General Category > Skin Complaints and Skin Disorders

Genetic Warts?

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missmash:
 :hi: Txinmommie....    welcome to skincell...  i`m looking forward to the replies...  i have these "flat warts" (thanks Gobe!!) mainly around my lower legs/ankles ..  been wondering for a while what they are, like you they seem to be more noticeable when i have been in the sun...  

jo

peterb:
Or read this about warts can be genetic.

WARTS

Warts are a viral infection of the skin that cause unsightly growths. Warts can be flat or protuberant, soft or crusty. One thing is constant - they are contagious and should be treated before you develop further lesions. One of my pet peeves is when a patient arrives in the office with 20, 30, 40 warts or more and they tell me that their primary care physician told them not to treat the first wart as it would go away on its own in good time. Although this may occasionally be true, its much more common to see them increase in number. There are hundreds of old wives tales about eradicating warts. One of my favorites is the idea of rubbing the wart with a raw piece of potato, and then burying it at night under a full moon on the east side of the house!

Warts are categorized by families. There are individual wart groups within a family, and typically this shouldnt make any difference unless youre a researcher. There is no clinical way to identify which group of wart youre looking at, only the general family category. And it honestly doesnt matter for daily practice sake. The warts most people think of are hard and crusty and can be located on most any body surface. Most of the time they will be raised, especially as they age. The misconception that warts have seeds stems from the appearance of pinpoint black flecks within a wart. These are actually the blood vessels that feed the wart viewed head on. Think of looking at the end of a pipe, and this is how you are visualizing the blood vessel. The black color is due to small clots within the vessel. Warts DO NOT have roots! I dont know how that idea arose, but it seems to be a common misconception.

Warts are an infection. I think that a major reason they affect certain individuals and not every one is that certain peoples immune systems simply dont recognize the existence of the wart on the surface of the skin. This doesnt mean that the person has a major immune deficiency, it simply means that certain families have genetic predispositions to this. Think of people who always have sinus infections or strep. throat or fungal infections. This is the same thing. I do know that families with atopic dermatitis as well as red haired individuals seem to be more predisposed to chronic reinfections with warts..

Here are a few of the groups of warts within this most common family:

Plantar warts are a form of wart everyone has heard of. However, what most people dont realize is that they are no different from any other wart in that family. Its simply that they are on the Plantar surface (bottom) of the foot.

Periungual warts are a terribly difficult form of wart that affects the skin surrounding the nail. The wart virus can get under the skin fold, or even the nail plate and sometimes the nail will become deformed. If caught early enough before damage can occur to the area of the nail fold where the actual nail is made, it usually resolves with time. I have also seen several patients develop yeast or fungal infections of the involved nail due to breaks in the nail created by the upward motion of the warts growth. Periungual warts often make for prolonged treatment.

Flat warts are tiny, smooth warts, often only a few millimeters in diameter. Many people are familiar with them on areas that get shaved through, such as the beard area and legs. Although I happen to like treating these very gently with liquid nitrogen, I have found that topical Retin A or a chemotherapy cream called Efudex can help in stubborn cases.

Treatment of routine warts still involves physical destruction for the most part. There are no topical antiviral agents that kill the wart on contact, nor are there any oral medications to give a patient they way antibiotics are used.

Liquid nitrogen sprayed onto the lesion (or applied with a cotton swab), is still one of the most effective and easiest of therapies. It usually takes 3 treatments to kill the average wart. For warts that are huge it could take much longer. I usually do a treatment every 2 weeks. This allows the treated area to heal for the next round. An area treated with liquid nitrogen is usually pink and puffy for a day or so, and the discomfort is typically minimal. However, Liquid nitrogen can cause a blister, blood blister or a superficial sore as it is basically controlled frostbite.

I also often have patients use an OTC wart medication on a non-blistered site, as this helps denude some of the infected tissue. My favorites contain 17% salicylic acid as the active ingredient. Occlusol HP and Duofilm are in this category. Wart medications are now over the counter-they were originally available by prescription only. The best way for these medications to be effective is to make sure the area is moist, and then lightly rough up the surface with either a pumice stone, emery board, or even a piece of fine-grade sand paper. Remember, you&#8217;re just roughing up the surface to enhance absorption of the medication, not trying to rub off the wart. These OTC meds arent to be used by diabetics unless under direction and supervision by a physician. Usually 2 coats of the medication are applied to the treated area. These medications will make the wart soft, white and moist over time as its being treated.

Physical destruction with other methods such as electrodessication and curettage (ED&C) or by CO2 laser, have also been used on warts. Statistics have shown that ED&C for wart removal is about as effective as liquid nitrogen. It tends to be a somewhat messy procedure and there is more discomfort and healing time involved, so I tend to hold off on this therapy if at all possible. Theres no question that destruction by CO2 laser which simply evaporates the wart tissue, or by Tunable Dye Laser, which kills the blood vessels that feed the wart are effective, cost can be an issue. Lasers are expensive to purchase, and medical insurance only pays for the category of destruction of warts regardless of how they were destroyed. This may not be enough to cover the laser costs by some practitioners. Be sure to inquire before therapy.

Use of a chemotherapy medication called Bleomycin injected into large recalcitrant warts that arent on fingers or toes has been helpful for some of my patients. It can be rather painful, and is a costly therapy. The Bleomycin kills the blood vessels that support the warts growth, and the lesion turns black.

Use of a topical agent DNCB is a chemical that is initially applied to the forearm to elicit a reaction similar to poison ivy. DNCB was found to cause a contact dermatitis on all people when contacted. The theory goes that if you stimulate the body to recognize the DNCB and then apply it to a recalcitrant wart, the body which is oblivious to the wart will destroy the area wart and all. I have also tried stimulating patients immune systems with oral vitamins C and A. An ulcer medication, Tagamet in combination with another medication known as Levamisole, seems to have an effect on some warts. A report in the Austalian Journal of Dermatology reports more than a 70% reduction in the size and/or number of warts with this therapy.

Molluscum are another family of warts that are very common in children, often spreading to adults. They are highly contagious. These lesions are usually flesh colored or almost clear and often have a central depression like a belly button. Lesions are usually rather small, just a few millimeters in size. There are several ways to treat these warts ranging from liquid nitrogen to physically removing by curettage. This simple method is relatively painless (I didnt say pain free) and an instrument literally scrapes them off. Molluscum are self contained, so that they come off basically in 1 piece, sort of like scooping them out of a shell. In cases where children wont cooperate, medications can be applied to the lesions in the doctors office to kill the lesion. Routine OTC wart medications wont help these warts.

Genital wart are another family of wart, which I will address in a separate article.

What can you do about warts? For one thing, I recommend that you protect your feet at pools and areas such as locker rooms by wearing foot wear. These are common places to pick up the infection. Its much better to be proactive and prevent infections in the first place! Second, dont wait for lots of warts to develop or for your wart to be the size of a quarter before you seek medical attention. This will only make your treatment that much more difficult. Third, by all means if you know you have a regular wart, you can go ahead and start treating it with an OTC wart medication such as recommended above while youre waiting to see the doctor.

juliep:
Good article Peter

"Warts are an infection. I think that a major reason they infect certain individuals and not every one is that certain people's immune systems simply don't recognize the existence of the wart on the surface of the skin. This doesn't mean that the person has a major immune deficiency, it simply means that certain families have genetic predispositions to this."

This sounds sensible so maybe this is what your derm meant Txinmommie

kneecapper:
Peter.

this is an excellent article on warts. I had the flat warts on my fingers, and whatever it is that I get on my neck is also wartlike. The flat warts are a sign of Darier's Disease, which the doctor did not mention in his article on warts.

Maggie

txinmommie:
Wow!  Thank you all for the huge welcome  ;D and tons of information!  It does sound more and more like I have flat warts.  I just can't imagine having to treat each and everyone on my legs!  I have hundreds of little tiny ones.  It's good to know that it's not my immune system causing these.

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