Warts Muna Hassan Tasneem Hassoun what are the warts ? • A wart is a benign skin growth caused by some types of the virus called the human papillomavirus (HPV). there are over 100 HPV subtypes. • warts can grow anywhere on the body. • they are most common among children and young adults. How is it form? • HPV infects the top layer of skin, usually entering the body in an area of broken skin. The virus causes the top layer of skin to grow rapidly forming warts. Types • there are seven kinds of warts: " they look different and form on different part of the body“ 1.Common warts 2.Filiform warts 3.Flat warts 4.Palmar and plantar warts 5.Mosaic warts 6.Periungual warts 7.Genital warts. 1.Common warts • Common warts: Common warts are caused by HPV. They are usually asymptomatic but sometimes cause mild pain when they are located on a weight-bearing surface (eg, bottom of the feet). • Common warts are sharply demarcated, rough, round or irregular, firm, and light gray yellow nodules . • They appear most often on sites subject to trauma (eg, fingers, elbows, knees, face) but may spread elsewhere. Common warts 2.Filiform warts • Filiform warts: These warts are long, narrow, frondlike growths, usually located on the eyelids, face, neck, or lips. • They are usually asymptomatic. This morphologically distinct variant of the common wart is benign and easy to treat. Filiform warts 3.Flat warts • Flat warts: Flat warts caused by HPV.they are smooth, flat-topped, yellow-brown, pink, or flesh-colored papules, most often located on the face and along scratch marks; they are more common among children and young adults. • They generally cause no symptoms but are usually difficult to treat. Flat warts 4.Palmar and plantar warts • Palmar and plantar warts: These warts, caused by HPV type 1, occur on the palms and soles; they are flattened by pressure and surrounded by cornified epithelium. • They are often tender and can make walking and standing uncomfortable. • They can be distinguished from corns and calluses by their tendency to pinpoint bleeding when the surface is pared away. Palmar and plantar warts 5.Mosaic warts • .Mosaic warts: Mosaic warts are plaques formed by the coalescence of myriad smaller, closely set plantar warts. As with other plantar warts, they are often tender. Mosaic warts 6.Periungual warts • Periungual warts: These warts appear as thickened and fissured around the nail plate. They are usually asymptomatic, but the fissures cause pain as the warts enlarge. • Periungual warts are more common among patients who bite their nails. Periungual warts 7.Genital warts • Genital warts: Genital warts (Sexually Transmitted Diseases (STDs)manifest as discrete flat to broadbased smooth papules on the perineal, perirectal, labial, and penile areas. • Infection with high-risk HPV types (most notably types 16 and 18) is the main cause of cervical anal cancer. These warts are usually asymptomatic. • Perirectal warts sometimes itch. How can it spread? • warts are easly spread by direct contact with a human papiloma virus. • pepeole can infect them self again by touching the wart and then another part of their body. • you can infect another person by sharing towels or other personal items. Cont… • immune factors appear to influence spread. immunosuppressed patients(esp those with HIV infection or kidney transplantation are at risk of developing generalized lesions that are difficult to treat. • It is unlikely that you will get a wart every time you come in contact with HPV. • Some people are more likely to get warts than others Diagnosis 1.Clinical evaluation 2.Rarely biopsy Diagnosis • Diagnosis is based on clinical appearance; biopsy is rarely needed. • A cardinal sign of warts is the presence of pinpoint black dots (thrombosed capillaries) or bleeding when warts are shaved. • If necessary, confirm the diagnosis of a wart by shaving its surface to reveal thrombosed capillaries in the form of black dots. Prognosis • Many warts regress spontaneously (particularly common warts); others persist for years and recur at the same or different sites, even with treatment. Factors influencing recurrence appear to be related to the patient's overall immune status as well as local factors. Prognosis • Genital HPV infection has malignant potential (cervical and anal cancer), but malignant transformation is rare in HPV-induced skin warts, except among immunosuppressed patients. How to differentiate between corns,calluses, and plantar warts? • a corn may be differentiated from a plantar wart or calluses by paring away the thickened skin. After paring, a callus shows smooth translucent skin, where a wart appears sharply circumscribed, sometimes withsoft macerated tissue or with central black dots (bleeding point). while a core, when pared, shows a sharply outlined yellowish to transluscent core. How are they treated? • Most warts don't need treatment. But if you have warts that are painful or spreading, or if you are bothered by the way they look, your treatment choices include: 1.Using a home treatment such as salicylic acid . You can get these without a prescription. 2.Putting a stronger medicine on the wart, or getting a shot of medicine (antiviral acyclovir)in it. Cont… 3. Freezing the wart (cryotherapy). The most common agent is liquid nitrogen. Mixture of dimethyl ether &propane(DMEP) 4. Removing the wart with surgery (electrosurgery, laser surgery). Cont… • Wart treatment does not always work. Even after a wart shrinks or goes away, warts may come back or spread to other parts of the body. This is because most treatments destroy the wart but do not kill the virus that causes the wart. • Up to 30% of warts disappear by themselves within 6 months, and most will disappear without any treatment within 3 years.
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