Warts are caused by a virus known as the papova virus. The
numerous strains of papova virus that cause the common wart are transferred by physical contact and enter
the skin at the point of contact. Contrary to popular belief, the wart virus is
not systemic and does not 'circulate through your system'. Warts are only
contracted by direct contact on the skin. The papova virus has a
long incubation period ranging from 1 to 20 months, meaning that it may take
quite some time before a person will even notice any presence of the wart. One
theory regarding the etiology of warts suggests
that the virus is able to enter the skin at areas where the skin has sustained
recurrent damage. The skin on the hands and feet can be damaged in a number of
different ways. Examples of injuries include fissures or cracks in the
skin, fissures in the cuticle, chronic nail biting and maceration caused by
excessive perspiration. Warts seem to thrive in skin that is thick and
moist. Therefore, we tend to find warts on the palm of the hand and the
sole of the foot.
Warts are saprophytic, meaning that they need
something (or someone) on which to live. We have yet to determine why the
papova virus prefers some individuals over others. We have to assume that
the immune system in these suseptable individuals does not or can not recognize the
wart as a foreign tissue. Warts are rare in infants and older adults. Children
and adolescents are particularly susceptible to warts. It seems the papova virus is able to 'fly
under the radar screen' of an adolescent's immune system. One theory that
attempts to explain this preponderance of warts in adolescence questions whether
puberty is so overwhelming to the immune system that the
papova virus is not recognized as foreign tissue. In the near future, studies
in immunology should shed some light on the papova virus and help us understand
some of the changes we see in our immune systems as we age.
Another theory proposed to explain why teens are so susceptible to
the papova virus relates to dietary intake of Vitamin A. Vitamin A is found in green leafy vegetables.
Teens are well known for their distaste of spinach and green leafy vegetables.
Is there credibility to this theory or is simply a way for moms to get their
children to each their vegetables? So far the jury is out on this theory.
But from a scientific standpoint, we do find high doses of Vitamin A useful in
the treatment of warts (see below).
Treatment of warts
There's probably more ways to treat a wart than
any other condition in medicine. What that implies is that there is no one method of
treatment for warts that is superior to any other method. In selecting a
treatment method, it's important to remember that warts are a self-limiting condition, meaning to say that most warts do resolve on their
own over time. I know this doesn't help someone who has a painful wart, but bear in mind, treatment methods have changed dramatically over the past few
years. As a result, many physicians are becoming less aggressive with their
The treatment of warts can be divided into two types of care; old school methods and new school methods. Old school
treatment methods focus on the fact that the wart tissue is bad and bad tissue
needs to be destroyed. Freezing (cryotherapy), hyfercation (burning), and
surgical excision were commonly used methods of care. Serial application of
is another old school method that is often used both as a home remedy and one
common in the doctor's office.
New school methods focus on changing the patient to be 'less of a
host' or 'less liked' by the virus. If a wart seems to like you, it's
perhaps time that you change. There's a number of ways to accomplish this
Some methods are considered internal and others are considered external, while some employ a combination of
both. Vitamin A is a common nutritional supplement that can be used as a
medication to change the internal characteristics of the skin.
Vitamin A has been shown to clinically change many skin conditions including
acne, wrinkles and warts. Vitamin A is a fat soluble vitamin, meaning that
it is dissolved and stored in body fat. In the subcutaneous space, that
area just beneath the lowest layer of skin, all of us have a layer of body fat
for warmth, possible fuel (stored as fat) and storage of important minerals we use on a daily
basis. The fat pad of the palm of the hand and the sole of the foot and
condensed pads of fat. Vitamin A is known to provide a supporting role for skin. And in
the case of warts, vitamin A appears to alter the nature of the skin to a degree
that the skin becomes inhospitable to the wart. Subsequently, the papova
virus dies. Do be careful when using vitamin A which may be toxic in large
doses. Most texts recommend a dose of
20,000 to 30,000 units daily for a period of three months for adults. We recommend
you contact your doctor for advise in using high doses of vitamin A.
Drying the foot is an important aspect of the new school approach
to treating warts. Use of a
on a daily basis to decrease perspiration of the foot significantly changes the
character of the skin and often reduces wart counts. Drying the skin is an
external, new school method of changing the individual, subsequently making the
life of the papova virus more difficult.
Another medication used to treat resistant
warts is called Aldara (5% Imiquimod cream). Aldara reduces the DNA of
human papilloma virus subtypes 6 and 11 by the increase in production of
cytokine. Aldara is currently FDA approved for the treatment of external
genital and perianal warts (subtypes 6 and 11). Although the use of Aldara
is considered 'off label' use when used for warts of the hand or foot, many
dermatologists and podiatrists are now trying Aldara for resistant warts of the
hands and feet. Aldara is used under occlusion, meaning that the
medication is applied and then covered with a plastic occlusive wrap. The
cost of Aldara is a significant consideration when considering its' use.
Most contemporary dermatologists consider Aldara as a method of treatment only
used for cases of resistant warts. More information regarding Aldara can
be found at the Aldara web
In resistant cases of warts that fail to respond to new school
methods, mechanical debridement of the wart is indicated. Removal of the
wart with a curette, scalpel or laser is still used by many doctors. A CO2 laser is effective in
removing large areas of virus. The CO2 laser is helpful in defining the
margin between the wart and adjacent healthy skin, subsequently resulting in
less post-op scarring. Each of these minor surgical procedures require a local
anesthetic and do
result in some degree of short term disability due to limited post-op
pain. Surgical excision of a wart can often be performed with a local anesthetic
in an office setting. Large numbers of warts that cover significant
surface area are best treated on an out-patient center using a local anesthetic
The images below show the steps taken to excise a wart.
Images 1 and 2 show prep of the surgical site and definition of the border of
the excision with a tissue nipper. Images 3 and 4 show the use of a
curette to bluntly dissect the wart free of the dermis (deep layer of skin).
Image 5 shows the application of phenol (77% carboxylic acid). Phenol acts
as both a topical anesthetic and cautery agent.. Image 6 shows packing the
wound with 40% salicylic acid. Sal acid is used to chemically destroy any
residual papilloma virus left following curettage. And Image 7 is the
specimen viewed from the bottom or underside of the wart. This specimen is
an example of how well warts are compartmentalized.
Other methods used to treat warts include;
Stippling - the lesion is anesthetized and a fine
needle is used to pierce the wart over and over. This method destroys the
vascular network within the wart.
Injections of neoblastic agents - Bleomycin and
5-flurouracil have been injected directly into the wart. These agents act
as chemotherapy for the wart to arrest its' growth.
Tagemet - By coincidence, folks taking Tagemet
for stomach problems find that it does have an effect on warts. Most
literature suggests 1200mg daily in divided doses.
Tea tree oil - This is a popular alternative
approach. Tea tree oil is available in most health food stores and is
applied daily to the lesion until it is gone.
Topical vitamin A - Topical application of
vitamin A has worked for many. Some break open a vitamin A gel cap or even
use cod liver oil topically.
Half a potato - I mention this folk remedy because it has worked for many people. Rub a half of a potato on the wart
and bury it in the back yard. Obviously, the power of suggestion is
effective in treating warts.
Cryosurgery - freezing the wart is
popular. It works well for lesions in areas of thin skin such as the top
of the foot or hand. The thickness of the palm or sole does limit the
effectiveness of this method. Cryosurgical methods work by forming a
blister beneath the wart. This technique can be painful for some patients.
Duct tape - don't laugh, it can work. Covering a wart with
an impervious barrier, such as duct tape can alter the environment in which the
wart thrives. When practical, covering a wart for 4 weeks with duct tape is an
acceptable method of new school treatment. Covering the skin with a
non-porous tape like duct tape is a great, new school way of changing the skin.
In many cases, the use of duct tape can become impractical from the standpoint
that trying to keep the tape on becomes too much work. the duct tape
approach can work well on easy places to wrap like fingers and toes. If
you can't keep the duct tape on for 4 weeks, your success rate of treatment will
be somewhat less than optimal. In this case, you may want to fall back on
a different method of treatment.