Warts

Learn about warts and how Knoxville Institute of Dermatology can help you.

Warts 2017-11-07T21:38:50+00:00

Project Description

Warts can be one of the most persistent and frustrating skin conditions. Our providers at Knoxville Institute of Dermatology are trained to identify and treat many different types of warts with a variety of treatment options. The customized treatment plan will depend on the age of the patient and the type of wart. The best way to keep warts from spreading is by treating them quickly to avoid shedding of the virus into nearby skin. Contact our office for an appointment today if you have warts that are multiplying, painful or troublesome.

What are viral warts?

Warts are very common non-cancerous growths of the skin caused by infection with human papillomavirus (HPV), a DNA virus. More than 100 HPV subtypes are known, giving rise to a variety of presentations. Skin infection occurs in the superficial layers of the epidermis, causing proliferation of the keratinocytes (skin cells) and hyperkeratosis.

HPV types 2, 3, 4, 27, 29, and 57 are the most common subtypes of HPV in warts. A viral wart on the sole of the foot is also called a verruca, and warty lesions are often described as verrucous.

Who gets viral warts?

Warts are particularly common in:

  • School-aged children, but they may arise at any age
  • Eczema, due to a defective skin barrier
  • People who are immune suppressed with medications such as azathioprine or cyclosporin, or with human immunodeficiency virus (HIV) infection. In these patients, the warts almost never disappear despite treatment.

What causes viral warts?

HPV is spread by direct skin-to-skin contact or autoinoculation. This means if a wart is scratched or picked, the viral particles may be spread to another area of skin. The incubation period can be as long as twelve months.

What are the clinical features of viral warts?

Warts have a hard surface. A tiny black dot may be observed in the middle of each scaly spot, due to a thrombosed capillary blood vessel.

Common warts present as papules with a rough, hyperkeratotic surface ranging in size from 1 mm to larger than 1 cm. They arise most often on the backs of fingers or toes, around the nails—where they can distort nail growth—and on the knees. Sometimes they resemble a cauliflower; these are known as butcher’s warts.

Plantar warts (verrucas) include tender inwardly growing and painful ‘myrmecia’ on the sole of the foot, and clusters of less painful mosaic warts. Plantar epidermoid cysts are associated with warts.

Plane warts have a flat surface. The most common sites are the face, hands and shins. They are often numerous. They may be inoculated by shaving or scratching, so that they appear in a linear distribution (pseudo-Koebner response). Plane warts are mostly caused by HPV types 3 and 10.

Filiform warts are on a long stalk like a thread. They commonly appear on the face. They are also described as digitate (like a finger).

Oral warts can affect the lips and even inside the cheeks, where they may be called squamous cell papillomas.

What are complications of viral warts?

Viral warts are very widespread in people with the rare inherited disorder epidermodysplasia verruciformis. Malignant change is rare in common warts, and causes verrucous carcinoma. Oncogenic strains of HPV, the cause of some anogenital warts and warts arising in the oropharynx, are responsible for intraepithelial and invasive neoplastic lesions including cervical, anal, penile and vulval cancer.

How are viral warts diagnosed?

Tests are rarely needed to diagnosis viral warts, as they are so common and have a characteristic appearance. Pinpoint dots (clotted capillaries) are revealed when the top of the wart is removed. Dermatoscopic examination is sometimes helpful to distinguish viral warts from other verrucous lesions such as seborrhoeic keratosis and skin cancer. Sometimes, viral warts are diagnosed on skin biopsy. The histopathological features of verruca vulgaris differ from that of plane warts.

What is the treatment for viral warts?

Many people don’t bother to treat viral warts because treatment can be more uncomfortable than the warts—they are hardly ever a serious problem. Warts that are very small and not troublesome can be left alone and in some cases they will regress on its own. However, warts may be painful, and they often look ugly so cause embarrassment. To get rid of them, we have to stimulate the body’s own immune system to attack the wart virus. Persistence with the treatment and patience is essential!

Topical treatment includes wart paints containing salicylic acid or similar compounds, which work by removing the dead surface skin cells. The paint is normally applied once daily. Treatment with wart paint usually makes the wart smaller and less uncomfortable; 70% of warts resolve within twelve weeks of daily applications. If the wart paint makes the skin sore, stop treatment until the discomfort has settled, then recommence as above. Take care to keep the chemical off normal skin.

Cryotherapy is normally repeated at one to two–week intervals. It is uncomfortable and may result in blistering for several day or weeks. Success is in the order of 70% after 3-4 months of regular freezing. A hard freeze using liquid nitrogen might cause a permanent white mark or scar. It can also cause temporary numbness.

Electrosurgery (curettage and cautery) is used for large and resistant warts. Under local anesthetic, the growth is pared away and the base burned. The wound heals in two weeks or longer; even then 20% of warts can be expected to recur within a few months. This treatment leaves a permanent scar.

How can viral warts be prevented?

HPV vaccines are available to prevent anogenital warts. Anecdotally, these have been reported to result in clearance of non-genital warts in some people.

What is the outlook for viral warts?

No treatment is universally effective at eradicating viral warts. In children, even without treatment, 50% of warts disappear within 6 months, and 90% are gone in 2 years. They are more persistent in adults but they clear up eventually. They are likely to recur in patients that are immune suppressed, eg, organ transplant recipients. Recurrence is more frequent in tobacco smokers.

WHAT OUR PATIENTS SAY

I really was impressed with Dr. Wright. He is extremely knowledgeable and I really recommend him as a fine Dermatologist.

Ronna P.

Dr. Rahman is wonderful. She is very professional, knowledgeable and kind. She takes time to listen. She handled my problem right away. I had been very concerned about it.

Donna B.

What a great experience! I was greeted promptly and courteously by the front desk staff. I was seen almost immediately and treated with care and concern by both Devon and Dr. Wright. I will certainly make KID my home for dermatology and would highly recommend them to everyone.

Penny F.

Dr. Adam Wright took his time to explain the procedure, perform the surgery, and teach how to care for wound afterwards. I have found few physicians take such time with their patients and I am a registered nurse.

Laurie J.

I was very pleased with the efficiency of the staff who handed me some forms, then directed me upstairs where I barely sat down before I was escorted to the exam room. Dr. Wright came in a few minutes later and got down to business in a most pleasant and professional manner. Thank you.

Jerome R.

I had a recurring dermatological condition for several and a series of dermatologists as a result. And yet until I met Dr. Wright, my condition remained undiagnosed and it turned out to be potentially life-threatening. I am so fortunate to have found him and I would not go to anyone else and recommend him often.

Donald B.

Knox Institute of Dermatology is the best! Dr. Adam Wright has always been very courteous and knowledgeable of my care.

Robin P.

Lindsey Best, NP is a great listener and she is sensitive to my daughter’s questions and concerns. Her acne is getting better! Thank you!

Campbell T.

I saw the NP. She was personable, informative and skilled in taking care of my problem. I recommend her and will ask for her if I have need to go again.

Martha M.

Awesome doctor, awesome staff. Definitely would recommend this office to all my friends. Also, my husband is a patient and my daughters will have appointments soon.

Cynthia P.

Dr. Rahman and her nurse were very friendly, professional, and spent an appropriate amount of time with me. I have some benign lesions that I want to have removed at some time in the future and I will return to Knox Institute of Dermatology.

Patricia G.

We had a great experience with Dr Anderson, she was great with my 10 year old son, minimal wait times. Lovely office and staff!

Ian S.

Dr. Elizabeth Anderson is very thorough, knowledgeable, listens, explains the best treatments, and gives options for care.

Mark S.

I had an overall satisfying experience as usual. Short wait time, attractive and clean facilities, courteous and professional yet welcoming staff. Dr. Rahman was thorough and treatment options were well explained.

Larry Troy M.

Dr. Anderson has been my dermatologist for several years, and I continue to be impressed with her dedication, caring attitude, and professionalism. The staff are always friendly and helpful.

M Carol S.

I was called back promptly. Dr. Rahman was careful to make sure I was not experiencing any pain during the procedure.. The staff was friendly, yet very professional; clearly describing follow-up procedures I needed to perform. My insurance initially rejected a prescribed mediation, but the staff worked tirelessly and was successful in getting them to reverse their decision.

Susan P.

Friendly and excellent service! Love the staff, always up beat and happy. Comfortable with staff knowledge and skills. Just a great experience if there is such a thing when visiting a Dr.

Gary C.

Dr. Wright was very caring, answered questions in a way I could understand, listened to what I had to say. I especially appreciate that he doesn’t prescribe medications without careful thought and trying alternatives first.

Jane R.

Dr. Anderson is a knowledgeable, compassionate, and caring doctor. Her nurse, Lori, was equally sensitive to my concerns and she showed the utmost respect and dignity during my medical treatment.

Terrissa D.

They have a very nice and knowledgeable staff. I didn’t have to wait long, and they did a great job of explaining the process and options to me. I highly recommend this practice!

Aaron H.

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