Warts

Definition

Warts, also called verrucae, are small benign growths usually caused by a viral infection of the skin or mucous membrane. The virus infects the surface layer of skin. The viruses that cause warts are members of the human papilloma virus (HPV) family, of which there are many different strains. Warts are not cancerous but some strains of HPV, usually not associated with warts, have been linked with cancer formation. Warts are contagious from person to person and from one area of the body to another on the same person.

Description

Particularly common among children, young adults, and women, warts are a problem for 7–10% of the population. There are close to 60 types of HPV that cause warts, each preferring a specific skin location. For instance, some types of HPV cause warts to grow on the skin, others cause them to grow inside the mouth, while still others cause them to grow on the genital and rectal areas. However, most can be active anywhere on the body. The virus enters through the skin and produces new warts after an incubation period of one to eight months. Warts are usually skin colored and feel rough to the touch, but they also can be dark, flat, and smooth.

Warts are passed from person to person, directly and indirectly. Some people are continually susceptible to warts, while others are more resistant to HPV and seldom get them. The virus takes hold more readily when the skin has been damaged in some way, which may explain why children who bite their nails tend to have warts located on their fingers. People who take a medication to suppress their immune system or are on long-term steroid use are also prone to a wart virus infection. The same is true for patients with AIDS .

The main categories of warts are common warts (face and hands), plantar warts (feet), and venereal warts.

Hand warts (verruca vulgaris) can grow anywhere on the hands, but usually occur where skin has been damaged in some way (e.g. picking or nail biting). This is a rough horny lesion varying in size from 1 mm–2cm in diameter.

Foot warts (verruca plantaris) known as plantar warts, are the most painful type of wart, due to the pressure exerted on them. They are most common in children and young adults, since they are often contracted in locker rooms and swimming pool areas. If left untreated, they can grow to an inch or more in circumference and spread into clusters. Those suffering from diabetes are more likely to suffer from plantar warts, and may also suffer complications due to the reduced potential for their bodies to heal themselves.

Flat warts tend to grow in great numbers and are smaller and smoother than other warts. They can erupt anywhere, appearing more frequently on the legs of women, the neck and dorsum of the hands, the faces of children, and on the areas of the face that are shaved by young adult males.

Genital warts , also called condylomata acuminata, moist warts, fig warts, or venereal warts, are one of the most common sexually transmitted diseases (STDs). Genital warts are more contagious than other types of warts. Approximately one million new cases of genital warts are diagnosed in the United States every year. It is estimated that two-thirds of persons coming into contact with genital warts will develop symptoms within three months.

Genital warts tend to be small flat bumps or they may be thin and pointed in shape. They are usually soft, moist, pink to red in color, occurring as a single lesion or in clusters that resemble a cauliflower, and not scaly like other warts. In women, genital warts appear on the external genitalia, within the vagina, on the cervix, and around the anus or within the rectum. In men, genital warts usually appear on the tip of the penis but may also be found on the scrotum or around the anus. Genital warts can also develop in the mouth of a person who has

had oral sexual contact with an infected person. They may also appear, less often, between the toes.

Filiform wart is a long, horny, finger-like projection that is usually found in multiples. Seen most commonly in adult males, they occur in the bearded area of the face or on the eyelids and neck.

Causes & symptoms

Since warts are caused by a virus, they can only be caught by contact with a source of infection. This can be direct physical contact, or secondary contact with the shed skin of a wart (through a floor or a towel for example). As the incubation period for warts is quite long, it is often difficult to pinpoint sources of infection. Individuals whose immune systems are deficient most often contract warts. AIDS patients commonly suffer from warts, and it is not uncommon for warts to appear at the site of a trauma (burns , cuts or abrasions.)

Diagnosis

Common warts are rough, irregular, skin colored or brownish. Warts that are brownish in color, or that do not respond to treatment, should be checked by a physician to exclude the possibility that they may be malignant growths.

Treatment

Warts may need no treatment at all, since a large proportion of them (67% over a two-year period) disappear spontaneously. This is particularly so in the case of flat warts. However, a wart that appears unusual in any way should be checked by a physician, as a small proportion can become malignant. Generally, the main criterion for treatment of warts is a cosmetic one, if it is found to be embarrassing by the sufferer, or unpleasant to others.

Acupuncture

The aim with acupuncture will be to raise the general well-being of the patient, improve the functioning of the immune system, and free blockages of "chi" or life force. Warts and other health problems will be less likely to occur as general health and resistance are improved.

Aromatherapy

Since warts are caused by viral infections , the aim of an aromatherapy treatment would be to kill the virus with the application of an appropriate essential oil. There are many oils that have antiviral properties, so the therapist will also endeavor to choose oils that are appropriate for the patient. Onion and garlic oils both have powerful antiviral properties, but perhaps tea tree oil , which also possesses remarkable anti-viral properties, might be more acceptable as far as smell is concerned.

Colloidal silver

The use of colloidal silver against viruses of all kinds has proved very successful. It should be topically applied to the wart, but can be taken internally to promote functioning of the immune system, and thus prevent warts from occurring.

Herbal medicine

Herbal remedies for genital warts and other STDs have attracted considerable recent attention because of the epidemic spread of these diseases in developing countries where most people cannot afford allopathic treatments. One traditional herbal remedy from Colombia that is being studied is extracts of plants belonging to the Euphorbia family. These compounds have been used to treat ulcers, tumors, and warts for generations, and some of them appear to be effective in treating genital warts.

Before applying any herbal cure to a wart, as much of the wart as possible should be removed, in order to give the cure a head start.

Apple juice: Apply the juice of a sour apple. Action is due to the magnesium in the juice.

Banana skin: First the wart should be rubbed with an abrader, and a fresh banana skin (immediately after opening) should be applied and left overnight.

Cabbage: Apply fresh juice from a white cabbage.

Chickweed : Apply the juice to the wart.

Dandelion : The juice of the dandelion is a very old English cure for warts.

Garlic: Rub a raw clove on the wart every night until it disappears.

Green figs: The white milk from a green fig is excellent at removing warts.

House leek: This is a plant commonly found in rock gardens. It has thick fleshy leaves and its juice is rich in supermalate of calcium , which will destroy warts.

Pineapple: Cotton wool should be soaked in the fresh juice of a pineapple. The enzymes of the pineapple will dissolve the wart.

Rubber plant: If the stem of a leaf from a rubber plant is broken, white liquid will ooze out. If this is applied to the wart over a period of two to three days, the wart should disappear.

Naturopathy

Naturopathy, in common with many alternative therapies, works on the principle that given the right circumstances, such as pure air, pure water, and first class nutrition , the body will heal itself and become extremely resistant to illness. Naturopaths believe that such symptoms as warts are the result of toxins in the body, and an immune system that is not running efficiently. They may prescribe treatments such as colonic irrigation , alongside a program of healthy eating to raise the general level of health. A naturopath may suggest a paste made with vitamin C , applied to the wart daily for a period of a few weeks.

Visualization

This method, also known as creative imagery, has skeptically been described as "willing yourself well," but practically it has been found to be very effective for a range of conditions, both physical and emotional. The patient is required to sit in a relaxed state, breathing evenly, and visualize the self in the condition he or she would like to be. In this case, perhaps he or she visualizes the body overcoming the warts and absorbing them, leaving behind healthy skin. This method has been found particularly suitable for children, as it has no side effects and therapists claim it has a good success rate.

Folk remedies

There are many remedies for warts that have been handed down from generation to generation all over the world. The following remedies have excellent track records.

Thread: a length of thread should be tied around the wart, and tightened every day until the wart drops off.

Human saliva: the sufferer applies his or her saliva to the wart first thing every morning.

Allopathic treatment

Warts may be self-treated by a number of allopathic remedies, but care should be taken as they are fairly strong chemicals (usually salicylic acid). Those suffering from diabetes, heart disease or circulation problems, or any degree of peripheral neuropathy , should not attempt to treat themselves with any of these preparations, because of the risk of damage to tissue, and because of their increased susceptibility to infection.

In addition, the face and mucous membranes may scar, so it may be preferable to seek professional advice.

A physician may use cautery (use of heat) or cryosurgery (use of extreme cold, usually in the form of liquid nitrogen) to remove warts. These are processes that require precision, and therefore are highly skilled procedures. Another drawback is that they can be painful. Increasingly, laser treatments are also being used to treat warts, whereby the laser beam vaporizes the wart tissue. Pulsed laser treatments appear to be particularly effective in treating warts in the anogenital region of children.

A newer allopathic medication that shows promise in the treatment of resistant viral facial warts is diphencyprone (DPC), a drug that was developed to treat a type of hair loss known as alopecia areata. DPC has shown effectiveness in removing facial warts that were resistant to both cryosurgery and other topical drugs.

Expected results

Allopathic methods for the treatment of warts are generally successful, but they carry more risk of scarring than natural methods. More than one alternative method may have to be tried before success is achieved, but they carry the added bonus of adding to the well-being of the patient, and not harming the body. Allopathic treatments involve the use of strong chemicals, which carry risks and are not compatible with body chemistry. Usually, warts either disappear spontaneously or are treated successfully with no scarring or lasting effects. However, occasionally, what appears to be a wart is the beginning of a type of cancer, so those that are resistant to treatment should be seen by a physician.

Recurrent genital warts are a serious personal and public health concern. Even though genital warts may be removed, the virus itself continues to live. Certain types of HPV can cause tissue changes in the cervix of women with recurrent infection that may lead to cervical cancer. The general recommendation for women who have a history of genital warts is to see their doctors every six months for Pap smears to monitor any changes that may occur.

Prevention

To avoid foot warts, footwear should always be worn in public places and feet should be kept clean and dry. In general, warts should not be picked, to avoid cross infection, and any patch of damaged skin should be protected. Every effort should be made to keep the immune system in peak working condition.

Genital warts can be prevented by using condoms and avoiding unprotected sexual contact. Barrier protection will not, however, prevent the spread of wart-causing HPV to such uncovered areas as the pubis and upper thighs.

Although vaccines to prevent the spread of human papilloma virus are under investigation as of 2002, they will not be available for general use for at least several years.

Resources

BOOKS

Buchman, Dian Dincin. Herbal Medicine. London: Tiger Books International, 1991.

Kenton, Leslie. The Joy of Beauty. London: Century Publishing, 1993.

The Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life Books, 1997.

Renner, John H. The Home Remedies Handbook. Publications International, Ltd., 1994.

Stupik, Ramona. AMA Complete Guide to Women's Health. New York: Random House, 1996.

PERIODICALS

Betancur-Galvis, L. A., G. E. Morales, J. E. Forero, and J. Roldan. "Cytotoxic and Antiviral Activities of Colombian Medicinal Plant Extracts of the Euphorbia Genus." Memorias do Instituto Oswaldo Cruz 97 (June 2002): 541-546.

Brentjens, M. H., K. A. Yeung-Yue, P. C. Lee, and S. K. Tyring. "Human Papillomavirus: A Review." Dermatologic Clinics 20 (April 2002): 315-331.

Centers for Disease Control and Prevention. "Sexually Transmitted Diseases Treatment Guidelines 2002." MMWR Recommendations and Reports 51 (RR-6) (May 10, 2002): 1-78.

Garland, S. M. "Human Papillomavirus Update with a Particular Focus on Cervical Disease." Pathology 34 (June 2002): 213-224.

Pollock, B., and A. S. Highet. "An Interesting Response to Diphencyprone (DPC) Sensitization on Facial Warts: Review of DPC Treatment for Viral Warts." Journal of Dermatological Treatment 13 (June 2002): 47-50.

Tuncel, A., M. Gorgu, M. Ayhan, et al. "Treatment of Anogenital Warts by Pulsed Dye Laser." Dermatologic Surgery 28 (April 2002): 350-352.

Vermani, K., and S. Garg. "Herbal Medicines for Sexually Transmitted Diseases and AIDS." Journal of Ethnopharmacology 80 (April 2002): 49-66.

ORGANIZATIONS

American Academy of Dermatology. P.O. Box 4014, 930 N. Meacham Rd., Schaumburg, IL 60168-5014. (847) 330-2300. Fax: (847) 330-0050. <www.aad.org>.

American Academy of Family Physicians. 8880 Ward Parkway, Kansas City, MO 64114 (816) 333-9700. <www.aafp.org/health.info>.

American Podiatric Medical Association. 9312 Old Georgetown Rd, Bethesda, MD 20814–1698. (301) 571-9200. <www.apma.org>.

Centers for Disease Control and Prevention (CDC). 1600 Clifton Road, Atlanta, GA 30333. (404) 639-3311. <www.cdc.gov>.

OTHER

Medscape. http://www.medscape.com/micromedex/CareNotes/dermatology/ElectrocauteryWartRemoval.html.

Patricia Skinner

Rebecca J. Frey, PhD

Warts

Definition

Warts are small, benign growths caused by a viral infection of the skin or mucous membrane. The virus infects the surface layer. The viruses that cause warts are members of the human papilloma virus (HPV) family. Warts are not cancerous, but some strains of HPV, usually not associated with warts, have been linked with cancer formation. Warts are contagious from person to person and from one area of the body to another on the same person.

Description

There are approximately 60 types of HPV that cause warts, each preferring a specific bodily location. For instance, some types of HPV cause warts to grow on the skin, others cause them to grow inside the mouth, while still others cause them to grow on the genital and rectal areas. However, most can be active anywhere on the body. The virus enters through the skin and produces new warts after an incubation period of one to eight months. Warts are usually skin-colored and feel rough to the touch, but they also can be dark, flat, and smooth.

Warts are passed from person to person, directly and indirectly. Some people are continually susceptible to warts, while others are more resistant to HPV and seldom get them. The virus takes hold more readily when the skin has been damaged in some way, which may explain why children who bite their nails tend to have warts located on their fingers. People who take a medication to suppress their immune system or are on long-term steroid use are also prone to a wart virus infection. This tendency is seen in people with AIDS .

Demographics

Particularly common among children, young adults, and women, warts are a problem for 7–10 percent of the population.

Causes and symptoms

The more common types of warts include the following:

• common hand warts
• foot warts
• flat warts
• genital warts

Hand warts

Common hand warts grow around the nails, on the fingers, and on the backs of hands. They appear more frequently where skin is broken, such as in areas where fingernails are bitten or hangnails are picked.

Foot warts

Foot warts are called plantar warts because the word plantar is the medical term for the sole of the foot, the area where the wart usually appears as a single lesion or as a cluster. Plantar warts, however, do not stick up above the surface like common warts. The ball of the foot, the heel, and the plantar part of the toes are the most likely locations for the warts because the skin in those areas is subject to the most weight, pressure, and irritation, making a small break or crack more likely.

Plantar warts are familiar to all ages groups, appearing frequently in children between the ages of 12 and 16. Adolescents often come into contact with a wart virus in a locker room, swimming pool area, or by walking barefooted on dirty surfaces. The blood vessels feeding them are the black dots that are visible on the wart. If left untreated, these warts can grow to an inch or more in circumference and spread into clusters of several warts. They are known to be very painful at times, the pain usually compared to the feeling of a permanent stone in the shoe particularly if the wart is on a pressure point of the foot. People with diabetes mellitus are prone to complications from plantar warts related to the development of sores or ulceration and the poor healing potential associated with diabetes.

Flat warts

Flat warts tend to grow in great numbers and are smaller and smoother than other warts. They can erupt anywhere, appearing more frequently on the legs of women, the faces of children, and on the areas of the face that are shaved by young adult males.

Genital warts

Genital warts, also called condyloma acuminata or venereal warts, are one of the most common forms of sexually transmitted disease (STD) in this country. Most experts contend that they are contracted by sexual contact with an infected person who carries HPV and are more contagious than other warts. It is estimated that two-thirds of the people who have sexual contact with a partner with genital warts will develop the disease within three months of contact. As a result, about 1 million new cases of genital warts are diagnosed in the United States each year.

Genital warts tend to be small flat bumps but they may be thin and tall. They are usually soft and not scaly like other warts. In women, genital warts appear on the genitalia, within the vagina, on the cervix, and around the anus or within the rectum. In men, genital warts usually appear on the tip of the penis but may also be found on the scrotum or around the anus. Genital warts can also develop in the mouth of a person who has had oral sexual contact with an infected person.

When to call the doctor

Individuals who notice warts in their genital area should see a doctor. A physician should be consulted for warts that bleed, are particularly painful, or that do not disappear after six to nine months.

Diagnosis

A physician may be able to diagnose warts with a simple examination. If the warts are small, the doctor may put a vinegar-like liquid on the skin, which makes the warts turn white and easier to see, and then use a magnifying glass to look for them.

Treatment

Most people attempt to treat warts themselves. Professional treatment is usually sought after self-treatment has been unsuccessful.

Home/self treatment

Many of the nonprescription wart remedies available at drug stores will remove simple warts from hands and fingers. These medications may be lotions, ointments, or plasters and work by chemically removing the skin that was affected by the wart virus. The chemicals are strong, however, and should be used with care since they can remove healthy as well as infected skin. These solutions should be avoided by diabetics and those with cardiovascular or other circulatory disorders whose skin may be insensitive and not appreciate irritation.

Flat warts are best treated with topical retinoides (retinoic acid) or a gel containing salicylic acid. The acid does not actually kill the wart virus, but waterlogs the skin so that the surface layer, with the virus, peels off. These products can take up to three months of treatment depending on the size and depth of the wart. Patches are also good to use. Rather than applying drops, a small pad is placed on the wart and left for 48 hours and then replaced with a new one. The patch usually contains a higher concentration of salicylic acid and may irritate the surrounding skin. If this occurs, people should switch to a gel or stop medication for a period. To help the healing process for flat facial warts, men should shave with an electric shaver or temporarily grow a beard. Women with flat warts on areas that are shaved should use other methods to remove hair such as depilatory cream or wax.

Professional treatment

Physicians should be consulted if there are no signs of progress after a month of self treatment. Doctors have many ways of removing warts, including using stronger topically applied chemicals than those available in pharmacies. Some of these solutions include podofilox, topical podophyllum, and trichloracetic acid (TCA). Some burning and discomfort for one or more days following treatment can be expected. Although these chemicals are effective, they may not completely destroy all warts. A second method of removal is freezing or cryosurgery on the wart using liquid nitrogen. Cryotherapy is relatively inexpensive, does not require anesthesia, and usually does not result in scarring. Although temporarily uncomfortable, it provides an effective and safe way to deliver freezing temperatures to a particular area on the skin, and healing is usually quick. Physicians may also choose to burn the wart with liquid nitrogen or numb the skin and then scrape off the wart. Another removal process is electrocautery (electric burning), destroying the wart by burning it with an electric needle. Laser surgery is also an option for removing warts.

Genital warts are the most difficult to treat. They can be removed, but the viral infection itself cannot be cured. Often, because the warts are so small, more than one treatment may be needed. The virus continues to live in the deeper skin, which is why warts often return after they have been removed. Strong chemicals may be applied as well as surgical excision with or without electrocautery. This therapy requires a small operative procedure and a local anesthetic. Laser therapy, although more expensive, is often used for treating venereal warts that are more extensive. The use of lasers, which vaporize the lesion, can theoretically transmit the HPV. It is not at all clear, however, if this occurs.

There is no single recommended method for eliminating plantar warts. If detected early, cryotherapy is usually enough. However, they can be very resilient, requiring repeated treatment over several months. Treatment ranges from the conservative approach of applying chemical solutions to the more aggressive option of surgery. Persons with diabetes or vascular disease are usually treated with the more conservative methods.

Alternative treatment

There are a variety of alternative approaches to the treatment of warts. The following suggestions apply to common warts and plantar warts. They are not recommended for genital or cervical warts. Since genital and cervical warts are transmitted sexually, they should be treated by a physician.

For the treatment of common or plantar warts, practitioners may recommend the following remedies:

• Apply a paste made of vitamin C powder to the wart for one to two weeks.
• Place a crushed or sliced garlic clove over the wart for seven consecutive nights while sleeping.
• Soak the wart in water, put cross-hatches over it with a sterile needle, and apply drops of thuja (Thuja occidentalis ) tincture onto the wart. Repeat the crosshatching and tincture application until the wart is saturated with the tincture. Repeat several times each day for one to two weeks. (A tincture is an herbal extract made with alcohol.)
• Tape a piece of banana peel, smooth side down, over the wart and leave it on overnight. Repeat nightly for one to two weeks.

Prognosis

Even though genital warts may be removed, the virus itself continues to live. The HPV can cause tissue changes in the cervix of women with cervical infection. The general recommendation for women who have a history of genital warts is to see their doctors every six months for Pap smears to monitor any changes that may occur.

For plantar warts, the treatment goal is to destroy the wart and its virus without causing much damage to healthy skin. It is not unusual for treatment to cause pain until the foot heals because of the weight put on the foot.

Prevention

Plantar warts can be prevented by wearing shoes, changing shoes daily, keeping feet clean and dry, and not ignoring skin growths and changes in the skin. Genital warts can be prevented by using condoms and avoiding unprotected sex. Barrier protection will not, however, prevent the spread of wart-causing HPV to uncovered areas such as the pubis and upper thighs.

Nutritional concerns

Because warts are caused by a virus, general immune system support can be effective in helping to keep warts from coming back after treatment or to keep them from multiplying or growing. Eating a well balanced diet high in sources of vitamins A, C, and E can help strengthen the immune system. Avoiding stress, which is believed to compromise the immune system, may also be helpful.

Parental concerns

Parents can help to prevent plantar warts by urging their children to wear shoes, change their shoes daily, and keep their feet clean and dry. Parents should also pay attention to growths and other changes in their child's skin. Instructing children in condom usage is a personal, parental decision. However, parents should tell their children that genital warts can be prevented by using condoms and avoiding unprotected sex. Barrier protection will not, however, prevent the spread of wart-causing HPV to uncovered areas such as the pubis and upper thighs.

KEY TERMS

Condyloma acuminata —Another term for a genital wart.

Cryotherapy —The use of a very low-temperature probe to freeze and thereby destroy tissue. Cryotherapy is used in the treatment skin lesions, Parkinson's disease, some cancers, retinal detachment, and cataracts. Also called cryosurgery.

Endometritis —Inflammation of the endometrium or mucous membrane of the uterus.

Epidermis —The outermost layer of the human skin.

Human papilloma virus (HPV) —A virus that causes common warts of the hands and feet, as well as lesions in the genital and vaginal area. More than 50 types of HPV have been identified, some of which are linked to cancerous and precancerous conditions, including cancer of the cervix.

Retinoic acid —Vitamin A₁ acid which is used topically to treat acne.

Salicylic acid —An agent prescribed to treat a variety of skin disorders, such as acne, dandruff, psoriasis, seborrheic dermatitis, calluses, corns, and warts.

Resources

BOOKS

Darmstadt, Gary L., and Sidbury, Robert. "Diseases of the Epidermis." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman, et al. Philadelphia: Saunders, 2003, pp. 2195-9.

Genital Warts: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: ICON Health Publications, 2003.

Plantar Warts: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: ICON Health Publications, 2003.

Royston, Angela. Warts. London: Heinemann, 2001.

Swerlick, Robert A., and Lawley, Thomas J. "Eczema, Psoriasis, Cutaneous Infections, Acne, and Other Common Skin Disorders." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald, et al. New York: McGraw-Hill, 2001, pp. 309–14.

Warts: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: ICON Health Publications, 2003.

PERIODICALS

Bellew, S. G., et al. "Childhood warts: an update." Cutis 73 (2004): 379–84.

Clemons, R. J., et al. "Comparing therapy costs for physician treatment of warts." Journal of Drugs in Dermatology 2 (2004): 649–54.

Laube, S. "Skin infections and ageing." Ageing Research Reviews 3 (2004): 69–89.

Silverberg, N. B. "Human papillomavirus infections in children." Current Opinions in Pediatrics 16 (2004): 402–9.

Tucker, S. B., et al. "Plantar wart treatment with combination imiquimod and salicylic acid pads." Journal of Drugs in Dermatology 2 (2003): 124–6.

ORGANIZATIONS

American Academy of Dermatology. 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 60168–4014. Web site: <www.aad.org/>.

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211–2672. Web site: <www.aafp.org/>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. Web site: <www.aap.org/default.htm>.

American Association of Naturopathic Physicians. 8201 Greensboro Drive, Suite 300, McLean, VA 22102. Web site: <http://naturopathic.org/>.

American College of Physicians. 190 N Independence Mall West, Philadelphia, PA 19106–1572. Web site: <www.acponline.org/>.

American Podiatric Medical Association. 9312 Old Georgetown Road Bethesda, MD 20814–1698. Web site: <www.apma.org/>.

WEB SITES

"Human Papillomavirus and Genital Warts." National Institute of Allergy and Infectious Disease, July 2004. Available online at <www.niaid.nih.gov/factsheets/stdhpv.htm> (accessed December 4, 2005).

"Warts." American Academy of Family Physicians. Available online at <http://familydoctor.org/209.xml> (accessed December 4, 2005).

"Warts." National Library of Medicine. Available online at <www.nlm.nih.gov/medlineplus/warts.html> (accessed December 4, 2005).

"Warts." University of Illinois. Available online at <www.mckinley.uiuc.edu/health-info/dis-cond/warts/warts.html> (accessed December 4, 2005).

"What are plantar warts?" American Podiatric Medical Association. Available online at <www.apma.org/topics/Warts.htm> (accessed December 4, 2005).

L. Fleming Fallon, Jr., MD, DrPH

Warts

Definition

Warts are small, benign growths caused by a viral infection of the skin or mucous membrane. The virus infects the surface layer. The viruses that cause warts are members of the human papilloma virus (HPV) family. Warts are not cancerous but some strains of HPV, usually not associated with warts, have been linked with cancer formation. Warts are contagious from person to person and from one area of the body to another on the same person.

Description

Particularly common among children, young adults, and women, warts are a problem for 7-10% of the population. There are close to 60 types of HPV that cause warts, each preferring a specific skin location. For instance, some types of HPV cause warts to grow on the skin, others cause them to grow inside the mouth, while still others cause them to grow on the genital and rectal areas. However, most can be active anywhere on the body. The virus enters through the skin and produces new warts after an incubation period of one to eight months. Warts are usually skin-colored and feel rough to the touch, but they also can be dark, flat, and smooth.

Warts are passed from person to person, directly and indirectly. Some people are continually susceptible to warts, while others are more resistant to HPV and seldom get them. The virus takes hold more readily when the skin has been damaged in some way, which may explain why children who bite their nails tend to have warts located on their fingers. People who take a medication to suppress their immune system or are on long-term steroid use are also prone to a wart virus infection. This same is true for patients with AIDS.

Causes and symptoms

The more common types of warts include:

• common hand warts
• foot warts
• flat warts
• genital warts

Hand warts

Common hand warts grow around the nails, on the fingers, and on the backs of hands. They appear more frequently where skin is broken, such as in areas where fingernails are bitten or hangnails picked.

Foot warts

Foot warts are called plantar warts because the word plantar is the medical term for the sole of the foot, the area where the wart usually appears as a single lesion or as a cluster. Plantar warts, however, do not stick up above the surface like common warts. The ball of the foot, the heel and the plantar part of the toes are the most likely locations for the warts because the skin in those areas is subject to the most weight, pressure and irritation, making a small break or crack more likely.

Plantar warts are familiar to all ages groups, appearing frequently in children between the ages of 12-16. Adolescents often come into contact with a wart virus in a locker room, swimming pool area, or by walking barefooted on dirty surfaces. The blood vessels feeding them are the black dots that are visible on the wart. If left untreated, these warts can grow to an inch or more in circumference and spread into clusters of several warts. They are known to be very painful at times, the pain usually compared to the feeling of a permanent stone in the shoe particularly if the wart is on a pressure point of the foot. People with diabetes mellitus are prone to complications from plantar warts related to the development of sores or ulceration and the poor healing potential associated with diabetes.

Flat warts

Flat warts tend to grow in great numbers and are smaller and smoother than other warts. They can erupt anywhere, appearing more frequently on the legs of women, the faces of children, and on the areas of the face that are shaved by young adult males.

Genital warts

Genital warts, also called condyloma acuminata or venereal warts, are one of the most common causes of sexually transmitted disease (STD) in this country. According to the Journal of the American Medical Association's STD Information Center, they are contracted by sexual contact with an infected person who carries HPV and are more contagious than other warts. It is estimated that two-thirds of the people who have sexual contact with a partner with genital warts will develop the disease within three months of contact. As a result, about one million new cases of genital warts are diagnosed in the United States each year.

Genital warts tend to be small flat bumps or they may be thin and tall. They are usually soft and not scaly like other warts. In women, genital warts appear on the genitalia, within the vagina, on the cervix, and around the anus or within the rectum. In men, genital warts usually appear on the tip of the penis but may also be found on the scrotum or around the anus. Genital warts can also develop in the mouth of a person who has had oral sexual contact with an infected person.

Diagnosis

Patients who notice warts in their genital area should see a doctor. The doctor may be able to diagnose the warts with a simple examination. If the warts are small, the doctor may put a vinegar-like liquid on the skin, which makes the warts turn white and easier to see, and then use a magnifying glass to look for them.

Treatment

Home/self treatment

Many of the nonprescription wart remedies available at drug stores will remove simple warts from hands and fingers. These medications may be lotions, ointments, or plasters and work by chemically removing the skin that was affected by the wart virus. The chemicals are strong, however, and should be used with care since they can remove healthy as well as infected skin. These solutions should be avoided by diabetics and those with cardiovascular or other circulatory disorders whose skin may be insensitive and not appreciate irritation.

Flat warts are best treated with topical retinoides (retinoic acid) or a gel containing salicylic acid. The acid doesn't actually kill the wart virus, but waterlogs the skin so that the surface layer, with the virus, peels off. These products can take up to three months of treatment depending on the size and depth of the wart. Patches are also good to use. Rather than applying drops, a small pad is placed on the wart and left for 48 hours and then replaced with a new one. The patch usually contains a higher concentration of salicylic acid and may irritate the surrounding skin. If this occurs, patients should switch to a gel or stop medication for a period. To help the healing process for flat facial warts, men should shave with an electric shaver or temporarily grow a beard. Women with flat warts on areas that are shaved should use other methods to remove hair such as depilatory cream or wax.

Professional treatment

Physicians should be consulted if there are no signs of progress after a month of self treatment. Doctors have many ways of removing warts, including using stronger topically applied chemicals than those available in drugstores. Some of these solutions include podofilox, topical podophyllum, and trichloracetic acid (TCA). Some burning and discomfort for one or more days following treatment can be expected. Although these chemicals are effective, they may not destroy all warts completely. A second method of removal is freezing or cryosurgery on the wart using liquid nitrogen. Cryotherapy is relatively inexpensive, does not require anesthesia, and usually does not result in scarring. Although temporarily uncomfortable, it provides an effective and safe way to deliver freezing temperatures to a particular area on the skin, and healing is usually quick. Physicians may also choose to burn the wart with liquid nitrogen or numb the skin and then scrape off the wart. Another removal process is electrocautery (electric burning), destroying the wart by burning it with an electric needle. Laser surgery is also becoming a more common option for removing warts.

Genital warts are the most difficult to treat. They can be removed, but the viral infection itself cannot be cured. Often, because the warts are so small, more than one treatment may be needed. The virus continues to live in the deeper skin, which is why warts often return after they have been removed. Strong chemicals may be applied as well as surgical excision with or without electrocautery. This therapy requires a small operative procedure and a local anesthetic. Laser therapy, although more expensive, is often used for treating venereal warts that are more extensive. The use of lasers which vaporize the lesion can theoretically transmit the HPV. It is not at all clear, however, if this occurs.

There is no one recommended method for eliminating plantar warts. If detected early, cryotherapy is usually enough. However, they can be very resilient, requiring treatment over several months. Treatment ranges from the conservative approach of applying chemical solutions to the more aggressive option of surgery. Patients with diabetes or vascular disease are usually treated with the more conservative methods.

Alternative treatment

There are a variety of alternative approaches to the treatment of warts. The suggestions described below apply to common warts and plantar warts, not to genital or cervical warts. Since genital and cervial warts are transmitted sexually, they should be treated by a physician

For the treatment of common or plantar warts, alternative practitioners may recommend these remedies.

• Apply a paste made of vitamin C powder to the wart for one to two weeks.
• Place a crushed or sliced garlic clove over the wart for seven consecutive nights while sleeping.
• Soak the wart in water, put cross-hatches over it with a sterile needle, and apply drops of thuja (Thuja occidentalis ) tincture onto the wart. Repeat the cross-hatching and tincture application until the wart is saturated with the tincture. Repeat several times each day for one to two weeks. (A tincture is an herbal extract made with alcohol.)
• Tape a piece of banana peel, latex side down, over the wart and leave it on overnight. Repeat nightly for one to two weeks.

Because warts are caused by a virus, general immune system support can be effective in helping to keep warts from coming back after treatment or to keep them from multiplying or growing. Eating a well balanced diet high in sources of vitamins A, C, and E can help strengthen the immune system. Avoiding stress, which is believed to compromise the immune system, is also helpful.

Prognosis

Even though genital warts may be removed, the virus itself continues to live. The HPV can cause tissue changes in the cervix of women with cervical infection. The general recommendation for women who have a history of genital warts is to see their doctors every six months for Pap smears to monitor any changes that may occur.

For plantar warts, the treatment goal is to destroy the wart and its virus without causing much damage to healthy skin. It is not unusual for treatment to cause pain until the foot heals because of the weight put on the foot.

Prevention

Genital warts can be prevented by using condoms and avoiding unprotected sex. Barrier protection will not, however, prevent the spread of wart-causing HPV to uncovered areas such as the pubis and upper thighs. Plantar warts can be prevented by wearing shoes, changing shoes daily, keeping feet clean and dry, and not ignoring skin growths and changes in the skin.

KEY TERMS

Condyloma acuminata— Another term for genital warts.

Cryotherapy— Freezing with liquid nitrogen for removal.

Endometritis— Inflammation of the endometrium or mucous membrane of the uterus.

Epidermis— The outer layer of human skin.

Human papilloma virus (HPV)— A family of viruses that causes hand warts, foot warts, flat warts and genital warts.

Retinoic acid— Vitamin A1 acid which is used topically to treat acne.

Salicylic acid— An agent prescribed in the treatment of hyperkeratotic skin conditions and fungal infections.

Resources

ORGANIZATIONS

American Academy of Dermatology. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. Fax: (847) 330-0050. 〈http://www.aad.org〉.

American Academy of Family Physicians. 8880 Ward Parkway, Kansas City, MO 64114. (816) 333-9700. 〈http://www.aafp.org〉.

American Podiatric Medical Association. 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (301) 571-9200. 〈http://www.apma.org〉.

Dermatology College of Medicine. The University of Iowa, 200 Hawkins Dr., Iowa City, IO 52242. (319) 356-2274. 〈http://tray.dermatology.uiowa.edu〉.

WARTS

DEFINITION

Warts are small, benign (harmless) growths caused by a viral infection. They occur on the skin or the mucous membrane. The mucous membrane is tissue that lines the nose, throat, digestive tract, and other body openings. The viruses that cause warts are members of the human papilloma virus (HPV) family. Warts can be transmitted from one person to another and they can travel from one part of the body to another.

DESCRIPTION

Warts occur most commonly among children, young adults, and women. They are a problem for 7 to 10 percent of the population. Warts are caused by nearly sixty different kinds of HPV. Each type prefers a certain part of the body. For example, some types of HPV produce warts on the skin, others cause warts inside the mouth, and still others produce warts on the genital and rectal areas.

Viruses enter the body through the skin or mucous membrane. They usually do not produce symptoms for one to eight months after entering the body. When warts appear, they are usually skin-colored and feel rough to the touch, but they can also be dark, flat, and smooth.

People differ in their sensitivity to HPV. Some individuals get warts over and over again. Others seldom or never get them. The virus is able to penetrate the body more easily if the skin has been damaged. For example, children who bite their nails may damage their skin in the process, which makes it easier for the virus to enter the body and cause warts. People with weakened immune systems are especially sensitive to HPV and wart infections.

CAUSES

The most common types of warts include:

• Common hand warts
• Foot warts
• Flat warts
• Genital warts

Hand Warts

Common hand warts grow around the nails, on the fingers, and on the backs of hands. They appear most often where the skin is broken.

Foot Warts

Foot warts are also called plantar warts. Plantar warts usually occur on the ball of the foot, the heel and the bottom of the toes. The skin in these areas is subject to weight, pressure, and irritation and has a tendency to crack or break open, providing an opening for the virus. Foot warts usually do not stick up above the skin.

People of all age groups can get plantar warts. But they are most common among adolescents between the ages of twelve and sixteen. The virus can be picked up in locker rooms, swimming pools, or by walking barefooted on dirty surfaces. People with diabetes mellitus (see diabetes mellitus entry) are very likely to develop plantar warts. The warts develop in areas where sores did not heal properly.

Flat Warts

Flat warts are smaller and smoother than other kinds of warts and tend to grow in large numbers. Although they can appear anywhere on the body, flat warts appear most often on the legs of women and the faces of children and young adult males.

Warts: Words to Know

Cryosurgery:

The use of liquid nitrogen for the purpose of removing diseased tissue.

Human papilloma virus (HPV):

A family of viruses that cause hand, foot, flat, and genital warts.

Genital Warts

Genital warts are a type of sexually transmitted disease (STD). A sexually transmitted disease (see sexually transmitted diseases entry) is a condition that is passed from one person to another during sexual activity. The forms of HPV that cause genital warts are very contagious. A person who has sexual contact with someone

infected with HPV is very likely to contract the disease. Experts estimate that two-thirds of these people will develop genital warts within three months of contact. As a result, about one million new cases of genital warts are diagnosed each year in the United States.

SYMPTOMS

While it is very easy to recognize the presence of warts, depending on the area of the body that is infected, the symptoms may vary. For instance, if left untreated, plantar warts can grow to a size of one inch or more. They can spread out and form clusters of warts that can become painful at times. They cause the most discomfort when they occur on parts of the foot where pressure occurs, such as the heel or ball of the foot. Some people say they feel as if they have a stone in their shoe all the time.

Genital warts are usually small flat bumps. They may also be thin and tall. They are mostly soft, and not scaly, like other kinds of warts. In women, genital warts usually appear within the vagina, on the cervix, and around the anus or within the rectum. In men, the warts usually appear on the tip of the penis, on the scrotum, or around the anus. Genital warts can also develop in the mouth of a person who has had oral sexual contact with an infected person.

DIAGNOSIS

The distinctive appearance of warts makes them fairly easy to diagnose. Patients with genital warts should seek medical attention. A doctor can confirm the presence of genital warts with a simple visual examination.

TREATMENT

Many over-the-counter wart treatments are available that remove hand and foot warts. These products are usually in the form of lotions, ointments or plasters. They work by removing the skin affected by a wart virus. After treatment, the skin and wart simply drop off. These products must be used with care, however. The chemicals they contain are quite strong and can affect healthy skin as well as infected skin. People with diabetes or heart conditions should not use these products.

Non-prescription drugs are also available for the treatment of flat warts. These products cause the skin to become saturated with water. Over time, the skin layer peels off, taking the wart virus with it. Flat wart remedies can take as long as three months to work, depending on the size and depth of the wart.

Moist patches are often the easiest and most effective products to use. They are placed on a wart for forty-eight hours. Then they are replaced with a new patch. In some cases, the patch may irritate the skin. In that case, the person should switch to a milder medication or stop treatment for a while.

Professional Treatment

A doctor should be consulted if home remedies do not work within a month. Doctors have many methods available for removing warts. One method involves the use of chemicals stronger than those found in non-prescription drugs. The use of these chemicals is often effective, but they may produce some burning and discomfort for a few days.

A second method of wart removal is cryosurgery (pronounced KRY-oh-SUR-juh-ree). Cryosurgery is the process by which tissue is frozen with liquid nitrogen, which has a temperature of about 330° F (200° C). This process freezes the tissue very quickly and the frozen tissue can then simply be removed. Healing of the frozen area usually occurs quickly.

Another method of wart removal is electrocautery in which an electric needle is used to burn the wart. The tissue around the wart is killed and can be peeled off, taking the wart with it. Laser surgery works in a similar way. A laser beam is aimed at the wart and the heat of the laser kills the skin around the wart, and the skin and wart simply fall off.

Genital warts are very difficult to treat. Any of the described methods can be used. But the first round of treatment may not be very effective. Although it may be possible to remove the warts, the virus that causes the warts may continue to survive under the skin and can produce new warts at a later time.

Plantar warts are also very resistant to treatment. The use of chemicals can be successful if the warts are diagnosed early. However, the treatment may take many months. In the most serious cases, surgical removal of the warts may be necessary.

Alternative Treatment

A number of alternative approaches have been recommended for the treatment of warts. The scientific justification for some of these treatments is inconclusive. The suggestions listed should not be used for genital warts, which should be treated by a doctor.

For the treatment of common or plantar warts, alternative practitioners recommend the following remedies:

• Apply a paste made of vitamin C powder to the wart for one to two weeks.
• Place a crushed or sliced clove of garlic over the wart for seven consecutive nights while sleeping.
• Soak the wart in water. Then make scratches in the wart with a sterile needle. Apply drops of thuja dissolved in alcohol to the wart. Repeat several times a day for one to two weeks.
• Tape a piece of banana peel on the wart over night, with the inner side of the peel touching the skin. Repeat nightly for one to two weeks.

Strengthening one's immune system is an objective of some forms of alternative treatment. A stronger immune system may be able to fight off the viruses that cause warts. A well-balanced diet rich in vitamins A, C, and E may help strengthen the immune system. Avoiding stress is thought to be another way of strengthening the immune system.

PROGNOSIS

Even if warts are removed, the viruses that cause them may remain in the body and the warts may reappear at a later time. This problem is especially common in cases of genital warts. In addition, genital warts can cause other problems. The human papilloma virus can also cause infections of the cervix. Women who have had genital warts should see their doctor regularly and should have a pap smear every six months. A pap smear is a test for cervical cancer.

Plantar warts are difficult to treat because of the weight placed on feet. The goal of treatment is to destroy the plantar wart and the virus without damaging healthy skin but the treatment can often cause pain until the foot heals completely.

PREVENTION

Using condoms during sexual activity can prevent genital warts. Condoms do not offer protection against areas that are not covered, however, such as the upper thighs. Plantar warts may be prevented by practicing good foot care. Good foot care involves keeping feet clean and dry, changing socks daily, and taking note of growths on the skin or changes in skin appearance.

FOR MORE INFORMATION

Books

The Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life Books, 1997.

Stupik, Ramona. AMA Complete Guide to Women's Health. New York: Random House, 1996.

Periodicals

Siwek, J. "Warts on the Hands." Washington Post Health (April 19, 1995): p. 15.

"What to Do about Warts." Consumer Reports on Health (July 1997): pp. 81-82.

Organizations

American Academy of Dermatology. P.O. Box 4014, 930 North Meacham Road, Schaumburg, IL 60168-5014. (847) 330-2300. http://www.aad.org.

American Podiatric Medical Association. 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (301) 571-9200. http://www.apma.org.

Warts

What Are Warts?

Who Has Warts and Why?

How Are Warts Diagnosed and Treated?

Can Warts Be Prevented?

Resources

Warts are small, hard growths on the skin or inner linings of the body that are caused by a type of virus.

KEYWORDS

for searching the Internet and other reference sources

Condyloma

Flat warts

Genital warts

Human papilloma virus (HPV)

Plantar warts

Sexually transmitted disease (STD)

Verrucae

What Are Warts?

Warts are small areas of hardened skin that can grow on almost any part of the body. They are caused by human papilloma (pah-pih-LO-mah) viruses, or HPV. There are more than 100 different kinds, or strains, of HPV. Warts are usually skin-colored and bumpy or rough, but sometimes they are dark and smooth. The way a wart looks depends on where it is growing, and different kinds of warts appear on different parts of the body.

Common warts usually grow on fingers and hands, especially around fingernails. These warts usually have a rough, bumpy surface with tiny black dots, which are the blood vessels that feed the wart and allow it to grow. Flat warts are much smaller than common warts and are very smooth. This type of wart typically grows in little bunches on the face and legs; as many as 100 flat warts may grow together in one place. Common warts and flat warts generally are not painful except under certain circumstances, such as when the pressure of a pencil pushes against a wart on the finger while writing. Plantar warts, which grow on the bottoms of the feet, can be quite painful as a person walks on them, flattening them and pushing them back into the skin. Like a common wart, a plantar wart is covered with black dots marking the place of blood vessels.

Genital warts are small and pink, and they can grow one at a time or in bunches that make them look a bit like cauliflower. This type of wart can grow on the genitals*, the skin around the genitals, the rectum*, the buttocks, or in the vagina* or cervix*. Although most warts do not cause major health problems, genital warts may itch or bleed, and the ones caused by some strains of HPV are known to increase a woman’s chances of developing cancer of the cervix.

*genitals

(JEH-nih-tuls) are the external sexual organs.

*rectum

is the final portion of the large intestine, connecting the colon to the anus.

*vagina

(vah-JY-nah) is the canal, or passageway, in a woman that leads from the uterus to the outside of the body.

*cervix

(SIR-viks) is the lower, narrow end of the uterus that opens into the vagina.

Who Has Warts and Why?

About 1 in 4 people have common, flat, or plantar warts at some time in their lives. Children tend to have warts more often than adults do, and people who bite their fingernails or pick at hangnails may be more likely to have warts because tiny openings in the skin provide a way for HPV to enter the body. Someone with a weakened immune system, due to a chronic* illness or an infection, for example, also may be more likely to have warts. Warts are very contagious because HPV can pass easily from one person to another by contact. Genital warts spread through sexual intercourse. In fact, they are the most common viral sexually transmitted disease in the United States. In rare cases, a mother with genital warts can pass HPV to her baby during birth. The virus can cause growths on the baby’s vocal cords or elsewhere in the infant’s respiratory tract.

*chronic

(KRAH-nik) means continuing for a long period of time.

How Are Warts Diagnosed and Treated?

Health care providers can diagnose a wart by its appearance. It is important to have a professional examine the wart, because it is not always easy to know exactly what is growing on the skin or how to treat it. In the case of genital warts, a doctor also may screen a woman for cervical cancer by performing a pelvic exam*, including a Pap smear*. In some cases, warts eventually disappear on their own without any treatment. However, if a person has a lot of warts or if the warts are painful or seem to be spreading, there are several possible treatments.

*pelvic exam

is an internal examination of a woman’s reproductive organs.

*Pap smear

is a common diagnostic test used to look for cancerous cells in the tissue of the cervix.

Over-the-counter medicines containing salicylic (sah-lih-SIH-lik) acid often are used to remove common warts. The medicine can be painted on, or it may come in a patch that sticks to the wart. This type of treatment can take longer than others do, but it is painless. Cryotherapy, or freezing, is a typical treatment for common warts. A special chemical freezes the wart, and a scab develops as the skin heals. Cryotherapy may be used on plantar warts as well. These warts can be difficult to treat, because most of the wart is located beneath the surface of the skin. Electrosurgery can burn warts with a tool that uses an electric current; this type of treatment is used on both common and plantar warts. Chemical peels that contain acids are used to treat flat warts, which grow in such large bunches that the other types of treatments usually cannot be used efficiently. The chemicals are applied to the skin, and they eventually “peel” away the warts. Doctors also may use laser treatment to destroy any type of wart that proves difficult to remove. In some cases, doctors may give injections of interferon (in-ter-FEER-on), a substance that stimulates the body’s immune system to attack the HPV causing the wart.

Genital warts require treatment from a doctor. To remove them, doctors may use cryotherapy, lasers, medicines that can be applied directly to the warts, or surgery. Once a woman has had genital warts, doctors may advise her to have Pap smears more often. In some cases, certain types of HPV infection can lead to cancer of the cervix, and a Pap smear will allow the doctor to find and treat the disease in its early stages.

Can Warts Be Prevented?

It can be very difficult for people to protect themselves from common, flat, and plantar warts, because they are so common and the virus spreads so easily. In addition, a person can come into contact with HPV many months or even a year before a wart grows big enough to see, so it is often impossible to know for sure where and how someone caught the virus. If a person has a wart, it is best for other people not to touch it. It is also advisable to avoid sharing towels and washcloths with someone who has a wart and to wear sandals at public showers or pools or in locker rooms, to avoid infection. It can be difficult to prevent genital warts, because skin-to-skin contact spreads them. Condoms may limit the spread of genital warts, but because some warts grow on the skin around the genitals and on the buttocks, a condom may not cover every one of them, making it still possible for the HPV to pass between sexual partners. Abstaining from sex with a person who has genital warts is the safest choice.

Worried About Warts?

Warts have a long history in folklore, and the myths about them abound. Touching a frog, for example, has been thought both to cause and to cure warts. No one knows why certain unconventional treatments became popular; perhaps it is simply mind over matter. Among the many wart “remedies” are these, none of which has been proven to work:

• Put pebbles in a bag with a silver coin and then tie up the bag and throw it in the street. Whoever finds the money and keeps it will also keep the warts.
• Rub a dirty washcloth on the warts and bury it by the light of the full moon.
• Make the wart bleed. Put one drop of blood on seven grains of corn and feed it to a black hen.
• Apply a piece of raw meat to the warts and bury it. As the meat decays, the warts will disappear.
• Mix brown soap with saliva and make a paste. Apply it to the warts and leave on for 24 hours.
• Write a wish for your warts to disappear on a piece of paper, take it to the intersection of two roads, tear it up, and cast it to the winds.

See also

Sexually Transmitted Diseases

Skin and Soft Tissue Infections

Resources

Organization

American Academy of Dermatology, P.O. Box 4014, Schaumburg, IL 60168-4014. The American Academy of Dermatology offers a fact sheet and general information about warts on its website. Information for young people can be found through the Kids’ Connection at the website.

Telephone 847-330-0230 http://www.aad.org

Website

KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children’s health. It contains articles on a variety of health topics, including warts.

http://www.KidsHealth.org