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| {{Infobox Disease |
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| Name = Warts |
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| ICD10 = {{ICD10|B|07| |b|00}} |
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| ICD9 = {{ICD9|078.1}} |
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| Image = Dornwarzen.jpg |
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| Width = 150px |
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| Caption = Warts on the big toe |
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| DiseasesDB = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MedlinePlus = 000885 |
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| MeshName = Warts |
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| MeshNumber = D014860 |}}
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| {{CMG}}
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| | {{Wart}} |
| | {{CMG}}; {{AE}} {{KS}} |
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| ==Overview== | | ==[[Wart overview|Overview]]== |
| A '''wart''' is generally a small, rough [[tumor]], typically on hands and feet, that can resemble a [[cauliflower]] or a solid blister. Warts are common, and are caused by a [[virus (biology)|viral]] infection, specifically by the ''[[human papillomavirus]]'' (HPV) and are contagious when in contact with the skin of another. It is also possible to get warts from using towels or other objects. They typically disappear after a few months but can last for years and can reoccur. A few papilloma viruses are known to cause cervical [[cancer]].
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| ==Types of wart== | | ==[[Wart classification|Classification]]== |
| A range of different types of wart have been identified, which differ in shape and site affected, as well as the type of human papillomavirus involved.<ref>''Mosby's Medical, Nursing, & Allied Health Dictionary'' (5th edn), Anderson KN, Anderson LE, Glanze WD, eds, Mosby</ref> These include:
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| *'''common wart''' (''Verruca vulgaris''): a raised wart with roughened surface, most common on hands and knees
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| *'''[[Verruca plana|flat wart]]''' (''[[Verruca plana]]''): a small, smooth flattened wart, tan or flesh coloured, which can occur in large numbers; most common on the face, neck, hands, wrists and knees
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| *'''[[filiform wart|filiform or digitate wart]]''': a thread- or finger-like wart, most common on the face, especially near the eyelids and lips
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| *'''[[plantar wart]]''' (verruca, ''Verruca pedis''): 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
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| *'''[[mosaic wart]]''': a group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet
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| *'''[[donkey wart]]''' (venereal wart, ''Condyloma acuminatum'', ''Verruca acuminata''):
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| ==Treatment== | | ==[[Wart pathophysiology|Pathophysiology]]== |
| ===Prescription===
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| [[Image:Wart ASA animated.gif|200px|thumb|right|Two viral warts on a middle finger, being treated with a mixture of acids (like salicylic acid) to remove them. A white precipitation forms on the area where the product was applied.]] | |
| Treatments that may be prescribed by a medical professional include:
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| *[[Treatment of warts by keratolysis|Keratolysis]], removal of dead surface skin cells usually using [[salicylic acid]], blistering agents, immune system modifiers ("immunomodulators"), or [[formaldehyde]].
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| *[[Cryosurgery]], which involves freezing the wart (generally with [[liquid nitrogen]]), after which the wart and surrounding dead skin falls off by itself.
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| *Surgical [[curettage]] of the wart.
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| *[[Laser]] treatment.
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| *[[Imiquimod]], a topical cream that helps the body's immune system fight the wart virus by encouraging [[interferon]] production.
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| *[[Candida (genus)|Candida]] injections at the site of the wart, which also stimulate the body's immune system.<ref>[http://archderm.ama-assn.org/cgi/content/short/141/5/589 Horn TD, Johnson SM, Helm RM, Roberson PK (2005) Intralesional immunotherapy of warts with mumps, Candida, and Trichophyton skin test antigens. ''Arch Dermatol'' 141: 589–94]</ref>
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| *[[Cantharidin]], a chemical found naturally in many members of the beetle family [[Meloidae]] which causes dermal blistering.
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| The wart often regrows after the skin has healed.
| | ==[[Wart causes|Causes]]== |
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| One review of 52 clinical trials of various cutaneous wart treatments concluded that topical treatments containing salicylic acid were the best supported, with an average cure rate of 75% observed with salicylic acid compared with 48% for placebo in six placebo-controlled trials including a total of 376 participants.<ref name="Cochrane">[http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/rel0001/CD001781/pdf_fs.html Gibbs S, Harvey I, Sterling JC, Stark R. (2003) Local treatments for cutaneous warts. ''Cochrane Database of Systematic Reviews'' Issue 3]</ref> The reviewers also concluded that there was little evidence of a significant benefit of cryotherapy over [[placebo]] or no treatment.<ref name="Cochrane"/>
| | ==[[Wart differential diagnosis|Differentiating Wart from other Diseases]]== |
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| ===Over-the-counter=== | | ==[[Wart epidemiology and demographics|Epidemiology and Demographics]]== |
| There are several [[over-the-counter drug|over-the-counter]] options. The most common ones involve [[salicylic acid]]. These products are readily available at [[drugstore]]s and [[supermarket]]s. There are typically two types of products: adhesive pads treated with salicylic acid or a bottle of concentrated salicylic acid. Removing a wart with salicylic acid requires a strict regimen of cleaning the area, applying the acid, and removing the dead skin with a [[pumice]] stone or [[emery board]]. It may take up to 12 weeks to remove a wart.
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| Another over-the-counter product that can aid in wart removal is [[silver nitrate]] in the form of a [[caustic pencil]], which is also available at drug stores. This method generally takes three to six daily treatments to be effective. The instructions must be followed to minimize staining of skin and clothing.
| | ==[[Wart risk factors|Risk Factors]]== |
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| Over-the-counter cryosurgery kits are also available, however they can often cost three times as much as the previously named products.
| | ==[[Wart natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| Like prescription treatments, over-the-counter treatments usually require multiple applications and are only necessary if the warts are problematic. Additionally, these treatments are capable of destroying healthy skin as well as warts, so caution must be exercised by those attempting them without medical supervision.
| | ==Diagnosis== |
| | [[Wart history and symptoms|History and Symptoms]] | [[Wart physical examination|Physical Examination]] | [[Wart laboratory findings|Laboratory Findings]] | [[Wart other diagnostic studies|Other Diagnostic Studies]] |
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| ===Household remedies=== | | ==Treatment== |
| [[Duct tape occlusion therapy]] involves placing a piece of [[duct tape]] (or medical tape) over the affected area for a week at a time. The procedure is otherwise identical to that of using salicylic acid adhesive pads. One study by ''Focht et al.'' found that the duct tape method was 85% effective, compared to a 60% success rate in the study's cryotherapy group.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12361440&query_hl=3&itool=pubmed_docsum Focht DR III, Spicer C, Fairchok MP (2002) The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart). ''Archives of Pediatrics & Adolescent Medicine'' 156(10): 971-4] (reviewed in [http://www.aafp.org/afp/20030201/tips/8.html Miller KE (2003) Duct tape more effective than cryotherapy for warts. ''American Family Physician'' 67(3)] & [http://www.jyi.org/volumes/volume7/issue5/features/demichele.html DeMichele J (2003) A new medical breakthrough: wart to do when verruca vulgaris attacks. ''Journal of Young Investigators'' 7(5)])</ref> Another study by ''Wenner and coworkers'', however, found no statistically significant effect in a double-blind, randomized and controlled clinical trial in 90 adults when duct tape was compared to mole skin.<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17372095&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Wenner et al. Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial. Arch Dermatol. 2007 Mar;143(3):309-13.]</ref> There was no statistically significant difference for resolution of the target wart between patients treated with moleskin versus patients treated with duct tape. Eight of 39 patients [21%] in the treatment group vs 9 of 41 patients in the control group [22%] had complete resolution of the target wart. Fewer of the patients achieving resolution of their wart in the moleskin group had recurrence of their wart. Of the patients who had complete resolution, 6 (75%) in the treatment group and 3 (33%) in the control group had recurrence of the target wart by the sixth month. "Whether or not the standard type of duct tape is effective is up in the air," said co-author Dr. Rachel Wenner of the University of Minnesota, who started the new study as a medical student. "Theoretically, the rubber adhesive could somehow stimulate the immune system or irritate the skin in a different manner."<ref>[http://newsmax.com/archives/articles/2007/3/20/161113.shtml Study Casts Doubt on Duct Tape Wart Cure]. [[March 21]], [[2007]].</ref> | | [[Wart medical therapy|Medical Therapy]] | [[Wart surgery|Surgery]] | [[Wart primary prevention|Primary Prevention]] | [[Wart secondary prevention|Secondary Prevention]] | [[Wart cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Wart future or investigational therapies|Future or Investigational Therapies]] |
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| Fig latex, the sap from a fig tree, is also a common treatment for warts. Studies on cows comparing treatment with fig latex to salicylic acid showed that fig latex worked equally well. An Iranian study compared fig latex treatment on humans to cryotherapy and found the fig latex to be only slightly less effective, but with the benefit of fewer side effects.
| | ==Related Chapters== |
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| Tempra paint serves as a successful treatment as well. Dabbed onto the surface of a wart and allowed to dry completely, it will noticably reduce the size of the wart over a period of days. Removal of the wart can take a week or more. Children who frequently fingerpaint with Tempra show it to be successful as a remedy. Caution and close observation is advised however, as infection and permanent scarring can occur.
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| Other household remedies include the application of common household items, such as a bruised garlic (held in place with a bandage or duct tape), banana skin, vinegar <ref>{{cite web|url=http://www.cidervinegar.org/2007/07/apple-cider-vinegar-for-warts_02.html|title=Apple Cider Vinegar for Warts}}</ref>, hot water and washing liquid, aerosol sprays or compressed air, [[Thuja occidentalis]], [[tea tree oil]] and other natural oils, unskinned potatoes, potato or cauliflower or tomato juice, salt, or [[vegemite]] to the affected area. [[Milkweed]], [[dandelion]], and [[poison ivy]] sap have also been used. Accounts vary in regards to how long these remedies must be applied with each session and how long they take to work.
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| Without controlled studies for most household remedies, it is difficult to know whether the warts disappear because the remedies work, or if they disappear due to the individual's own immune system response to the virus (possibly augmented by a [[placebo effect]]). The success of [[hypnosis]] in curing warts<ref>[http://www.internethealthlibrary.com/Health-problems/Warts%20-%20researchAltTherapies.htm Alternative & Complementary Therapies: Hypnotherapy & Warts]</ref> at least suggests that the condition may be cured by belief in a remedy, the placebo effect or other psychological means.
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| Some household remedies are potentially dangerous. These include attempts to cut or burn away the warts. [[Incense]] is sometimes used in Asian countries to burn warts. These methods are very [[Pain and nociception|painful]], and can lead to [[infection]] and/or permanent [[scar]]ring.
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| ==References==
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| <references />
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| ==See also==
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| * [[Laryngeal papillomatosis]] | | * [[Laryngeal papillomatosis]] |
| * [[Molluscum contagiosum]] | | * [[Molluscum contagiosum]] |
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| ==External links==
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| *[http://www.wikisurgery.com/ Warts:Information for patients on Wikisurgery]
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| [[es:Verruga]] | | [[es:Verruga]] |
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| [[ru:Бородавки]] | | [[ru:Бородавки]] |
| [[zh:疣]] | | [[zh:疣]] |
| | {{WH}} |
| | {{WS}} |
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| [[Category:Viruses]] | | [[Category:Viruses]] |
| [[Category:Dermatology]] | | [[Category:Dermatology]] |
| [[Category:Infectious disease]] | | [[Category:Gynecology]] |
| [[Category:Overview complete]] | | [[Category:Disease]] |
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| {{WH}}
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| {{WS}}
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