Warts (verrucae) are caused by infection with the human papilloma virus (HPV). They present as growths on the skin or mucous membranes that may protrude and be rough or they may be very smooth and flat as occurs most often on the soles. They can be spread from person to person or be transmitted on inanimate objects like toilet seats or shoes. They normally disappear after a few months, but they can persist and spread for years. Even though warts are contagious, infection is more dependent on a person’s lack of immunity to the virus rather than its virulence.
There are approximately 130 strains of human papilloma viruses. Some strains are responsible for deep warts on the bottom or “plantar” surface of the foot (“plantar warts”). Other strains are responsible for flat warts, and still other strains are responsible for genital warts. Some strains of HPV may cause cancer of the cervix, mouth, larynx, trachea and lungs.
There is not one good treatment for warts which is why there are so many different treatments. One theory in the treatment of warts is that treatments are really stimulating one’s own immune system to eradicate the wart virus. In instances where the immune system is severely compromised as in HIV/AIDS, it is very difficult to eradicate the warts.
Liquid nitrogen cryotherapy; lasers; various chemicals such as cantharidin, salicylic acid, dinitrochlorobenzene (DNCB) or squaric acid dibutyl ester immunotherapy, intralesional bleomycin, 5-fluorouracil, imiquimod and electrodesiccation are all used with variable success. Hypnotherapy is also useful in some people. The goal of all treatments is removal of the wart(s) without leaving a scar.
This discussion would be incomplete without advocating that all young adolescents be immunized with recommended doses of Gardasil or other antivirals which protect against several strains of HPV that are responsible for most dysplasia and carcinoma of the cervix. Initially it was recommended solely for young women, but immunizing young men will confer more complete protection from this devastating condition.