Introduction
Warts are noncancerous skin growths that occur due to viral infection. The virus enters the top layer of the skin through cuts, and warts are raised with irregular nodules on the skin. Nongenital warts are those that are caused by Human papillomavirus (HPV). There are various kinds of warts, with about 100 different types.
What Is a Nongenital Wart?
Nongenital warts are a self-limiting skin condition that is benign and extremely common. It occurs when Human papillomavirus infects the epidermal cells resulting in the multiplication of cells, and a thickened papule is formed on the skin. Any area of skin may be affected, but it is commonly seen in hands and feet. They are contagious and can spread by contact. It is mostly skin colored or may be brown or gray-black.
What Are the Types of Warts?
There are about 100 different types of warts. The type is determined by the location of the body where it appears.
1. Common Warts:
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They are found on fingers, the back of the hand, and around nails.
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They are skin-colored papules (bumps) with a rough (verrucous) surface.
2. Foot Warts:
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They are also called plantar warts.
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They grow on the soles of the feet and resemble callouses.
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They can hurt, causing a sensation of pebbles inside shoes.
3. Flat Warts:
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They can occur at any site, often seen on the backs of hands and legs.
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They are smoother than other warts and appear slightly raised and as plaques of skin-colored or light brown.
4. Filiform Warts:
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They look like slender fingers that project outward.
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They proliferate around the eyes, nose, and mouth.
What Are the Causes and Risk Factors of Warts?
Viral inoculation at the site of trauma leads to wart formation, often found in areas such as hands and feet. This is because the virus invades the damaged area of the epidermis.
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It can occur in areas that are frequently prone to trauma.
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It can occur due to walking barefoot in areas where other people walk barefoot, in locker rooms.
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It can also be seen in meat-handling occupations such as butchers.
Warts caused by HPV are contagious. Risk factors include:
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Communal showers.
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Immunosuppression. It is often seen in renal transplant recipients.
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Handling the meat as part of the occupation.
In the cases of people being affected by warts as a result of immunosuppression, warts do not pose a threat and will resolve when natural immunity is regained.
What Is the Clinical Presentation?
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The primary clinical presentation largely varies but is often well-demarcated papules that are rough. The clinical manifestation depends on the type of HPV that causes warts. Diagnosis is based on clinical examination.
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It accounts for almost 8 percent of dermatological consultations. It can be disfiguring and recalcitrant to treat. If it is hands or feet can cause mobility or functional difficulties for the patients.
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It can occur at any age but is most frequently found in children and adolescents.
How to Treat Warts?
Nongenital warts are often harmless and spontaneously resolve without treatment. Genital warts need evaluation by a professional. Some warts may be chronic in nature and may require multiple visits for treatment. This varies depending on the severity, clinical variant, and treatment modality. The difficulty in treating warts is that they have a high chance of recurrence. And because of this, multiple methods of treatment may be necessary.
Treatment may be broadly divided into
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Physical destruction using cryotherapy, surgical removal, electrosurgery, and laser treatment.
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Chemical destruction with Salicylic acid, Cantharidin.
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Immunomodulator therapy includes Bleomycin, Imiquimod, and Interferon.
1. Freezing (Cryotherapy):
It may be done with the help of a doctor or by using over-the-counter freezing products. Liquid nitrogen is used to freeze a wart. It works by blister formation around the wart, and dead tissue falls off within two weeks.
It is widely accepted as it is safe and causes moderate discomfort for patients.
Even in home-based treatment, the temperature can reach as low as 100 degrees, but the limitation in it is that the wart may not freeze deep enough to give effective results. It can also be painful as it takes more time than when treated by a doctor.
2. Cantharidin:
This substance is an extract of blister beetle. It is applied to the skin so that it forms a blister around the wart. It is then covered with a bandage. The blister formation lifts warts off the skin.
3. Salicylic Acid:
Over-the-counter treatment forms are available in the form of gels, ointments, or pads. These products contain Salicylic acid, which, when regularly applied, can slowly dissolve the wart tissue. This is a slow process and takes several weeks to show results.
4. Minor Surgery:
If non-invasive procedures are ineffective, warts may be removed by surgery. The wart is sliced off by surgery, and the base of the wart is destroyed using cryosurgery or an electric needle. This is done to ensure that all the tissue is removed and to prevent a recurrence.
5. Electrosurgery:
This involved electrocautery or thermal coagulation to destroy the lesion. The flow of electricity produces heat which is then applied to the lesion. The goal is to destroy the virus without harming the underlying dermis and to minimize scarring. Local anesthesia is needed to perform the surgery.
6. Laser Surgery:
A laser beam (intense light beam) is used to burn away and destroy wart tissue.
7. Medications:
These include medical formulations that are injected into the site to kill the virus. They include Bleomycin and Imiquimod. Immunotherapy drugs may also be used to activate the immune system against the wart.
8. Over-the-counter medication:
These are products that are readily available that can be applied regularly on the skin, and the wart will gradually fall off. It usually contains Salicylic acid. It is to be emphasized that these medications can only be used on nongenital warts and genital warts need to be treated by a doctor.
What Is the Prognosis of Nongenital Warts?
Warts usually resolve on their own in immunocompetent patients and resolve as a result of natural immunity, and in immunosuppressive patients, it gets resolved when immunity is re-established.
How to Prevent Warts?
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If a person already has warts, they can be prevented from spreading by not picking on them.
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Cover warts with bandages.
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Control moisture content as warts are harder to be contained in moist environments.
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Avoid shaving, combing, and brushing areas where warts are present to prevent viral spread.
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Wash hands after touching warts.
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The use of different hygiene products, razors, and towels can help prevent the transmission of infection.
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HPV vaccination can also prevent warts.
Conclusion
Nongenital warts are self-limiting skin lesions that are caused as a result of Human papillomavirus infection of the epidermal cells. A verrucous raised lesion may be found in areas of minor trauma that the virus has infected. It is noncancerous and mostly resolves itself by natural immunity. If treatment is required, various modalities of treatments are available such as cryotherapy, laser treatment, and electrosurgery, among others. Proper hygiene practices and vaccinations can prevent the spread of the infection.
