Warts (Verrucae)

Warts are sharply defined, benign skin growths of various shapes that have a rough, scaly surface. The trigger for warts is a contagious virus (human papilloma virus, HPV), whereby over 100 different subtypes of this virus are known, all of which can cause warts on the skin and mucous membranes. Some subtypes are also thought to be involved in the development of cervical cancer.

Warts can be divided into groups according to their appearance and place of origin. They occur on different areas of the skin, depending on which subtype of the virus they are caused by. The most common type of wart is the common wart (verrucae vulgares), which occurs mainly in children and adolescents (rarely in adults) on the hands and feet. This type of wart is a nuisance, but it is not usually dangerous.

Another type of wart is the genital wart (genital wart), which is transmitted during sexual intercourse and is much more contagious.

The so-called dell wart (Mollusca contagiosa) does not belong to the group of warts, as it is triggered by a different group of viruses. Their appearance also differs from the classic warts: their size is one to five millimetres. They are bright red in color and have a pearl-like appearance. Their name is derived from the central dent that the larger nodules have. Hence the name dell warts (mollusks).

The reason for the emergence of warts are viruses that penetrate the upper layer of the skin as a result of small skin lesions or cracks. Six weeks after they have entered the skin, there is a thickening and keratinization at the entry site and the skin forms growths that correspond to the classic appearance of the wart.

The viruses multiply in the affected skin cells and are later released on the surface. Thus, one can become infected by touching a wart. This is especially true if you have small cracks in your skin. Through this cycle, warts can spread all over a person's body and be transmitted from person to person.

Warts can also be contracted indirectly, such as in swimming pool shower rooms. After swimming, the skin is usually softened and thus forms a favourable entry point for viruses, which can penetrate more easily as a result.

Every person is susceptible to warts to a different extent. Thus, warts occur more easily on hands and feet with poor circulation, cold or sweaty. People who have thin, dry skin are also more susceptible to warts. On the other hand, warts infections are less common in older people.

The incubation period varies greatly and is usually between 1 and 21 months. A distinction is made between different forms of warts:

Common warts (verrucae vulgares):

In the initial phase, they are usually two to three millimeters in size and of an inconspicuous skin coloration. Over time, they become larger and acquire a rough surface due to progressive keratinization. The exact appearance of warts depends on their location. In the area of the fingers and the back of the hand their shape is usually hemispherical, they are located between the fingers and toes (interdigital spaces) and are usually more flattened. If warts occur on the eyelids, they are mainly filiform with a long thread-like stalk (brush tail).

Plantar warts (verrucae plantares):

This type of wart is found on the soles of the feet, where they can cause painful discomfort when strained. This is especially the case when they are located on areas of skin that are subject to high pressure. Plantar warts usually extend deep into the skin.

Flat warts (verrucae planae):

Flat warts are similar in shape to small, flat, roundish-oval nodules that are more common on the face. In some cases there is a very strong proliferation.

For the diagnosis is usually enough the appearance and the place where the wart appears. On the hands and feet resemble rough, usually raised nodules, which have a rough, scaly surface. There may be isolated small black dots in the center. On the sole of the foot (plantar warts), there is often a mosaic-like distribution of warts. If the affected area is exposed to great pressure, sometimes painful plantar warts develop (for example on the ball of the foot).

On the face and the rest of the body, warts can often appear as inconspicuous, reddish, slightly rough elevations. Genital warts, which occur in the genital region, usually grow as small bumps that resemble a cauliflower-like appearance later in life. If left untreated, they can reach a considerable size (Buschke-Löwenstein tumour).

For a reliable diagnosis, the doctor can dab the warts with acetic acid. As a result, they turn white in contrast to the rest of the skin. This method can also be used to identify invisible areas of infection. For an exact diagnosis, a smear or a tissue sample (biopsy) can also be taken.

It often happens that warts heal on their own. Otherwise, the treatment depends on the type of wart:

• Wart tinctures and wart patches contain acids such as salicylic acid or lactic acid, which have the effect of etching away the skin structure caused by the viruses. However, care should be taken when applying them so as not to injure the surrounding skin area. A zinc paste, which is applied around the wart beforehand, offers protection. This treatment is not directed against the viruses themselves, which is why the therapy must be carried out consistently until the entire wart and with it the viruses have disappeared. Such treatment is used exclusively for common warts. The doctor can achieve a similar effect by icing the warts with liquid nitrogen.
• In most cases, the doctor treats plantar warts by icing them, scraping them, scabbing them electrically, or lasering them. These procedures can sometimes leave scars.
• In homeopathy, dilutions of Thuja extract are used. The solution can either be ingested or applied.

In some cases, the treatments have to be repeated, as warts often become stubbornly attached or form again. The following measures can be taken to protect yourself from warts:

• If one has a lot of warts, a clarification from the doctor is essential. The doctor can rule out the possibility that one or more warts are malignant growths.
• Surgical measures such as cutting, drilling or biting should be avoided, as there is a risk of viruses being released and spreading to other parts of the body. In addition, other people can be infected more easily.
• For the patch and solution treatment to be effective, the skin cells that have been etched away must be removed before each new treatment. This should be done with a pumice stone. However, it is important that the affected areas of skin do not begin to bleed during treatment.
• Home remedies such as discussing warts, letting a snail crawl over the wart during a full moon or dubious herbal tinctures do not achieve any effect from a medical point of view and can only trigger a placebo effect.

Normal warts (verrucae vulgares) ideally heal on their own, as they are merely unsightly but benign growths. However, scars may still remain if they have been treated with aggressive measures.

Plantar warts (verrucae platares) are difficult to treat as they are considered very resistant to therapy. They have a high recurrence rate because, once treated, they often reappear in the same location.

Caution is advised when dealing with genital warts, as they can also degenerate in the worst case. If genital warts are suspected, a doctor should be consulted immediately. Some types of warts (human papilloma viruses) that affect the cervix can, under certain circumstances, also be responsible for cervical cancer.

To avoid infection with warts, care should be taken to wear shoes in swimming pools after bathing, as the protective sebaceous film on moist skin is missing.

Extremely dry skin, however, cracks easily and thus forms a good breeding ground for warts. The hands are particularly susceptible to warts as they come into contact with objects such as cutlery, newspapers and handles on the underground and bus on a daily basis. Remedy in this case is the regular cream the hands to protect them from drying out. The nail fold should also not be left out, as the skin here is particularly prone to dryness.

If a wart nevertheless appears, the first measure should be to dry the surrounding skin region with a towel, which should not be used later for other body regions, as the viruses could otherwise spread and trigger warts in other places. This towel should be changed afterwards and washed hot.

In any case, scratching and manipulating warts should be refrained from, as the viruses can spread to other areas through fingernails and fingertips. For example, warts are often seen spreading along scratch marks.

To protect yourself from HP viruses that are transmitted through sexual intercourse, a simple measure that helps is the use of a condom. In the meantime, a vaccination has also been approved for the market (Gardasil), which protects against the most common HP viruses and is recommended above all for young girls. However, the vaccination does not offer 100% protection against cervical cancer, which is why regular check-ups by the gynaecologist are recommended.