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General Dermatology

Warts

Two main types of warts affect human skin.  Human papovavirus accounts for the majority of infections.  There are more than 70 types of HPV and they can occur anywhere on the body.  Warts are named by their location (i.e. “plantar” is the bottom of the foot, and “genital” is on or near the genital areas).  Although warts are contagious, the virus is so ubiquitous that it is usually not reasonable or possible to pinpoint the source of infection.  The exception to this is, of course, infections in the genital area.  Certain strains of genital wart virus can predispose to cervical cancer – so identification and avoidance of contagious sources and treatment of the warts is important.

Warts often regress spontaneously, but this process can be slow.  If a wart is painful or unsightly, treatment may be sought.  Most warts can be destroyed by burning, freezing, or acids.  For stubborn warts, several types of laser may be used.  Carbon dioxide or erbium laser vaporizes the top layers of skin.  Vascular lasers target the dilated blood vessels at the base of the wart and may also be helpful.  It is important to realize that no destructive modality is perfect and several treatments may be needed.  Additionally, wart destruction may result in white spots or scarring. 

A newer form of therapy for HPV is immunotherapy.  In this modality, a drug (imiquimod) is applied to the skin.  This drug stimulates the formation of interferon and other cytokines, which fight the wart infection.  Essentially, this treatment helps the body to cure itself through its own immune system.  New on the horizon is the possibility of a vaccine to type 16 HPV.  This form of virus is implicated in many cases of cervical cancer.  Theoretically, immunization at an early age would prevent genital infection with type 16 HPV and subsequent cervical cancer.  Overlap of immunity to type 16 and other strains of HPV is not fully understood.

A second type of wart virus (a pox virus) causes molluscum contagiosum.  These are small, dome shaped bumps seen most commonly in children and young adults.  They should be considered an annoyance because they are so common and do not lead to further disease.  If treatment is desired, any of the destructive methods or immunotherapy can be used.

Warts, then, are common and, in most cases, benign.  Understanding the significance of an infection and the options for therapy is essential in dealing with this problem. 

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202-695-1000


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Suite 308
Washington, DC 20016-4382
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