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Viral wart: causes, treatment

 
, medical expert
Last reviewed: 06.07.2022
 
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Benign neoplasms in the form of small rounded growths with a flat surface, nodules on legs or with a sharp tip, flesh-colored, appearing on the skin or mucous membrane are called differently, depending on the appearance, warts, papillomas, condylomas. Any such formation is a viral wart. And the process of proliferation of the epithelium begins with infection with papillomavirus infection.

Epidemiology

Statistics show that viral warts can be found on the skin of every third or fourth representative of the world's population, regardless of gender and race. Clinical manifestations of HPV infection are more common in adults (about 30%) than in childhood and adolescence (from 3 to 9%). In children, vulgar warts are mainly found, in adults - anogenital ones, and the prevalence of venereal genital warts is growing all over the world.

Oral papillomatosis is quite common. Single large formations are typical for adults, women are more susceptible to this pathology (60% of cases). Multiple formations are characteristic of childhood and adolescence. One fifth of viral warts of the oral cavity are detected in this category of the population, more often in 7-12-year-old schoolchildren, and girls suffer from papillomatosis of this localization almost twice as often as boys. [1]

Causes of the viral wart

The abbreviation HPV is now known, probably, to everyone. It stands for human papillomavirus . Many different strains of this virus have already been discovered, about two hundred. They are classified into five genera - α-, β-, γ-, μ- and η-papillomaviruses and 27 species. It is assumed that viruses of different species are characterized by a certain ability to infect specific types of tissues, the so-called tissue specificity. For example, with the appearance of vulgar warts on the soles of the feet, μ-papillomavirus-1, α-papillomavirus-2 or γ-papillomavirus-4 are found. The last two species are detected with a different localization of common warts (the back of the hands, feet, face), in addition, they can be caused by HPV types 26, 27, 29, 57. [2]However, usually DNA fragments of several pathogens are found in those infected with papillomavirus. [3]

The cause of infection is direct contact of the skin or mucous membranes of a healthy person with virus-infected areas of the infected epithelium. Moreover, infection occurs when virions enter the damaged epithelial surface. It does not have to be wounds or abrasions, just a little inflammation, irritation, imperceptible microcracks. Introduced viruses multiply and are manifested by excessive proliferation of the epithelium near the site of introduction. They do not migrate throughout the body to distant parts of the body. If several foci of infection appear in different places, this rather indicates self-infection, which is also possible when healthy and infected areas come into contact in the same person.

Outside of keratinocytes, the virion retains its viability for a short time, up to three hours, and then on wet towels and linen. Therefore, the household route of infection is also not excluded, but this happens extremely rarely.

HPVs are generally very common and it seems that they are often encountered, however, according to the researchers, in the vast majority of cases of such meetings (they name more than 90%), the body itself copes with infection, and we may not even know about infection. Many cases say that sometimes unexpectedly appeared single warts just as suddenly disappear on their own.

Risk factors

Risk factors for infection and the development of the disease, in addition to damaged epithelium, include viral load (the number of viruses that have penetrated the basal layer of the epithelium), the frequency and nature of contacts with a papillomavirus carrier, and the immune status of the infected person.

Pathogenesis

The pathogenesis of morphological changes in the epithelium can trigger any decrease in the body's defenses, for example, a cold. The human papillomavirus has been in the body for a long time (often for years), without showing itself in any way, and is activated, having begun to multiply intensively, in cases of a decrease in the host's immunity. In an infected cell, the virus can be in different forms: extrachromosomal (episomal) and integrated into the DNA of the cell (intrasomal). The first option is considered more favorable.

Under favorable conditions for the replication of the virus in the macroorganism, under its influence, hyperproliferation of keratinocytes occurs and skin growths appear. Basically, these conditions are: high viral load (regular contact with virus carriers; entry into the wound of physiological fluid or skin flakes abundantly seeded with virions) and / or infection of a person with a weakened immune system. In the second case, the introduction of single virions is sufficient for the appearance of clinical symptoms on the skin in the form of viral warts. Virus replication occurs at the level of the basal layer of the integumentary epithelium. [4]

In these cases, clinical symptoms of infection - viral warts - can appear quite quickly. More often they are caused by α-papillomaviruses of type 2, 27, 57; γ-papillomavirus-4 and μ-papillomavirus-1. Much less often in patients with viral warts, α-papillomaviruses of type 3, 7, 10, 28 are found; γ-papillomaviruses type 65, 88, 95; η-papillomavirus-41. [5]

The reaction of the immune system to the ingestion of papillomaviruses has not been studied enough. It is known that in response to infected patients, antibodies are produced - immunoglobulins of the IgM and IgG classes, specific for viral diseases. It is also believed that a more extensive pathological process develops in patients with a low immune status. [6]

Symptoms of the viral wart

Viral warts on the hands, fingers usually have the appearance of small rounded elevations above the surface of the skin with a rough and sometimes dry, cracked surface. They are painless, do not differ in color from the surrounding skin or are slightly darker than it. They can merge into fairly large plaques. Often, an impressive maternal wart is visible on the skin, surrounded by smaller child warts. In most cases, such symptoms indicate that we are dealing with ordinary (simple, vulgar) viral warts. A characteristic, but not obligatory, feature is their symmetrical arrangement relative to the skin fold or extension-fold lines. They are also called "kissing" warts.

Localization of skin growths is diverse. They appear not only on the thin skin of the hands, but also on the legs, face, but also on the thick skin of the palms and soles. [7]

A viral wart on the leg, foot appears when virions from an infected surface enter the damaged skin. On the thin skin of the lower limb, they look exactly the same as on the back of the hands.

If the thick skin covering the soles or palms has been infected, a viral plantar wart occurs. These formations are painful, because the bundles from the filiform papillae grow into the skin, harden, resembling a corn in appearance. They often appear in places that are under pressure from shoes. Palmar-plantar warts do not rise above the skin, have a granular dry surface covered with small scales. Sometimes a black dot is visible in the center of the plantar wart. This is a thrombosed vessel, damaging which, you can cause bleeding.

A viral wart may form under the nail or around the nail bed. Such formations are characteristic of people who have the habit of biting their nails. Barbs and cracked fingers increase the risk of viral warts. More often, according to experts, subungual growths are observed on the hands. The growing formation leads to the fact that the nail rises above the bed, exfoliating from it. [8]

For example, a tubercle under the nail is most likely a viral wart, however, if there is swelling and hyperemia, then a bacterial infection is more likely, which could be caused by a stabbing injury or manicure.

Viral warts may appear in the mouth. These are painless colored mucous membranes or whitish soft pedunculated lesions (papillomas) that can be visually detected. In half of the known cases, viral warts in the oral cavity were located on the tongue. Another favorite localization is palatine, less often papillomas are found on the inner surface of the cheek, on the bottom of the mouth or on the gums. If you accidentally bite on a wart, it bleeds.

Anogenital viral warts (genital warts) appear in people who are sexually active. They spread with all types of sexual contacts, are painless, often found during examinations for another reason, since single formations in hard-to-reach places can stay there unnoticed for a long time.

Viral warts in children and adolescents usually belong to the vulgar varieties. At this age, they often appear on the thin skin of the hands, papillomatosis of the oral cavity occurs, palmar-plantar warts appear, formations on the face. They are sometimes quite a lot. Parents often associate the appearance of growths with the acute respiratory viral infections, influenza, tonsillitis transferred the day before, that is, a temporary decrease in immunity. In most cases, in children and young people, viral warts disappear just as suddenly as they appeared.

Complications and consequences

Most often, these growths itch, and involuntary scratching can cause damage and bleeding. Palmar and plantar growths can cause discomfort and pain. Education under the nail - its exfoliation from its bed (onycholysis). Sometimes, though in rare cases, when the wart is damaged, another infection joins - mycosis or bacterial.

Large clusters of genital warts can block a woman's birth canal.

Also, quite rarely, with constant injury to the formation, malignant degeneration of keratinocytes is possible. [9]

Diagnostics of the viral wart

A viral wart has a rather characteristic appearance, and when it is located on visible surfaces, a diagnostic conclusion is made on the basis of anamnestic data and an external examination.

If atypical growths are detected, scraping, biopsy and analyzes of biological material are performed to confirm the presence of papillomavirus DNA fragments by polymerase chain reaction.

Instrumental diagnostics is not used, except to differentiate the diagnosis (dermatoscopy), to take biopsies from inaccessible places, for example, colposcopy, or to assess the general condition of the patient at the choice of a doctor.

Differential diagnosis

Differential diagnosis is carried out with other diseases of the epidermis - syphilis, neoplasms, mixed skin infections, fibrous polyps, hyperplastic changes caused by chronic somatic diseases.

Who to contact?

Treatment of the viral wart

Remedies for papillomavirus infection and warts should be prescribed by a doctor after examining the patient and establishing the origin of growths on the skin. You should not remove warts on your own, since in the presence of any neoplasm there is a possibility of malignant degeneration. [10]

Currently, preference is given to conservative methods of treatment of viral warts.

For example, in the treatment of various types of warts on thin and thick skin, local treatment is used by rubbing ointments with antimitotic, antiviral, keratolytic, caustic components into the formations. [11]

Depending on the size, location and number of growths, the individual sensitivity of the patient, the doctor may prescribe a variety of ointments for viral warts.

Fluorouracil ointment 5% (cream). Its active ingredient fluorouracil is a cytostatic that inhibits the enzymatic activity of thymidylate synthetase, which catalyzes the process of cell division. When applying the ointment to the wart, the sequence of cell proliferation in the growth is disrupted by blocking the synthesis of viral DNA. Active metabolites accumulate in the tissues of the wart, block cell division in the growths, as a result of which they disappear. The tool also effectively prevents the occurrence of relapses and malignancy.

The drug is very toxic, so even with topical application, you must strictly adhere to medical prescriptions. It is strictly contraindicated in pregnant and lactating women. Even external use can cause weakness, dizziness, dyspeptic disorders, anorexia, and heart disorders. Baldness from local short-term use of the cream is unlikely, but the application site must be protected from sunlight. The drug is a prescription drug.

For viral warts, the cream is applied with a spatula (cotton bud) in a thin layer directly on the neoplasm at bedtime every day for seven days. According to another more gentle scheme, the ointment can be applied once a week for ten weeks. In any case, you need to periodically clean off the dead particles of the wart.

For the treatment of genital warts of genital or anal localization, the ointment is applied directly to the growths or tampons soaked in the ointment are administered intravaginally.

Kolhamin ointment 0.5%. Its main antitumor component is colchamine, an alkaloid of plant origin. Possesses cytostatic activity. The composition of the ointment also includes thymol, an antiseptic and preservative, as well as synthomycin, a component with broad-spectrum antibacterial activity. Contraindications and precautions when using the ointment are similar to the previous one. It is not recommended to apply Kolhamin ointment to the mucous membranes, it also contains ethyl alcohol.

The ointment is applied for 7-10 days on skin growths with a spatula once a day, covered with gauze and sealed with a plaster. Dressings are done daily, while removing necrotic particles of the wart.

When using ointments with antimitotic activity, it is recommended to periodically monitor the composition of the blood, since they can cause leukopenia.

Ointment Viferon. This remedy is a stimulant of local immunity, inhibits the transcription of viral DNA and, due to this action, prevents the reproduction of viruses, helping the body cope with warts of any localization. Tocopherol acetate, which is part of the ointment, due to the ability to stabilize cell membranes and bind free radicals, increases the effectiveness of interferon at times.

The ointment is treated with the affected skin and mucous membranes every 12 hours, that is, twice a day. Suitable for long term use. The ointment is applied in a thin layer with a spatula, allowed to soak and dry. It is not necessary to remove the remaining ointment.

Oxolinic ointment 0.25% also has antiviral activity, it produces a gentle effect, which allows it to be used for warts of any localization, even on the delicate skin of the face and mucous membranes. However, its effectiveness is questioned by many experts. The ointment is applied to the growths and the skin around them two to three times a day. The treatment process is long - from two weeks to two months.

These antiviral ointments have practically no contraindications, except for hypersensitivity. Reactions are usually limited to a burning sensation at the site of application. It is believed that they can be used by pregnant women and children of any age.

Salicylic ointment: for more delicate skin - 2%, for rougher (on the soles) - 5%. The tool works due to the keratolytic (exfoliating) properties of salicylic acid. It is not recommended for pregnant and lactating women and children under the age of twelve. The ointment can cause burns, so use it carefully.

Removal of warts is carried out as follows. The limb, on which there are warts, is steamed in a hot bath. This is especially true of the palmar-plantar neglected growths or large dry warts. Dry and apply with a spatula a small layer of salicylic ointment. Small formations on thin skin are simply smeared with ointment without steaming.

Apply a gauze bandage. After about 12 hours, the bandage is removed and the top exfoliated layer of the wart is gently peeled off, then the ointment is applied again and covered with a bandage (possible under a band-aid) for the next 12 hours.

The process of removing warts, especially large ones, is quite long, about a month, and requires daily efforts.

To speed up the process, you can combine the use of 5% salicylic ointment with tebrofen (3%). The treatment regimen is the same, only first an exfoliating salicylic ointment is applied to the wart, then, after waiting about a quarter of an hour, upstairs - tebrofen, which has antiviral activity. It is used on its own to remove viral warts in children.

Tretinoin cream 0.05% based on retinoids is used to eliminate warts on the face. Before treatment, the skin area with warts is thoroughly washed with soap and water, dried well, then a pea of cream is applied to each wart. The procedure is done daily before bedtime. When going outside, protect treated skin from direct sunlight. In general, this precaution should always be observed, even if it is not indicated in the instructions.

To remove viral warts, not only ointments are used, but also solutions of caustic substances: solcoderm (nitric, acetic, oxalic, lactic acid and copper trihydrate), betadine (contains iodine), trichloroacetic acid, verrukacid. Freezing solution of cryopharm. The destructive effect of the solutions is more effective, however, burns and scars are also more likely if they are used carelessly.

There are plasters and pencils for the treatment of warts, phonophoresis with interferon is used.

In a medical institution, bleomycin sulfate injections are used to treat large warts. This is a drug with a pronounced cytostatic activity. Injections are made directly into the wart. Often one procedure is enough, sometimes it is necessary to make several injections at intervals of three to four weeks. Cytostatics are very toxic drugs, even their local use can lead to a number of complications. Therefore, the possibility of this treatment, the effectiveness of which is high (estimated at 92%), should be discussed with the attending physician.

In the treatment of viral warts, systemic agents are also used that increase the body's immunity, for example, vitamin-mineral complexes, Immunal, Echinacea-Ratiopharm, Immunoplus.

Alternative Treatment

Viral warts have caused physical and moral discomfort in people at all times. Therefore, there are many alternative means to remove them. Opinions about their effectiveness vary greatly, however, many get rid of growths very quickly.

Mostly herbal treatment is used. True, it should be noted that weed-ants that can eliminate warts are poisonous. Therefore, treatment should be carried out under the supervision of a phytotherapeutist and all recommended precautions should be observed.

Perhaps the most famous and simple remedy for removing warts is fresh celandine juice. In the summer, you need to pick a branch of the plant, a bright-desiring liquid will come out on the cut. She lubricates the wart. Such treatment should be carried out daily, however, it is possible only in summer and in places of direct access to the plant, for example, in the country or in the countryside.

You can squeeze the juice from the celandine and dilute it with a small amount of alcohol as a preservative. This solution can also lubricate the growths on the skin.

Apple cider vinegar and regular vinegar are not only exfoliating, but also virucidal.

Vinegar essence is even more effective. It can burn a wart in one application, however, you should be very careful. The skin around you need to be lubricated with petroleum jelly and drip the essence strictly on the neoplasm. It will turn white, loosen, then shrink, darken and fall off.

Many argue that if you seal the wart with an ordinary adhesive plaster, then it will also disappear.

In alternative medicine, this ointment is used to combat warts: two parts of green walnuts, finely crushed, are rubbed with one part of kerosene. Infuse for a month, squeeze out the resulting liquid. She regularly lubricates warts at least twice a day. They should be gone in about a week.

Also, daily applications of garlic gruel are made, which are applied to the growths under a bandage at bedtime.

In addition, the use of vegetables and fruits, freshly squeezed juices from them, vitamin teas from rose hips, leaves and shoots of raspberries and currants, citrus fruits, sprouted buckwheat, wheat and other cereals will help strengthen the immune system, and warts will eliminate themselves.

Alternative treatments have helped many people get rid of skin growths, however, before resorting to such treatment, you need to make sure that you have a viral wart and not a malignant neoplasm.

Homeopathy

Hard palmoplantar warts, dry and keratinized, require the appointment of antimony sulfide (Antimonium crudum). This drug can also be prescribed for growths of other localization - in the nasopharynx, anogenital zone.

With papillomatosis of the mouth and throat, silver nitrate (Argentum nitricum) is prescribed; anal warts -
Hemp (Cannabis), Cossack juniper (Sabina); genital: men - more often Lycopodium, Red mercury sulfide (Cinnabaris), women - Cossack juniper (Sabina), Gonorrheal nosode (Medorrhinum).

With flat youthful warts, Celandine (Chelidonium), Nightshade (Dulcamara), Iron (Ferrum metallicum), weeping and itchy -
Nitric acid (Nitricum acidum), Thuja (Thuja) are indicated.

In the treatment of viral warts, many drugs are used, the correct appointment should be made by a doctor who will take into account not only their type and localization, but many other symptoms and characteristics of the patient, and also determine the required dosage. Then the treatment will be successful and fast.

Removal of viral warts

The most effective and fastest method is destructive therapy. Surgical removal of viral warts with a scalpel is usually resorted to only in cases of atypical formations requiring histological examination. [12]

If the origin of the build-up is beyond doubt, then radical methods of eliminating neoplasms that are not related to surgical interventions are recommended.

Electrocoagulation - removal of warts with a needle electrode by exposure to high frequency currents, simply - cauterization. Allows you to eliminate several not too large growths in one session. The duration of the procedure is 15-20 minutes. At the site of the removed warts, dryish crusts remain, falling off on the second or third day after the procedure. It is considered a rather gentle method, it is applied on the face and any other available places.

Cryodestruction (freezing with liquid nitrogen) - a cryoprobe with a nozzle of the required diameter is pressed tightly against the neoplasm for a period of one to five minutes. If necessary, for example, a large growth, removal of the viral wart with liquid nitrogen is repeated a week or ten days after the previous procedure. [13], [14]

More modern methods are the removal of viral warts with a laser, that is, their layer-by-layer evaporation. The time of the procedure, as, in fact, in other cases, depends on the size and number of warts. You can get rid of all formations in one session.

Another modern method is radiosurgical destruction using high-power electromagnetic waves that cause tissue destruction at the point of contact with the radioknife electrode. [15]

The last two methods can lead to the formation of scars in the places where large warts are removed.

After removal, the patient is prescribed a course of antiviral drugs to prevent the recurrence of the disease.

No method guarantees that warts will not reappear. Firstly, you can become infected again, and secondly, outwardly healthy surrounding tissues could be infected.

Prevention

The best way to prevent HPV infection is to strengthen the immune system, then even if the warts appear, they will be single and disappear on their own after a while.

A healthy lifestyle, good nutrition, compliance with well-known sanitary and hygienic standards - there is no other prevention today.

Forecast

In most cases, our immunity copes with the human papillomavirus on its own.

If the warts do not go away and their number increases, then you need to see a doctor with this problem. Although modern medicine does not guarantee complete eradication of the virus, it has an extensive arsenal of means of providing assistance in cases of infection.

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