Warts are an infectious disease of low infectivity caused by a virus. They may occur anywhere on the body but are frequently seen on the hands, feet, and face (areas of frequent contact). Warts may be named by their location and appearance.
On the soles of the feet they are called plantar warts. Around and under the fingernails or toenails they are periungual or subungual warts, respectively. Common warts on the hands, arms, legs, and elsewhere are verrucae vulgaris but often just called common warts. Numerous very small smooth flat warts (pinhead size) often seen in large numbers on children's faces, foreheads, arms and legs are called verrucae planae juveniles. These are seen less often in adolescents and seldom in adults.
The typical wart is a rough round or oval raised lump on the skin that may be lighter or darker than the surrounding normal skin, skin colored or even (rarely) black. Most people are familiar with the look of a typical wart and have little trouble in diagnosing the condition. Warts with a smooth surface and the small flat warts in children may cause some difficulty in diagnosis for the average parent. Common warts cause no discomfort unless they are in areas of repeated trauma.
Plantar warts are no different than the common wart but, because of their location on the soles of the feet, they tend to be deeper and can become painful. Large numbers of planter warts on the foot may cause difficulty running and walking and can be debilitating.
Warts around and under the fingernail are similar to the common wart but much more difficult to cure.
Because people generally consider warts unsightly and there appears to be a social stigma (among school children) associated with having warts, parents often seek treatment. Treatment of warts has improved significantly in the last 10 years but even with effective treatment recurrence is not uncommon.
The common wart may disappear spontaneously, often within 2 years of its appearance.
Thuja internally and topically may help dramatically. A typical dose is 10 drops of tincture bid taken orally.
Olive leaf extract has been reported to help.
Grapefruit or citrus seed extract has been reported to help.
Food grade hydrogen peroxide (36%) can be applied directly to the wart with a Q-tip, while being very careful not to contact normal skin. Continue applying twice per day until the wart becomes white and the surrounding skin becomes somewhat white. After a few days to two or three weeks, depending on location, it will start to blacken. Continue applying until wart falls off. Any skin damage to normal skin is temporary. Hydrogen peroxide is dangerous around children, who may consume it or get it in their eyes.
According to the findings of a small study in children, applying ordinary duct tape to the common wart (Verruca vulgaris) appears to be superior to traditional cryotherapy with liquid nitrogen. While anecdotal reports abound of duct tape's wart-removing abilities, the therapy has not gone head-to-head with other wart removal techniques, according to the report published in the October, 2002 issue of the Archives of Pediatric and Adolescent Medicine.
In the current study, the researchers compared duct tape therapy to cryotherapy, which involves several visits to the doctor's office. During the treatment, a physician freezes the wart by applying a quick, narrow blast of liquid nitrogen to the offending blemish. This is repeated once every two or three weeks until the wart is gone. Aside from the inconvenience of frequent visits to the doctor's office, another potential drawback to this method is that many children are afraid of the treatment and may find it painful, according to lead author Dr. Dean R. Focht III, who conducted the study with colleagues Dr. Mary Fairchok and Carole Spicer while at the Madigan Army Medical Center in Tacoma, Washington.
"Tape occlusion, if proven effective, could be an inexpensive, convenient and painless alternative to cryotherapy in the treatment of pediatric warts," they write. Focht is now at the Children's Hospital Medical Center in Cincinnati.
In the study, the researchers randomly assigned 51 patients between the ages of 3 and 22 to receive either a maximum of 6 cryotherapy treatments, once every two to three weeks, or two months of duct tape therapy.
For duct tape therapy, a nurse covered the wart with a piece of duct tape roughly the same size as the wart. Patients (or their parents) were instructed to keep the duct tape on for 6 consecutive days and if the tape peeled off during that time, apply another at home. At the end of 6 days, patients soaked the wart in water and rubbed it with an emery board or pumice stone. The next morning a new piece of tape was applied. The routine was repeated for a maximum of two months.
During the study, all of the patients returned frequently to the doctor's office to have their warts measured and evaluated by a nurse. The investigators found that 85% of those in the duct tape group, compared to 60% of those in the cryotherapy group, had complete resolution of their warts. "This study shows that duct tape occlusion therapy is not only equal to but exceeds the efficacy of cryotherapy in the treatment of the common wart. Tape occlusion therapy can now be offered as a nonthreatening, painless, and inexpensive technique for the treatment of warts in children", according to the report.
It is not clear exactly how the duct tape acts, "but, as with other therapies, it may involve stimulation of the patient's immune system through local irritation."
[Archives of Pediatric and Adolescent Medicine 2002;156: pp.971-974]
Dry ice can be substituted for liquid nitrogen when freezing warts for removal.
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