Warts are benign skin lesions that occur in the mucosa and skin, and are caused by the human papillomavirus (HPV). Clinical manifestations of a common wart appear as a 1 mm to several centimeters papular lesion that can be rough, flat, or smooth in nature, and range from skin-colored to brown, or grayish-black. It is commonly seen in Caucasians, immunosuppressed individuals, and school-aged children. HPV viral replication occurs in the upper level of the epithelium and can be found in the basal layer. The warts appear commonly on the hands, feet, face, and genitalia. Different types of warts caused by HPV infection include common warts, genital warts, flat warts, and deep palmoplantar warts (Myrmecia). There are over 100 different types of HPV, and those associated with malignancies include HPV types 6, 1, 16, 18, 31, and 35. Individuals infected with genital warts and immunocompromised patients are more likely to develop malignancies. Likewise, HPV types 5, 8, 20, and 47 are associated with cancer that may lead to epidermodysplasia verruciformis, which is characterized by reddish-brown scaly patches or formation of wart-like lesions on the face, neck, hands, arms, legs, feet, and trunk. Warts are a communicable skin infection transferred by direct or indirect contact with the affected area. Damage to the epithelial barrier, for instance, a cut or scrape of the skin, increases the opportunity for HPV infection and wart development. Most warts resolve independently of treatment, and do not cause scarring if it disappears on its own. However, several surgical procedures and pharmacologic treatments are available.
Different wart-removing procedures include cryosurgery, electrosurgery and curettage, and laser treatment. Cryosurgery is a common treatment that involves freezing the wart via application of liquid nitrogen with a cotton swab against the affected area or sprayed with a nozzle. The extremely cold temperature destroys the surface of the skin, and there are multiple sessions involved. Electrosurgery and curettage involves burning the warts followed by curettage, which is scraping off the wart with a sharp device. Laser surgery involves heating and destroying the wart with a laser beam, such as pulsed dye laser treatment. Pulsed dye laser treatment involves the conversion of a concentrated beam of yellow light into heat, which targets the blood vessels that supply blood to the wart, thereby destroying the affected area and stopping cellular epithelial multiplication.
Pharmacological treatment of warts include salicylic acid, bleomycin injections, cantharidin, and systemic treatment with cimetidine. Salicylic acid is considered first-line, over-the-counter therapy that destroys the HPV-infected epidermis through induction of an immune response from mild irritation of the salicylic acid. It is available over-the-counter as 17% salicylic acid combined in a flexible collodion or as a 40% patch. Another treatment option is bleomycin injection, which is reserved for refractory warts. Bleomycin works by inhibiting DNA and protein synthesis of squamous cells and reticuloendothelial tissue. It causes acute tissue necrosis, stimulates the immune response, and destroys the wart. Expected adverse effects include pain and burning at the injection site and swelling. Moreover, cantharidin treatment is another option which is derived from the blister beetle, and is a vesicant. The liquid is applied to the wart and let dry with tape. Blister formation is expected, and the lesion may fall off or the blistered lesion is removed at the base. Cantharidin works by causing death of epidermal cells, and acantholysis, which is the loss of intercellular connections between epidermal cells. Systemic cimetidine is also another pharmacological treatment believed to work by inhibiting suppressor T-cell function and increasing lymphocyte proliferation, which leads to cell-mediated immune responses to destroy the wart. Cimetidine for wart treatment is given 20 to 40 mg/kg.
In conclusion, it is common for HPV-induced warts to resolve independently of therapy. However, invasive procedures and pharmacologic treatment are available for those who want immediate removal or for refractory or recurring warts.
References
Aboud, Ahmad M, and Pramad K Nigam. “National Center for Biotechnology Information.” Wart, 16 Apr. 2023, www.ncbi.nlm.nih.gov/books/NBK431047/.
Lipke, Michelle M. “An Armamentarium of Wart Treatments.” Clinical Medicine & Research, Dec. 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC1764803/#:~:text=Salicylic%20acid%20is%20a%20first,caused%20by%20the%20salicylic%20acid.
“National Center for Biotechnology Information.” What Are the Treatment Options for Warts?, 7 Nov. 2019, www.ncbi.nlm.nih.gov/books/NBK279585/.
“Warts: Diagnosis and Treatment.” American Academy of Dermatology, www.aad.org/public/diseases/a-z/warts-treatment. Accessed 5 June 2023.
Different Therapies to Treat Cutaneous Warts
Warts are benign skin lesions that occur in the mucosa and skin, and are caused by the human papillomavirus (HPV). Clinical manifestations of a common wart appear as a 1 mm to several centimeters papular lesion that can be rough, flat, or smooth in nature, and range from skin-colored to brown, or grayish-black. It is commonly seen in Caucasians, immunosuppressed individuals, and school-aged children. HPV viral replication occurs in the upper level of the epithelium and can be found in the basal layer. The warts appear commonly on the hands, feet, face, and genitalia. Different types of warts caused by HPV infection include common warts, genital warts, flat warts, and deep palmoplantar warts (Myrmecia). There are over 100 different types of HPV, and those associated with malignancies include HPV types 6, 1, 16, 18, 31, and 35. Individuals infected with genital warts and immunocompromised patients are more likely to develop malignancies. Likewise, HPV types 5, 8, 20, and 47 are associated with cancer that may lead to epidermodysplasia verruciformis, which is characterized by reddish-brown scaly patches or formation of wart-like lesions on the face, neck, hands, arms, legs, feet, and trunk. Warts are a communicable skin infection transferred by direct or indirect contact with the affected area. Damage to the epithelial barrier, for instance, a cut or scrape of the skin, increases the opportunity for HPV infection and wart development. Most warts resolve independently of treatment, and do not cause scarring if it disappears on its own. However, several surgical procedures and pharmacologic treatments are available.
Different wart-removing procedures include cryosurgery, electrosurgery and curettage, and laser treatment. Cryosurgery is a common treatment that involves freezing the wart via application of liquid nitrogen with a cotton swab against the affected area or sprayed with a nozzle. The extremely cold temperature destroys the surface of the skin, and there are multiple sessions involved. Electrosurgery and curettage involves burning the warts followed by curettage, which is scraping off the wart with a sharp device. Laser surgery involves heating and destroying the wart with a laser beam, such as pulsed dye laser treatment. Pulsed dye laser treatment involves the conversion of a concentrated beam of yellow light into heat, which targets the blood vessels that supply blood to the wart, thereby destroying the affected area and stopping cellular epithelial multiplication.
Pharmacological treatment of warts include salicylic acid, bleomycin injections, cantharidin, and systemic treatment with cimetidine. Salicylic acid is considered first-line, over-the-counter therapy that destroys the HPV-infected epidermis through induction of an immune response from mild irritation of the salicylic acid. It is available over-the-counter as 17% salicylic acid combined in a flexible collodion or as a 40% patch. Another treatment option is bleomycin injection, which is reserved for refractory warts. Bleomycin works by inhibiting DNA and protein synthesis of squamous cells and reticuloendothelial tissue. It causes acute tissue necrosis, stimulates the immune response, and destroys the wart. Expected adverse effects include pain and burning at the injection site and swelling. Moreover, cantharidin treatment is another option which is derived from the blister beetle, and is a vesicant. The liquid is applied to the wart and let dry with tape. Blister formation is expected, and the lesion may fall off or the blistered lesion is removed at the base. Cantharidin works by causing death of epidermal cells, and acantholysis, which is the loss of intercellular connections between epidermal cells. Systemic cimetidine is also another pharmacological treatment believed to work by inhibiting suppressor T-cell function and increasing lymphocyte proliferation, which leads to cell-mediated immune responses to destroy the wart. Cimetidine for wart treatment is given 20 to 40 mg/kg.
In conclusion, it is common for HPV-induced warts to resolve independently of therapy. However, invasive procedures and pharmacologic treatment are available for those who want immediate removal or for refractory or recurring warts.
References
Aboud, Ahmad M, and Pramad K Nigam. “National Center for Biotechnology Information.” Wart, 16 Apr. 2023, www.ncbi.nlm.nih.gov/books/NBK431047/.
Lipke, Michelle M. “An Armamentarium of Wart Treatments.” Clinical Medicine & Research, Dec. 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC1764803/#:~:text=Salicylic%20acid%20is%20a%20first,caused%20by%20the%20salicylic%20acid.
“National Center for Biotechnology Information.” What Are the Treatment Options for Warts?, 7 Nov. 2019, www.ncbi.nlm.nih.gov/books/NBK279585/.
“Warts: Diagnosis and Treatment.” American Academy of Dermatology, www.aad.org/public/diseases/a-z/warts-treatment. Accessed 5 June 2023.