What Should Rural Patients Know About Common Warts?

By: Dr. J. Gnanaraj and Dr. Sunitha Gadudasu

What are warts?

Warts are common skin lesions that are caused by certain types of Human Papilloma virus [HPV]. They have been around for thousands of years starting from the mummies of Egypt and being mentioned in Shakespeare plays. They are not dangerous but can be ugly, potentially embarrassing, contagious and sometimes painful.

There are about 130 different types of HPV that causes the skin cells to grow faster than normal. Trauma or maceration facilitates initial inoculation and spread is by auto–inoculation. Local and systemic immune factors influence the spread of the warts.

What are the types of warts?

There are several types depending on the virus that causes it. The common ones are the following:

• Common warts: These are called verrucae vulgaris. They are about 2 to 10 mm diameter lesions that have clear demarcated edges. They commonly occur in areas subject to trauma. In head and neck and scalp they could cause cauliflower like lesions
• Filiform warts: These are narrow frond like growths commonly found on the eyelids, face, lips, etc and generally do not cause symptoms
• Palmar and plantar warts: These are caused by HPV type 1 virus and occur in the palms and soles. They are often painful and are flattened
• Mosaic warts: These are groups of different types of warts.
• Periungual warts: These thick fissured cauliflower like lesions near the nail beds.
• Genital warts: Those occurring in women can lead to cancers and immunization is available for prevention of these warts
• Butchers wart: These are present in the hands of butchers and sometimes 20% of them can have these
• Heck’s disease: It is a wart like lesion occurring in the oral cavity
• Flat warts: These are often found in the teens in the face.

How are they diagnosed?

Most of the time clinical examination should suffice for diagnosing the warts. However biopsies are sometimes necessary if cancers are suspected. The important sign of wart is that skin lines are not crossed by warts or significant bleeding if they are shaved as they are very vascular.

They should be differentiated from other common lesions like:

• Corns
• Lichen planus
• Seborrheic keratosis
• Skin tags
• Squamous cell carcinoma or cancer

What happens to these warts?

The warts regress spontaneously most of the time. However they can persist for years and occur at other places. Patients prone to trauma often have recurrent and resistant warts. Malignant change or cancer occurring is very rare except in genital warts and in immune-compromised patients.

Is there any way of prevention of these warts?

The warts do not spread easily but can spread through contaminated objects or close skin to skin contact. Sharing towels, shoes and socks and areas surrounding swimming pools and communal changing areas can contribute to spread. Hence the following are important for preventing spread:

• Avoid touching warts [others or yours] and wash hands after touching
• Avoid sharing towels, shoes, socks etc.
• Keep the hands and feet clean and dry
• Cover warts with waterproof dressing while swimming
• Avoid scratching the warts
• Be careful while shaving

What are the available treatment methods?

There are two methods that are available for treatment.

1. Topical irritants
2. Destructive methods

Treatment is considered if cosmetically unacceptable or if the warts are painful or their location interferes with function. However, in immune-compromised patient’s treatment is always better.

Several medicines have been used as topical irritants. They include:

• Salicylic acid
• Trichloracetic acid
• 5 – Flurouracil
• Podophylline resin
• Tretinoin
• Cantharidine
• Topical creams like Imiquimod, cidofovir, Bleomycin

These are generally tried for flat warts and are often difficult to get and expensive. Special precautions are necessary to prevent spread to normal tissues.

The destructive therapy could be in the following forms:

1. Cryotherapy: Special instruments are used for freezing the warts that fall off after few days. They are good for small ones but are time consuming and multiple sessions might be required.
2. Surgical excision: These are simple one-time intervention but the drawback is that they do leave scars and need suture removal.
3. Electrocautery excision: This like the cryotherapy can burn off the wart but the heat spread can cause a bad scar.
4. Laser therapy: This can accurately burn the cautery but is expensive.
5. Harmonic scalpel excision: this again is expensive but leaves minimal scar and is quickly carried out.

What are the facilities available at SEESHA?

At Karunya Community Hospital, at ICC hospital in Coimbatore, the Bethesda Hospital at Aizawl, Sielmat Christian Hospital at Churachandpur, Family health hospital Dimapur and other places where the SEESHA health care team provides surgical camp and diagnostic camp facilities, all the treatment modes mentioned above are available except for the medical treatment and Laser therapy. Laser therapy is available at KRCH.

Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore currently working as Director of Medical Services of the charitable organization SEESHA and Adjunct Professor in Karunya University. He has special interest in rural surgery and during the last three decades of service in rural areas helped 23 rural hospitals start minimally invasive surgeries. Karunya is now recognized as center for excellence in innovation for rural surgery by Lancet Commission on Global Surgery. He has over 200 publications. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. Recently, he was awarded the Lockheed Martin innovations award by the Department of Science and Technology of Indian Government and the Lockheed Martin Group (USA)

Dr. Sunitha Gadudasu is currently working as a Dental Surgeon at Seesha Karunya community Hospital, Coimbatore, Tamil Nadu. She graduated from TN MGR University, Chennai ‐Tamilnadu. She is also certified in rotary endodontics from International Academy of Rotary Endodontics, USA. She also completed her M.B.A. (Hospital Administration).