Health Awareness blog

 

 

Wart is a cutaneous neoplasm. We classify it as a benign skin tumour.  It caused by Human Papilloma Virus (HPV). It is also known as corn. The typical appearance is a “dome-shaped” lesion with irregular filamentous surface. It is presented as a thickened skin lesion with a rough surface. There is loss of skin markings over the surface area.

 Common site for warts:

• Face – the lesion often spread by shaving
• Arms
• Fingers
• Legs
• Toes
• Genital – spread by sexual contact
• Perianal – spread by sexual contact

 Types of warts:

1. Common warts – it most common in children and young adults. It often resolves spontaneously but some individual lesion may be stubbornly persistent.
2. Plantar warts – Can be found over sole area. Large confluent lesions (mosaic warts) can be resistant to repeated treatment. Warts are highly infectious and surgical excision is best avoided.
3. Plane warts – flat skin coloured or brownish lesions and tend to köbnerise (form a skin lesion) in scratch marks.
4. Genital warts (condylomata accuminata) – presented over genital parts. The vulva, perineum, anus, vagina or cervix may be affected. Penile warts might not be obvious. Warts may be florid in the pregnant mothers and immunosuppressed patients. The patients should be screened for other sexual transmitted disease. HPV is also plays a large role in the development of neoplasia of the uterine cervix and external genitalia in females. Women with genital warts or female partners of men with genital warts should have cervical smear and observation of the vulval to be carried out yearly (HPV 16, 18 & 33 strongly associated with cervical and vulval cancer). Warts may also give rise to anal carcinoma.

 Treatment:

• Croyotherapy with liquid nitrogen – it might be a bit painful but it really works!
• Keratolytic agents (salicylic acid) – this may work on small lesion
• Intralesional bleomycin – to treat stubborn common warts
• Diathermy, cryocautery, lasers – to treat stubborn common and genital warts
• Curettage – help to debulk large persistent warts (mostly over sole area)
• Application of podophyllin solution – this is effective for genital warts. However, it can be associated with marked local reactions. It is contraindicated in pregnancy because it is teratogenic (cause abnormality in fetus). Only few warts should be treated at a time to avoid toxicity.
• Topical imiquinod – for genital warts

 SUMMARY 

Wart is a common skin lesion. However, if it involve the genital and anal parts, the condition might be serious than what we might thought. Genital and anal warts are transmitted sexually, so we have to exclude other genital infections as well. Thorough examination should be done to look for evidence of early neoplasm change. The principal of treatment is to treat both partners. We should take a note that HPV types 6 and 11 may cause laryngeal or respiratory papillomas in the offspring of affected mothers. The risk is 1:50 to 1:1500. 50% of the disease present in child less than 5 years of age.

 Reference:

•  
  1. Harrison’s Manual of Medicine. 16^th edition. 2005.
  2. Quick reference cards by Medical Protection Society. 2001.
  3. Oxford Handbook of Clinical specialties. 5^th edition. 2001.

 

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