Warts : Things should know!!

Abstract

• Warts are benign skin proliferations caused by human papillomavirus (HPV).
• They are prevalent across all age groups globally.
• The article discusses the etiology, clinical features, diagnosis, and treatment of warts.
• Focus is on HPV’s virology, immune interactions, and therapeutic strategies.

Introduction

• Warts, or verrucae, are non-malignant skin growths linked to HPV infection.
• HPV has over 200 genotypes, each causing specific types of warts.
• Despite being benign, warts can cause physical discomfort and psychological stress.

Etiology and Virology

• HPV is a double-stranded DNA virus that infects skin via micro-injuries.
• The virus leads to cell proliferation, forming hyperkeratotic lesions.
• Specific HPV types (e.g., HPV-1, 2, 4) cause different wart varieties like plantar and common warts.

Epidemiology

• Warts are common worldwide, affecting 7-10% of the population.
• Higher incidence in children and adolescents due to frequent close-contact activities.
• Immunocompromised individuals are more prone to persistent and recurrent warts.

Clinical Manifestations

• Warts appear in several forms: common warts, plantar warts, flat warts, and genital warts.
• Common warts are rough lesions on hands and fingers.
• Plantar warts, found on feet, can be painful due to pressure.
• Flat warts are smooth, often occurring on the face.
• Genital warts are soft growths in the genital and anal regions.

Pathogenesis

• HPV infects the basal skin layer, leading to viral replication and cell growth.
• The virus evades the immune system by infecting cells with low antigen presentation.
• Host immune response determines whether warts persist or regress.

Diagnosis

• Warts are typically diagnosed through visual examination and location.
• Dermoscopy aids in identifying characteristic features like thrombosed capillaries.
• A biopsy may be needed for uncertain cases to confirm the diagnosis.

Differential Diagnosis

• Conditions similar to warts include calluses, corns, seborrheic keratosis, and squamous cell carcinoma.
• Accurate differentiation is essential for effective treatment, especially for atypical or treatment-resistant lesions.

Treatment Options

• Treatment aims to remove warts with minimal pain and scarring.
• Options include cryotherapy, salicylic acid, and immunotherapy, depending on wart type, location, and patient history.

Cryotherapy

• Cryotherapy uses liquid nitrogen to freeze and destroy wart tissue.
• It is effective with a relatively low risk of side effects.

Salicylic Acid

• Salicylic acid is a keratolytic agent that helps exfoliate infected skin.
• It is a common, over-the-counter treatment for various wart types.

Immunotherapy

• Immunotherapy stimulates the immune system to attack HPV-infected cells.
• Treatments include topical agents like imiquimod and intralesional injections like candida antigen.

Surgical Removal

• Surgical options include curettage, excision, and laser therapy.
• These methods are generally used for large or resistant warts.

Laser Therapy

• Laser therapy uses focused light to vaporize wart tissue.
• It is effective but can be costly and requires specialized equipment.

Topical Treatments

• Topical treatments such as podophyllotoxin and fluorouracil disrupt viral replication.
• These are used for warts resistant to other therapies.

Alternative Therapies

• Alternative treatments include duct tape occlusion and homeopathic remedies.
• Their effectiveness is less established compared to conventional treatments.

Preventive Measures

• Preventing warts includes avoiding direct contact with warts and maintaining good hygiene.
• Vaccination against HPV can reduce the risk of genital warts and related cancers.

HPV Vaccination

• HPV vaccines, like Gardasil, prevent infection with common wart-causing HPV strains.
• Vaccination is recommended for pre-teens, adolescents, and young adults.

Natural History

• Warts can regress spontaneously due to the immune system’s response.
• Some warts may persist or recur, requiring repeated treatments.

Psychosocial Impact

• Warts can cause significant psychological distress, especially in visible areas.
• Patients may experience embarrassment and social anxiety.

Complications

• Potential complications of warts include pain, bleeding, and secondary infections.
• Persistent warts may increase the risk of squamous cell carcinoma, particularly in immunocompromised individuals.

Epidemiological Trends

• Studies show varying prevalence based on age, gender, and geographic region.
• Warts are more common in certain occupational groups, like butchers and meat handlers.

Genital Warts

• Genital warts are primarily caused by HPV types 6 and 11.
• They are sexually transmitted and can cause discomfort and stigma.

Management in Immunocompromised Patients

• Immunocompromised patients may require more aggressive and prolonged treatment.
• Warts in these patients are more likely to be extensive and recalcitrant.

Warts in Pediatric Populations

• Children frequently develop warts, particularly on hands and feet.
• Treatment in pediatric patients requires consideration of compliance and pain tolerance.

Cost-effectiveness of Treatments

• The cost-effectiveness of wart treatments varies by method and healthcare setting.
• Cryotherapy and salicylic acid are generally considered cost-effective first-line treatments.

Prognosis

• Most warts are benign and eventually resolve without intervention.
• Persistent or recurrent warts may require ongoing management.

Public Health Implications

• Warts are a significant public health concern due to their high prevalence and potential for transmission.
• Public health efforts focus on education, prevention, and access to effective treatments.

Future Directions in Research

• Ongoing research aims to develop more effective and less invasive treatments.
• Studies are exploring the role of the immune system in wart regression and persistence.

Conclusion

• Warts are a common dermatological issue with a variety of treatment options.
• Understanding HPV’s role and host immune responses is crucial for effective management.
• Continued research and public health efforts are essential to reduce the burden of warts.