic acid and/or formalin, either in a paint or in a paste, are the most beneficial. If progress is slow, cryotherapy is the best alternative. Both diathermy and curettage, and superficial X-ray therapy, may be effective. However, there is a high incidence of recurrence and scarring. The scar may be more painful than the preceding wart, and more persistent!
Genital warts usually respond well to podophyllin paint. This type of preparation is really only useful in moist areas, and therefore rarely effective on other types of wart. The applications may have to be multiple, and should ideally be carried out at weekly intervals if necessary. Occasionally cryotherapy may be required. Diathermy and curettage requires a general anaesthetic, and is therefore a last resort.
Unusual and controversial forms of treatment include immunotherapy, where a persons own wart extract is injected into the warts. Also, D.N.C.B. (dinitrochlorbenzenel has been used to stimulate a person's immunity, so as to enhance the natural rejection process. Similarly, smallpox vaccination has been tried. Treatment based on psychotherapy and on hypnosis both have their proponents. More recently the anti-cancer drug, bleomycin, has been injected into warts.
These are but a few of the many forms of treatment available for this very common infection.
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