The warts are small rough protuberances benign, well-defined, which form in the epidermis (the outer layer of the skin). They are usually a few millimeters in diameter but may be larger. They result from an infection caused by a human papillomavirus (HPV) virus and can be contagious. They are most often painless and do not necessarily require treatment. Children and adolescents are the most likely to be affected.
Warts most often appear on the fingers or feet, but can also be on the face, back or other parts of the body (elbows, knees). They can be isolated or form clusters of several grouped warts.
It is estimated that warts affect of 7 to 10% of the general population. A study in a Dutch primary school in 2009, however, found that a third of children had one or more warts, located mainly on the feet or hands.
Types of vulgar and plantar warts
There are several types of warts, depending on the type of papillomavirus involved. Their appearance also varies depending on where they are located. Here are the most common forms:
- The common wart: this wart takes on the appearance of a hard and rough dome of flesh-colored or greyish color. In general, she appears alone. It can form especially on the knees, elbows, and feet (toes), but more often on the hands and fingers. Rarely painful (except when located near or under the nails), it can, however, be troublesome.
- Plantar wart: As the name suggests, the plantar wart is located on the sole of the foot. It can go unnoticed for a moment. Looking closely, one can nevertheless observe a rough nodule. The plantar wart can be painful due to the pressure exerted by the weight of the body. It may feel as if it is deep, but it is always in the outer layer of the skin, the epidermis.
- Other types include: filiform warts (located on the eyelids and around the mouth, in children), flat warts (usually grouped on the face, back of the hands and wrists), myrmcia (on the sole of the foot, with blackheads), mosaic warts (underfoot) and digitalis warts (often on the scalp). The finger warts result from the stacking of several warts, which forms a kind of tiny “cauliflower”.
|Genital warts or warts are a special case. They are caused by a different type of HPV and can pose health risks (for example, in women, condyloma increases the risk of cervical cancer ). Moreover, they treat each other differently. It will not be discussed in this sheet. For more information, consult the sheet Condylomes.|
The contamination can be direct (skin to skin) or indirectly (by objects that had contact with infected skin, like socks or shoes). The wet soils of swimming pools, public showers, beaches, and sports centers are particularly conducive to the transmission of plantar warts. In addition, some HPVs can survive for more than 7 days on a dry surface.
The virus is introduced under the skin, by a small crack or a wound sometimes invisible to the naked eye. If the virus is not neutralized by the immune system, it triggers a multiplication of cells in a specific place. Exposure to the virus does not automatically show warts, because the immune system of each one reacts differently and can be more or less effective to fight this virus.
On average, 2 to 6 months elapse between exposure to the virus and the appearance of warts. This is called the incubation period. However, some warts can remain dormant for years.
In an infected person, warts can also spread from one part of the body to another. They say they are self-contagious. Avoid scratching or bleeding a wart, as this increases the risk of spreading it.
Most warts go away without treatment after a few months. Several studies have shown that two-thirds of warts disappear without treatment in less than 2 years. However, in some people, they may be chronic.
Complications of vulgar and plantar warts
Despite their unattractive look, warts are usually not serious. Even when they are scratched, they rarely become infected, but it is recommended not to do so. In addition, unless it is a plantar wart or is located near a fingernail, they are usually painless.
That said, some complications are still possible. The appearance of one or more of the following symptoms should prompt a doctor.
- A wart that persists, multiplies or reappears, despite the house treatments;
- A painful wart;
- A wart located under the nail or deforming the nail;
- A suspicious appearance (in exceptional cases, a wart may be malignant). Some skin cancers may also be mistaken for warts;
- Signs of infection, such as redness around the wart
- Spread to other parts of the body;
- Back or leg pain caused by a painful plantar wart (limping or bad positioning of the feet when walking);
- An inconvenience related to the location of the war.
Diagnostic of vulgar and plantar warts
To make sure that this is a wart, the doctor first inspects the lesion. Sometimes, he uses a scalpel to scrape it: if it bleeds or if black spots are present, it indicates the presence of a wart. Very rarely, the appearance of the lesion leaves a doubt about the diagnosis. The doctor can then perform a biopsy, to make sure it is not cancer.
Symptoms of vulgar and plantar warts
- One or more small, rough, well-defined skin growths that usually appear on the hands, toes, soles, faces, elbows, knees, or backs;
- Small black dots in the outgrowth. These blackheads are not the “roots” of the war, but rather small blood vessels that have formed due to the rapid growth of the wart;
- Sometimes, itching;
- Sometimes a pain (especially in case of the plantar wart).
Note. Plantar warts can be confused with corns. However, they are free of blackheads. In addition, corns are usually located in areas of skin that are under pressure or friction. The doctor or dermatologist will be able to make the correct diagnosis.
People at risk for vulgar and plantar warts
- The children and teenagers, especially those who have a brother, sister, classmates who have a wart.
- People whose skin tends to dry out and crack, as well as those who suffer from the excessive perspiration of the feet.
- People with the weak immune system. This can be caused by a disease (cancer, HIV infection, etc.) or by drugs (especially immunosuppressants). In addition, in these people, warts are often more difficult to treat.
For plantar warts only: walking barefoot in public places (swimming pools, changing rooms, public showers, beaches, sports centers, etc.).
The prevention of vulgar and plantar warts
|Basic measures to prevent warts|
|To prevent plantar warts, avoid walking barefoot in public areas, especially in gyms and showers, and around pools.
To avoid contagion
Medical treatments of vulvar and plantar warts
|Important. Pregnant women and people with diabetes or other health problems that interfere with blood flow should avoid treating their warts on their own using pharmacy products. They should rather consult a doctor. For warts that occur in infants, consultation is also advised.|
Treat or not treat?
Common warts, especially in children, sometimes disappear spontaneously within a few days. In adults, healing is often much longer, but two-thirds of warts disappear spontaneously before 2 years. Since these are benign lesions and the treatments are sometimes harmful to the skin, it is not always justified to start treatment. There are various reasons for treating a common or plantar wart: the discomfort they create (physical or aesthetic), the pain, their multiplication, the risk of contagion or complications, etc.
No matter what treatment is used, it does not completely eliminate the virus. Once the wart heals, the virus remains in the epidermis and can reactivate. It is the immune system that keeps it under control, but recurrences can be common.
|You should never try to remove a wart with a sharp instrument, such as a razor blade or a knife: the wart can become infected, bleed and spread, and leave a scar.|
Treatment will depend on the age of the patient, the type of wart and its location. Most treatments require several sessions (especially for plantar wart, more resistant to treatment). Doctors tend not to treat plantar warts if they are not painful. There are many treatments, but none offers a total guarantee.
It is possible to have to try several treatments before solving the problem. Finally, let us mention that the placebo effect is quite powerful in the treatment of warts. Indeed, the application of placebo solutions displays cure rates ranging from 0 to over 70% (with an average of 27%).
Products based on salicylic acid. Many salicylic acid products (some of which also contain lactic acid) are available over the counter and can work well, especially for common warts (eg Duoplant in Canada, Duofilm in Canada, Compound W and Off-Ezy in Canada). The effect of salicylic acid is comparable to that of a burn: after application, the skin becomes withered and whitish. Every day, a thin layer of this withered skin is removed. The acid also creates inflammation locally that could help the immune system fight the virus. It is important to follow the manufacturer’s instructions carefully and apply the product daily to be effective. These treatments are usually followed for 3 to 4 weeks.
The concentration of salicylic acid varies from one product to another, between 10 and 60%. The concentration chosen will depend on where the wart is and how resistant it is to treat. Some products are in the form of a liquid, some of gel or dressings to be placed on the war. It is not recommended to use them on the face or other sensitive areas.
NB The faster applications are started, the lower the risk of spreading the virus.
Cryotherapy. Cryotherapy is a process that uses cold to “burn” the war. The doctor drops liquid nitrogen directly at -196 ° C on the war, which causes the wart to detach. Nitrogen is applied until the skin is frozen for about 5 seconds. The product destroys both the wart and the virus, but a blister then appears, and the procedure is painful. Usually, several sessions (2 or 3 weeks apart) are required to remove the wart permanently. It is possible to make this treatment less painful by applying a local anesthetic 1 hour before the procedure. It should also be noted that this treatment may depigment the skin or, on the contrary, make it darker. A product (Freeze-Away in Canada, Cryopharma in France) based on cold, intense month that liquid nitrogen is also available over the counter in pharmacies.
Many other treatments exist and can be offered for plantar warts and more resistant warts
- The cantharidin in Canada (Canthacur, Cantharone). Sold without a prescription, this product must be applied by a doctor or podiatrist. A bulb forms under the wart and disappears in 1 to 2 weeks. The application is not painful and this product can be effective on plantar warts ;
- After performing local anesthesia, the doctor can incise and extract the wart or destroy it by electrocoagulation. Both of these minor procedures should be done carefully to avoid scarring;
- Again in rebellious cases or in people whose immunity is fragile, it is possible to inject interferons into the wart (in Canada). Interferons are substances that fight against viral infections;
- In the most severe cases, bleomycin, a substance that prevents cells from multiplying, is sometimes injected. This method is suitable for all types of warts, but it remains unpopular because of the intense pain it causes;
- Other products are sometimes used: imiquimod, trichloroacetic acid, cimetidine, and 5-fluorouracil or 5-FU (often used for genital warts);
- Another method is to destroy the laser wart. This technique does not cause any bleeding, but the healing is sometimes long and it often leaves a scar. It is, therefore, a solution of last resort.
In 2006, a meta-analysis compiled the results of 60 clinical trials on the treatment of warts (excluding genital warts). According to its authors, salicylic acid solutions are the treatment with the most evidence of efficacy. Their use leads to healing in 73% of cases. As for cold treatment with liquid nitrogen, its effectiveness would not be greater than that of salicylic acid, contrary to what we have long believed. However, a randomized trial published in 2010 compared the efficacy of these two treatments in 250 patients. For common warts, cryotherapy seemed more effective. On the other hand, cryotherapy, the application of salicylic acid or the abstention of treatment gave equivalent results on plantar warts.