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'{{short description|Small, rough growth resembling a cauliflower or a solid blister}} {{other uses}} {{Infobox medical condition (new) | name = Warts | synonyms = Verruca,<ref name=Loo2014/> papillomas<ref name=PubMed2016/> | image = Dornwarzen.jpg | image_size = 300px | caption = A large number of warts on the big toe | symptoms = Painless, small, rough skin growth<ref name=Loo2014/><ref name=IQ2014/> | complications = | onset = | duration = Months to years<ref name=Loo2014/> | causes = [[Human papillomavirus]]<ref name=Loo2014/> | risks = Public showers, [[eczema]]<ref name=IQ2014/> | diagnosis = | differential = [[Callus]], [[seborrheic keratosis]], [[squamous cell carcinoma]]<ref name=Bo2012/> | prevention = | treatment = [[Salicylic acid]], [[cryotherapy]]<ref name=Loo2014/> | medication = | frequency = Very common<ref name=PubMed2016/> | deaths = }} <!-- Definition and symptoms --> '''Warts''' are typically small, rough, and hard growths that are similar in color to the rest of the skin.<ref name=Loo2014/><ref name=IQ2014/> They typically do not result in other symptoms, except when on the bottom of the feet where they may be painful.<ref name=IQ2014/> While they usually occur on the hands and feet they can also affect other locations.<ref name=Loo2014/> One or many warts may appear.<ref name=IQ2014/> They are not [[cancerous]].<ref name=IQ2014>{{cite journal|title=Warts: Overview|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072770/|date=30 July 2014|publisher=U.S. National Library of Medicine|deadurl=no|archiveurl=https://web.archive.org/web/20170910145251/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072770/|archivedate=10 September 2017|df=}}</ref> <!-- Cause and diagnosis --> Warts are caused by infection with a type of [[human papillomavirus]] (HPV).<ref name=Loo2014/> Factors that increase the risk include use of public showers, working with meat, [[eczema]], and a [[immunosuppression|low immune system]].<ref name=Loo2014>{{cite journal|last1=Loo|first1=SK|last2=Tang|first2=WY|title=Warts (non-genital)|journal=BMJ clinical evidence|date=12 June 2014|volume=2014|pmid=24921240|pmc=4054795}}</ref><ref name=IQ2014/> The virus is believed to enter the body through skin that has been damaged slightly.<ref name=Loo2014/> A number of types exist, including common warts, [[plantar warts]], filiform warts, and [[genital warts]].<ref name=IQ2014/> Genital warts are often [[sexually transmitted]].<ref name=Hen2010>{{cite journal|first1=Henry|last1=W Buck|title=Warts (genital)|journal=BMJ clinical evidence|date=13 August 2010|volume=2010|pmid=21418685|pmc=3217761}}</ref> <!-- Prevention and treatment --> Without treatment, most types of warts resolve in months to years.<ref name=Loo2014/> A number of treatments may speed resolution including [[salicylic acid]] applied to the skin and [[cryotherapy]].<ref name=Loo2014/> In those who are otherwise healthy they do not typically result in significant problems.<ref name=Loo2014/> Treatment of genital warts differs from that of other types.<ref name=IQ2014/> <!-- Epidemiology and history --> Warts are very common, with most people being infected at some point in their lives.<ref name=PubMed2016>{{cite web|accessdate=2016-11-06|title=Papillomas (Warts) – National Library of Medicine|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022704/|website=PubMed Health|deadurl=no|archiveurl=https://web.archive.org/web/20170910145250/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022704/|archivedate=2017-09-10|df=}}</ref> The estimated current rate of non-genital warts among the general population is 1–13%.<ref name=Loo2014/> They are more common among young people.<ref name=Loo2014/> Estimated rates of genital warts in sexually active women is 12%.<ref name=Hen2010/> Warts have been described at least as far back as 400 BC by [[Hippocrates]].<ref name=Bo2012>{{cite book|last1=Bope|first1=Edward T.|last2=Kellerman|first2=Rick D.|title=Conn's Current Therapy 2012|date=2012|publisher=Elsevier Health Sciences|isbn=1455733059|page=275|url=https://books.google.com/books?id=BFIi40hGC9oC&pg=PT310|language=en|deadurl=no|archiveurl=https://web.archive.org/web/20161107013337/https://books.google.com/books?id=BFIi40hGC9oC&pg=PT310|archivedate=2016-11-07|df=}}</ref> ==Types== [[Image:Wart filiform eyelid.jpg|200px|thumb|right|A filiform wart on the eyelid.]] A range of types of wart have been identified, varying in shape and site affected, as well as the type of human papillomavirus involved.<ref>{{cite book |author1=Anderson, Keith |author2=Keith, Jeff |author3=Novak, Patricia D. |author4=Elliot, Michelle A. |title=Mosby's Medical, Nursing & Allied Health Dictionary |url=https://books.google.com/books?id=5RXAAQAACAAJ|year=2005|publisher=C.V. Mosby|isbn=978-0-323-03736-5 |edition=5th |deadurl=no |archiveurl=https://web.archive.org/web/20170107065555/https://books.google.com/books?id=5RXAAQAACAAJ|archivedate=2017-01-07|df=}}</ref><ref>{{cite web |url = http://www.webmd.com/skin-problems-and-treatments/tc/warts-and-plantar-warts-topic-overview |title = MedlinePlus: Warts |year = 2010 |deadurl = no |archiveurl = https://web.archive.org/web/20130516092530/http://www.webmd.com/skin-problems-and-treatments/tc/warts-and-plantar-warts-topic-overview |archivedate = 2013-05-16 |df = }}</ref> These include: * Common wart (''Verruca vulgaris''), a raised wart with roughened surface, most common on hands, but can grow anywhere on the body. Sometimes known as a Palmer wart or Junior wart. * [[Verruca plana|Flat wart]] (''Verruca plana''), a small, smooth flattened wart, flesh-coloured, which can occur in large numbers; most common on the face, neck, hands, wrists and knees. * Filiform or [[digitate wart]], a thread- or finger-like wart, most common on the face, especially near the eyelids and lips. * [[Genital wart]] (venereal wart, ''Condyloma acuminatum'', ''Verruca acuminata''), a wart that occurs on the genitalia. * [[Periungual wart]], a cauliflower-like cluster of warts that occurs around the nails. * [[Plantar wart]] (verruca, ''Verruca plantaris''), a hard, sometimes painful lump, often with multiple black specks in the center; usually only found on pressure points on the soles of the feet. ** Mosaic wart, a group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet. == Cause == {{main article|Human papilloma virus}} Warts are caused by the [[human papilloma virus]] (HPV). There are about 130 known types of human papilloma viruses.<ref name="deV2004">{{cite journal |vauthors=De Villiers EM, Fauquet C, Broker TR, Bernard HU, Zur Hausen H |title = Classification of papillomaviruses |journal = Virology |volume = 324 |issue = 1 |pages = 17–27 |date = Jun 2004 |pmid = 15183049 |doi = 10.1016/j.virol.2004.03.033 }}</ref> HPV infects the [[squamous epithelium]], usually of the skin or genitals, but each HPV type is typically only able to infect a few specific areas on the body. Many HPV types can produce a benign growth, often called a "wart" or "papilloma", in the area they infect. Many of the more common HPV and wart types are listed below. * Common warts – HPV types 2 and 4 (most common); also types 1, 3, 26, 29, and 57 and others. * Cancers and genital [[dysplasia]] – "high-risk" HPV types are associated with cancers, notably [[cervical cancer]], and can also cause some [[vulvar cancer|vulvar]], [[vaginal cancer|vaginal]],<ref name=VulvarCA>{{cite web |url = http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116945.htm |title = FDA Approves Expanded Uses for Gardasil to Include Preventing Certain Vulvar and Vaginal Cancers|publisher = FDA|date = 2008-09-12|deadurl = no|archiveurl = https://web.archive.org/web/20100306073734/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116945.htm|archivedate = 2010-03-06|df = }}</ref> [[penile cancer|penile]], [[anal cancer|anal]]<ref name="Bloomberg">{{cite web|url=https://www.bloomberg.com/apps/news?pid=20601202&sid=aajzweDaXZh0&refer=healthcare |author1=Cortez, Michelle Fay |author2=Pettypiece, Shannon |title=Merck Cancer Shot Cuts Genital Warts, Lesions in Men |work=Bloomberg News |date=2008-11-13 |accessdate=2013-05-17}}</ref> and some [[HPV-positive oropharyngeal cancer|oropharyngeal cancers]]. "Low-risk" types are associated with warts or other conditions.<ref name="pmid16670757">{{cite journal |vauthors=Lowy DR, Schiller JT |title = Prophylactic human papillomavirus vaccines |journal = J. Clin. Invest. |volume = 116 |issue = 5 |pages = 1167–73 |year = 2006 |pmid = 16670757 |pmc = 1451224 |doi = 10.1172/JCI28607 }}</ref><ref name="Muñoz2004">{{cite journal |vauthors=Muñoz N, Bosch FX, Castellsagué X, Díaz M, de Sanjose S, Hammouda D, Shah KV, Meijer CJ |title = Against which human papillomavirus types shall we vaccinate and screen? The international perspective |journal = Int J Cancer |volume = 111 | issue = 2 |pages = 278–85 |date = 2004-08-20 |pmid = 15197783 |doi = 10.1002/ijc.20244 }}</ref> :* High-risk: 16, 18 (cause the most cervical cancer); also 31, 33, 35, 39, 45, 52, 58, 59, and others. * [[Plantar wart]]s (verruca) – HPV type 1 (most common); also types 2, 3, 4, 27, 28, and 58{{fact|date=May 2018}} and others. * [[Anogenital warts]] (condylomata acuminata or venereal warts) – HPV types 6 and 11 (most common); also types 42, 44 and others.<ref name=Kumar19>{{cite book |author1=Kumar, Vinay |author2=Abbas, Abul K. |author3=Fausto, Nelson |author4=Mitchell, Richard |title=Robbins Basic Pathology|publisher=Saunders |location=Philadelphia |year= 2007|pages= |isbn=1-4160-2973-7 |oclc= |doi= | edition = 8| chapter = Chapter 19 The Female Genital System and Breast}}</ref> :* Low-risk: 6, 11 (most common); also 13, 44, 40, 43, 42, 54, 61, 72, 81, 89, and others. * ''[[Verruca plana]]'' (flat warts) – HPV types 3, 10, and 28. * [[Butcher's wart]]s – HPV type 7. * [[Heck's disease]] (focal epithelial hyperplasia) – HPV types 13 and 32. == Pathophysiology == Common warts have a characteristic appearance under the microscope. They have thickening of the [[stratum corneum]] (hyperkeratosis), thickening of the [[stratum spinosum]] (acanthosis), thickening of the [[stratum granulosum]], [[rete ridge]] elongation, and large [[blood vessel]]s at the [[dermoepidermal junction]]. ==Diagnosis== [[Image:Verruca vulgaris - very low mag.jpg|thumb|right|[[Micrograph]] of a common wart (verruca vulgaris) showing the characteristic features ([[hyperkeratosis]], [[acanthosis]], [[hypergranulosis]], [[rete ridge]] elongation, and large [[blood vessel]]s at the [[dermoepidermal junction]], [[H&E stain]])]] On dermatoscopic examination warts will commonly have fingerlike or knoblike extensions.<ref>{{Cite journal|last=Dong|first=Huiting|date=|title=Dermatoscopy of genital warts|url=|journal=Journal of the American Academy of Dermatology|volume=64|pages=859-864|via=Elsevier Science Direct}}</ref> == Prevention == [[Gardasil]] 6 is an [[HPV vaccine]] aimed at preventing cervical cancers and genital warts. Gardasil is designed to prevent infection with HPV types 16, 18, 6, and 11. HPV types 16 and 18 currently cause about 70% of [[cervical cancer]] cases,<ref name="pmid16670757" /><ref name="Muñoz2004" /> and also cause some [[vulvar cancer|vulvar]], [[vaginal cancer|vaginal]],<ref name=VulvarCA /> [[penile cancer|penile]] and [[anal cancer]]s.<ref name="Bloomberg" /> HPV types 6 and 11 are responsible for 90% of documented cases of genital warts.<ref name=NEJM>{{cite journal|doi=10.1056/NEJMp058305|pmid=16540608|title=The Potential of Human Papillomavirus Vaccines|journal=New England Journal of Medicine|volume=354|issue=11|pages=1109–12|year=2006|last1=Steinbrook|first1=Robert}}</ref> Gardasil 9, approved in 2014 protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.<ref>{{cite web |url= http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM426457.pdf |title= Prescribing information Gardasil 9 |publisher= [[Food and Drug Administration]] |date= 2015 |deadurl= no |archiveurl= https://web.archive.org/web/20161010062722/http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM426457.pdf |archivedate= 2016-10-10 |df= }}</ref> HPV vaccines do not currently protect against the virus strains responsible for [[plantar wart]]s (verrucas). === Disinfection === The virus is relatively hardy and immune to many common disinfectants. Exposure to 90% [[ethanol]] for at least 1 minute, 2% [[glutaraldehyde]], 30% [[Savlon]], and/or 1% [[sodium hypochlorite]] can disinfect the pathogen.<ref name=phac>[http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/papillome-eng.php Human Papillomavirus] {{webarchive|url=https://web.archive.org/web/20150823044955/http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/papillome-eng.php |date=2015-08-23 }}. Public Health Agency of Canada</ref> The virus is resistant to drying and heat, but killed by {{convert|100|C}} and [[ultraviolet]] radiation.<ref name=phac/> ==Treatment== {{further|Plantar wart#Treatment}} There are many treatments and procedures associated with wart removal.<ref name="pmid17210977">{{cite journal|vauthors=Lipke MM| title=An armamentarium of wart treatments. | journal=Clin Med Res | year= 2006 | volume= 4 | issue= 4 | pages= 273–93 | pmid=17210977 | doi=10.3121/cmr.4.4.273 | pmc=1764803}}</ref> A review of clinical trials of various cutaneous wart treatments concluded that topical treatments containing [[salicylic acid]] were more effective than placebo.<ref name="Cochrane 2011">{{cite journal |vauthors= Kwok CS, Gibbs S, Bennett C, Holland R, Abbott R | title = Topical treatments for cutaneous warts | journal = The Cochrane Database of Systematic Reviews | volume = 9 | issue = 9 | pages = CD001781 | date = Sep 12, 2012 | pmid = 22972052 | doi = 10.1002/14651858.CD001781.pub3 | url = https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011182/ | editor1-last = Gibbs | editor1-first = Sam | deadurl = no | archiveurl = https://web.archive.org/web/20130704095916/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011182/ | archivedate = 2013-07-04 | df = }}</ref> [[Cryotherapy]] appears to be as effective as salicylic acid, but there have been fewer trials.<ref name="Cochrane 2011" /> ===Medication=== [[Image:Wart ASA animated.gif|thumb|Two [[virus (biology)|viral]] warts on a middle finger, being treated with a mixture of acids (like salicylic acid) to remove them. A white precipitate forms on the area where the product was applied.]] [[File:Wart Treatment Timeline.jpg|thumb|This image shows throat warts (papillomas) before treatment and during the treatment process. Left to right: warts prior to treatment, warts on day of silver nitrate treatment, warts two days after treatment, warts four days after treatment, warts six days after treatment, and warts remaining nine days after treatment.]] [[File:A Throat After CO2 Laser Treatment of HPV6 Throat Papiloma (Warts).jpg|thumb|Throat warts before and after carbon dioxide laser treatment.]] * [[Salicylic acid]] can be prescribed by a dermatologist in a higher concentration than that found in over-the-counter products. Several [[over-the-counter drug|over-the-counter]] products are readily available at [[pharmacies]] and [[supermarket]]s of roughly two types: adhesive pads treated with salicylic acid, and bottled concentrated salicylic acid solution. * [[Imiquimod]] is a topical cream that helps the body's immune system fight the wart virus by encouraging [[interferon]] production. It has been approved by the [[U.S. Food and Drug Administration]] (FDA) for genital warts.<ref>{{cite web|title=Short-Acting Imiquimod Cream Approved for Genital Warts|vauthors=Barclay L |date=2011-06-04|work=Medscape|url=http://www.medscape.org/viewarticle/740315|accessdate=10 August 2011|deadurl=no|archiveurl=https://web.archive.org/web/20110818095949/http://www.medscape.org/viewarticle/740315|archivedate=18 August 2011|df=}}</ref> * [[Cantharidin]], found naturally in the bodies of many members of the beetle family [[Meloidae]], causes dermal blistering. It is used either by itself or compounded with [[podophyllin]]. Not FDA approved, but available through Canada or select US compounding pharmacies. * [[Bleomycin]] is not US FDA approved and can cause necrosis of digits and [[Raynaud syndrome]].<ref name="aafp.org" /><ref>Champion, R.H., et al. (1998) Rook's Textbook of Dermatology. Blackwell Science, p. 1044, {{ISBN|0-632-06429-3}}</ref> The usual treatment is one or two injections. * [[Dinitrochlorobenzene]] (DNCB), like [[salicylic acid]], is applied directly to the wart. Studies show this method is effective with a cure rate of 80%.{{medcn|date=August 2017}} But DNCB must be used much more cautiously than salicylic acid; the chemical is known to cause genetic mutations, so it must be administered by a physician. This drug induces an allergic immune response resulting in inflammation that wards off the wart-causing virus.<ref>{{cite web |url=http://www.health.harvard.edu/fhg/updates/update0303d.shtml |title=Treating Warts |publisher=British Medical Journal |date=2002-08-31 |accessdate=2013-05-17 |deadurl=yes |archiveurl=https://web.archive.org/web/20101103023520/http://www.health.harvard.edu/fhg/updates/update0303d.shtml |archivedate=2010-11-03 |df= }}</ref> * [[Cidofovir]] is an antiviral drug which is injected into HPV lesions within the larynx ([[laryngeal papillomatosis]]) as an experimental treatment.<ref name="SomaAlbert2008">{{cite journal|last1=Soma|first1=Marlene A|last2=Albert|first2=David M|title=Cidofovir: to use or not to use?|journal=Current Opinion in Otolaryngology & Head and Neck Surgery|volume=16|issue=1|year=2008|pages=86–90|doi=10.1097/MOO.0b013e3282f43408|pmid=18197029}}</ref> * [[Benzoyl peroxide]] (BPO) is effective in the treatment of flat warts.{{Medcn|date=August 2017}} Another product available over-the-counter that can aid in wart removal is [[silver nitrate]] in the form of a [[caustic pencil]], which is also available at drug stores. In a placebo-controlled study of 70 patients, silver nitrate given over nine days resulted in clearance of all warts in 43% and improvement in warts in 26% one month after treatment compared to 11% and 14%, respectively, in the placebo group.<ref>{{cite journal |vauthors=Sterling JC, Handfield-Jones S, Hudson PM |title=Guidelines for the management of cutaneous warts |journal=British Journal of Dermatology |volume=144 |issue=1 |pages=4–11 |year=2001 |pmid=11167676 |doi=10.1046/j.1365-2133.2001.04066.x |url=http://www.huidziekten.nl/richtlijnen/BADguidelineCutaneousWarts2001.pdf |archive-url=https://www.webcitation.org/60mUBze54?url=http://www.huidziekten.nl/richtlijnen/BADguidelineCutaneousWarts2001.pdf |archive-date=2011-08-08}}</ref> The instructions must be followed to minimize staining of skin and clothing. Occasionally pigmented scars may develop. Several randomized, controlled trials have found that [[zinc sulfate]], consumed orally, often reduces or eliminates warts.<ref name="Stefanietal2009">{{cite journal | vauthors = Stefani M, Bottino G, Fontenelle E, Azulay DR | title = Efficacy comparison between cimetidine and zinc sulphate in the treatment of multiple and recalcitrant warts | journal = An Bras Dermatol | volume = 84 | issue = 1 | pages = 23–29 | year = 2009 | pmid = 19377755 | doi = | url = http://www.scielo.br/scielo.php?pid=S0365-05962009000100003&script=sci_arttext&tlng=en | deadurl = no | archiveurl = https://web.archive.org/web/20111126062208/http://www.scielo.br/scielo.php?pid=S0365-05962009000100003&script=sci_arttext&tlng=en | archivedate = 2011-11-26 | df = }}</ref><ref>{{cite journal |vauthors=Yaghoobi R, Sadighha A, Baktash D | title = Evaluation of oral zinc sulfate effect on recalcitrant multiple viral warts: a randomized placebo-controlled clinical trial | journal = J. Am. Acad. Dermatol. | volume = 60 | issue = 4 | pages = 706–08 | date = April 2009 | pmid = 19293025 | doi = 10.1016/j.jaad.2008.09.010 }}</ref><ref>{{cite journal |vauthors=Al-Gurairi FT, Al-Waiz M, Sharquie KE | title = Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebo-controlled clinical trial | journal = Br. J. Dermatol. | volume = 146 | issue = 3 | pages = 423–31 | date = March 2002 | pmid = 11952542 | doi = 10.1046/j.1365-2133.2002.04617.x | url = }}</ref> The [[zinc sulfate]] dosage used in medical trials for treatment of warts was between 5 and 10&nbsp;mg/kg/day. For elemental zinc, a lower dosage of 2.5&nbsp;mg/kg/day may be appropriate as large amounts of zinc may cause a [[copper deficiency]].<ref name=Stefanietal2009/> Other trials have found that [[topical]] zinc sulfate solution<ref>{{cite journal |vauthors=Sharquie KE, Khorsheed AA, Al-Nuaimy AA | title = Topical zinc sulphate solution for treatment of viral warts | journal = Saudi Med J | volume = 28 | issue = 9 | pages = 1418–21 | date = September 2007 | pmid = 17768472 | doi = | url = }}</ref> or [[zinc oxide]]<ref>{{cite journal |vauthors=Khattar JA, Musharrafieh UM, Tamim H, Hamadeh GN | title = Topical zinc oxide vs. salicylic acid-lactic acid combination in the treatment of warts | journal = Int. J. Dermatol. | volume = 46 | issue = 4 | pages = 427–30 | date = April 2007 | pmid = 17442091 | doi = 10.1111/j.1365-4632.2006.03138.x | url = }}</ref> are also effective. A 2014 study indicates that [[lopinavir]] is effective against the human papilloma virus (HPV). The study used the equivalent of one tablet twice a day applied topically to the [[cervix|cervices]] of women with high-grade and low-grade precancerous conditions. After three months of treatment, 82.6% of the women who had high-grade disease had normal cervical conditions, confirmed by smears and biopsies.<ref>[http://www.manchester.ac.uk/aboutus/news/display/?id=11595 HIV drug used to reverse effects of virus that causes cervical cancer] {{webarchive|url=https://web.archive.org/web/20140322121606/http://www.manchester.ac.uk/aboutus/news/display/?id=11595 |date=2014-03-22 }} University of Manchester, 17 February 2014.</ref> Studies of fat-soluble garlic extracts have shown clearing in greater than 90% of cases. The extract is applied twice daily and covered with an adhesive bandage. Improvements show within 2–4 weeks and total clearing in an average of 6–9 weeks.<ref>{{cite journal |author1=Dehghani F. |author2=Merat A. |author3=Panjehshahin M. R. |author4=Handjani F. | year = 2005 | title = Healing effect of garlic extract on warts and corns | url = | journal = International Journal of Dermatology | volume = 44 | issue = 7| pages = 612–15 | doi = 10.1111/j.1365-4632.2004.02348.x | pmid=15985039}}</ref><ref>{{cite journal |author1=Kenawy S. |author2=Mohammed G. F. |author3=Younes S. |author4=Elakhras A. I. | year = 2014 | title = Evaluation of TNF-α serum level in patients with recalcitrant multiple common warts, treated by lipid garlic extract | url = | journal = Dermatologic Therapy | volume = 27 | issue = 5| pages = 272–77 | doi = 10.1111/dth.12136 }}</ref><ref>{{cite journal | author = Silverberg N. B. | year = 2002 | title = Garlic Cloves for Verruca Vulgaris | url = | journal = Pediatric Dermatology | volume = 19 | issue = 2| page = 183 | doi = 10.1046/j.1525-1470.2002.00038.x }}</ref> ===Procedures=== [[Image:Liquid nitrogen spray tank.jpg|thumb|[[Liquid nitrogen]] spray tank]] * [[Treatment of warts by keratolysis|Keratolysis]], of dead surface skin cells usually using [[salicylic acid]], blistering agents, immune system modifiers ("immunomodulators"), or [[formaldehyde]], often with mechanical paring of the wart with a pumice stone, blade etc.<ref>[http://dermatology.about.com/cs/warts/a/warts.htm Warts] {{webarchive|url=https://web.archive.org/web/20080517063828/http://dermatology.about.com/cs/warts/a/warts.htm |date=2008-05-17 }} at [[About.com]]</ref> * [[Electrodesiccation and curettage|Electrodesiccation]]<ref>{{cite journal |vauthors=Stone KM, Becker TM, Hadgu A, Kraus SJ | title = Treatment of external genital warts: A randomised clinical trial comparing podophyllin, cryotherapy, and electrodesiccation | journal = Genitourinary medicine | volume = 66 | issue = 1 | pages = 16–19 | year = 1990 | pmid = 2179111 | pmc = 1194434 | doi=10.1136/sti.66.1.16 }}</ref> * [[Cryosurgery]] or [[cryotherapy]], which involves freezing the wart (generally with [[liquid nitrogen]]),<ref>{{Cite web | url = http://www.webmd.com/skin-problems-and-treatments/cryotherapy-for-warts | title = Cryotherapy for Warts | publisher = [[WebMD]] | deadurl = no | archiveurl = https://web.archive.org/web/20160709042014/http://www.webmd.com/skin-problems-and-treatments/cryotherapy-for-warts | archivedate = 2016-07-09 | df = }}</ref> creating a blister between the wart and epidermal layer after which the wart and the surrounding dead skin fall off. An average of 3 to 4 treatments are required for warts on thin skin. Warts on calloused skin like plantar warts might take dozens or more treatments.<ref name="aafp.org">{{cite journal | vauthors = Bacelieri R, Johnson SM | title = Cutaneous warts: An evidence-based approach to therapy | journal = American Family Physician | volume = 72 | issue = 4 | pages = 647–52 | year = 2005 | pmid = 16127954 | url = http://www.aafp.org/afp/2005/0815/p647.html | deadurl = no | archiveurl = https://web.archive.org/web/20140421082525/http://www.aafp.org/afp/2005/0815/p647.html | archivedate = 2014-04-21 | df = }}</ref> * Surgical [[curettage]] of the wart * [[Laser]] treatment – often with a pulse dye laser or carbon dioxide (CO₂) laser. Pulse dye lasers (wavelength 582&nbsp;nm) work by selective absorption by blood cells (specifically [[hemoglobin]]). CO₂ lasers work by selective absorption by water molecules. Pulse dye lasers are less destructive and more likely to heal without scarring. CO₂ laser works by vaporizing and destroying tissue and skin. Laser treatments can be painful, expensive (though covered by many insurance plans), and not extensively scarring when used appropriately. CO₂ lasers will require local anaesthetic. Pulse dye laser treatment does not need conscious sedation or local anesthetic. It takes 2 to 4 treatments but can be many more for extreme cases. Typically, 10–14 days are required between treatments. Preventative measures are important.<ref name="aafp.org" /> * Infrared coagulator – an intense source of infrared light in a small beam like a laser. This works essentially on the same principle as laser treatment. It is less expensive. Like the laser, it can cause blistering pain and scarring.<ref>{{cite journal | author = Halasz CL | title = Treatment of common warts using the infrared coagulator | journal = The Journal of dermatologic surgery and oncology | volume = 20 | issue = 4 | pages = 252–56 | year = 1994 | pmid = 8163746 | doi=10.1111/j.1524-4725.1994.tb01620.x}}</ref> * Intralesional immunotherapy with purified candida, MMR, and tuberculin (PPD) protein appears safe and effective.<ref>{{cite journal |last1=Aldahan |first1=AS |last2=Mlacker |first2=S |last3=Shah |first3=VV |last4=Kamath |first4=P |last5=Alsaidan |first5=M |last6=Samarkandy |first6=S |last7=Nouri |first7=K |title=Efficacy of intralesional immunotherapy for the treatment of warts: A review of the literature. |journal=Dermatologic therapy |date=May 2016 |volume=29 |issue=3 |pages=197-207 |doi=10.1111/dth.12352 |pmid=26991521}}</ref><ref>{{Cite journal|last=Salman|first=Samer|date=10 July 2018|title=Intralesional Immunotherapy for the Treatment of Warts: A Network Meta-analysis|url=|journal=Journal of the American Academy of Dermatology|volume=|pages=|via=Elsevier Scince Direct}}</ref> * [[Duct tape occlusion therapy]] involves placing a piece of [[duct tape]] over the wart. The [[mechanism of action]] of this technique still remains unknown. Despite several clinical trials, evidence for the [[efficacy]] of duct tape therapy is inconclusive.<ref>{{cite journal |title= Topical treatments for cutaneous warts |author1= Kwok CS |author2= Gibbs S |author3= Bennett C |author4= Holland R |author5= Abbott R |date= 12 Sep 2012 |pmid=22972052 |doi=10.1002/14651858.CD001781.pub3 |volume=9 |issue= 9 |pages=CD001781 |journal=Cochrane Database Syst Rev}}</ref> Despite the mixed evidence for efficacy, the simplicity of the method and its limited side-effects leads some researchers to be reluctant to dismiss it.<ref>{{cite journal |vauthors=Stubbings A, Wacogne I | title = Question 3. What is the efficacy of duct tape as a treatment for verruca vulgaris? | journal = Archives of Disease in Childhood | volume = 96 | issue = 9 | pages = 897–99 | date = September 2011 | pmid = 21836182 | doi = 10.1136/archdischild-2011-300533 }}</ref> ==Society and culture== {{in popular culture|section|date=October 2018}} [[File:Bufo bufo 01 13Jul2009.jpg|thumb|right|Despite their appearance, [[True toad|toads]] do not cause warts]] According to English [[folk belief]], touching [[true toad|toads]] causes warts; according to a German belief, touching a toad under a [[full moon]] cures warts.<ref name="ley196312">{{Cite magazine |last=Ley |first=Willy |author= |last2= |first2= |date=December 1963 |title=The Names of the Constellations |department=For Your Information |url=https://archive.org/stream/Galaxy_v22n02_1963-12#page/n46/mode/1up |magazine=Galaxy Science Fiction |pages=90–99 |type=}}</ref> The most common Northern Hemisphere toads have glands that protrude from their skin that superficially resemble warts. Warts are caused by a virus, and toads do not harbor it.<ref>{{cite web | url=http://science.howstuffworks.com/environmental/life/zoology/reptiles-amphibians/toads-cause-warts.htm | title=Do toads cause warts? | publisher=science.howstuffworks.com | accessdate=October 20, 2012 | author=Clark, Josh | page=2 | deadurl=no | archiveurl=https://web.archive.org/web/20121016002453/http://science.howstuffworks.com/environmental/life/zoology/reptiles-amphibians/toads-cause-warts.htm | archivedate=October 16, 2012 | df= }}</ref> A variety of traditional [[folk remedy|folk remedies]] and rituals claim to be able to remove warts. The acrid yellow sap of [[Greater Celandine]] is used as a traditional wart remedy.<ref>[http://www.botanical-online.com/english/celandine_for_warts.htm Greater Celandine For Warts] {{webarchive|url=https://web.archive.org/web/20140717094406/http://www.botanical-online.com/english/celandine_for_warts.htm |date=2014-07-17 }}. botanical-online.com</ref> The sap can be applied directly to the wart in a similar manner to concentrated salicylic acid solution, but in more modest quantities. In ''[[The Adventures of Tom Sawyer]]'', [[Mark Twain]] has his characters discuss a variety of such remedies. Tom Sawyer proposes "spunk-water" (or "stump-water", the water collecting in the hollow of a tree stump) as a remedy for warts on the hand. You put your hand into the water at midnight and say: {{poemquote|Barley-corn, barley-corn, injun-meal shorts, Spunk-water, spunk-water, swaller these warts}} You then "walk away quick, eleven steps, with your eyes shut, and then turn around three times and walk home without speaking to anybody. Because if you speak the charm's busted." This is held to be superior to [[Huckleberry Finn]]'s preferred remedy which involved throwing a dead [[cat]] into a graveyard. Another remedy involved splitting a bean, drawing blood from the wart and putting it on one of the halves, and burying that half at a [[Crossroads (mythology)|crossroads]] at midnight. The theory of operation is that the blood on the buried bean will draw away the wart.<ref>[[Mark Twain]], ''[[The Adventures of Tom Sawyer]]'', [[s:The Adventures of Tom Sawyer/Chapter VI|ch. 6]]</ref> Twain is recognized as an early collector and recorder of genuine American folklore.<ref>LeMaster, J. R. (1993) ''The Mark Twain Encyclopedia'' (Taylor and Francis, pp. [https://books.google.com/books?id=zW1k-XS6XLEC&pg=PA293 293–94] {{webarchive|url=https://web.archive.org/web/20170107065759/https://books.google.com/books?id=zW1k-XS6XLEC&pg=PA293 |date=2017-01-07 }}, {{ISBN|0-8240-7212-X}}.</ref> Similar practices are recorded elsewhere. In Louisiana, one remedy for warts involves rubbing the wart with a potato, which is then buried; when the "buried potato dries up, the wart will be cured".<ref>{{cite journal|author=Webb, Julie Yvonne |title=Louisiana Voodoo and Superstitions Relating to Health|journal=HSMHA Health Reports|year=1971|volume=86|issue=4|pmc=1937133|pages=291, 296–97|doi=10.2307/4594154|pmid=4324337|jstor=4594154}}</ref> Another remedy similar to Twain's is reported from [[Northern Ireland]], where water from a specific well on [[Rathlin Island]] is credited with the power to cure warts.<ref>{{cite journal | author = Ballard LM | title = An approach to traditional cures in Ulster | journal = The Ulster medical journal | volume = 78 | issue = 1 | pages = 26–33 | year = 2009 | pmid = 19252727 | pmc = 2629017 }}</ref> ==Other animals== {{See also|Papillomavirus|Bovine papillomavirus}} {{Empty section|date=December 2017}} {{Clear}} ==References== {{Reflist}} ==External links== {{Wiktionary}} * [http://www.dermnet.com/moduleSearch.cfm?searchterm=warts Wart photo library], Dermnet {{Medical condition classification and resources | ICD10 = {{ICD10|B|07| |b|00}} | ICD9 = {{ICD9|078.1}} | DiseasesDB = 28410 | eMedicineSubj = emerg | eMedicineTopic = 641 | MedlinePlus = 000885 | MeshName = Warts | MeshNumber = D014860 }} {{Diseases of the skin and appendages by morphology}} {{Viral cutaneous conditions}} {{Skin tumors, epidermis}} {{Human papillomavirus}} [[Category:Papillomavirus-associated diseases]] [[Category:Virus-related cutaneous conditions]] [[Category:Cutaneous conditions]] [[Category:Viral diseases]] [[Category:RTT]] [[Category:RTTEM]]'