What are warts?

Warts are benign skin growths caused by the human papillomavirus. The virus, which is acquired through cracks in the skin, causes a thickening of the outer layer of skin. Warts affect 7-10% of the population, and young people are more commonly affected. Most warts are not worrisome, medically speaking, and are primarily of cosmetic concern except when causing discomfort, particularly on the bottom of the feet.

Transmission:

Warts are transmitted by direct contact or indirect contact (e.g., public showers or swimming pool areas). They can be transmitted to one’s self or others. Picking or scratching at warts can increase the risk of transmission. Trauma may play a role in the development of warts as they often occur at pressure points, for example, on the bottom of the foot.

Types of warts:

Each type of wart is caused by a slightly different virus and treatment may vary. The common forms include the following:

Common warts (verruca vulgaris) are flesh-colored, small raised spots on the skin with a rough surface. The size of the wart varies and may appear anywhere on the skin, particularly on the elbows, knees, hands, fingers and around the nails. The black dots found in these warts, often called seeds, are superficial blood vessels and not actual seeds.

Plantar warts (verruca plataris) are no different than common warts except that their location on the bottom of the foot may result in a flat appearance from being pressed into the foot by the weight of the person. Plantar warts may occur singly or in a pattern, grouped closely together. They may cause pain, redness and swelling.

Lat warts(verruca plana) have a smaller, smoother surface than common warts. They are often found in great numbers on the face but may occur elsewhere, particularly on the arms and legs.

Genital warts (condylomata accuminata) may be small or large. When large, they may have a cauliflower-like appearance. They grow on warm, moist surfaces such as the genital and rectal areas. They are usually, but not always, sexually transmitted. Do not treat genital warts yourself; medical treatment is necessary. These warts are commonly treated with weekly applications of podophyllin, liquid nitrogen or other agents, which may be irritating to the skin. Genital warts are common, contagious and may be difficult to eradicate.

Medical treatment:

Warts often disappear spontaneously over several years. If warts are painful, subject to infection or cosmetically objectionable, they should be treated. Treatment depends on the size, location and number of warts as well as the activities of the infected person. Warts may be very difficult to cure; often multiple treatments are needed, and even then treatment success cannot be guaranteed. Types of treatment include the following:

Cryotherapy (liquid nitrogen) is used on many warts at UHS. First, any dead skin surrounding the wart may be scraped off. Next, liquid nitrogen is applied, producing an uncomfortable blister within two days of treatment. Many warts require more than one treatment with the second treatment being performed 2-4 weeks after the first.

Electrodessication (electrocautery) is usually used only after warts have not responded to other procedures. It consists of burning the wart with a high frequency current, followed by scraping the surface. It should be used cautiously as it may occasionally cause scarring.

Salicylic acid is often used for plantar warts. A 40% salicylic acid plaster is cut to the size and shape of the wart and covered with an occlusive tape (e.g., duct tape). Alternatively, a 17-20% liquid may be applied. After 24 hours, the wart is pared down. This is repeated every day if the area is not too irritated.

Mole removal:

Moles can be described as a blemish that appears on the face or body that can vary in size, shape and colour. Some moles are flat, while others can have a raised appearance. The majority of moles are usually harmless, however if you notice a change in colour or shape, or if the mole begins to irritate, then you should have it checked by a doctor as these symptoms could be signs of something more serious.

Highly visible moles on the body or face can often lead to loss of confidence or embarrassment for certain individuals. Moles that restrict movement, or which are overly large, can sometimes result in pain and distress.

• Please remember that you may have one or more causes for lumps, bumps, or moles including some that may not be listed here.
• Small, hard, white bumps (milia)
• Enlarged oil glands (sebaceous hyperplasia)
• Acne
• Moles (nevi)
• “Barnacles” (seborrheic keratoses)
• Red bumps on the arms and face (hemangiomas)
• Bumps on the nose (fibrous papules)

Procedures

• Liquid nitrogen
• Hyfercators/cautery
• Surgical removal
• Glycolic or salicylic acid peels
• Microdermabrasion

Electrocautery

My preferred method of treating enlarged oil glands is with a small electric instrument that looks like a pencil and essentially melts the bumps. This is followed by cleaning out the deep oil pocket. This treatment flattens the bump nicely and does not cause much redness around the bump. It leaves a small crust while it is healing, which takes three to seven days depending on the size of the original spot. The one disadvantage of this method is that the sebaceous hyperplasia will eventually grow back. But that usually takes anywhere from many months to even years. They can just be flattened again if that happens, and usually the procedure can be done with no scarring at all.

Liquid nitrogen.

Another possibility is to freeze these bumps with liquid nitrogen, either with a swab or with a spray cannister. This also can work but takes longer to heal and causes more redness and irritation around the bumps than with the electrocautery (the electric pen). It also may scar occasionally.

Microdermabrasion does not work for this very well and neither do the lighter peels performed by most aestheticians, such as light glycolic or light salicylic acid peels.

Prior to the treatment:

Topical or local anaesthetic will be administered.

Shave excision- The procedure involves using a dermablade to remove the mole parallel to the surface of the skin. This leaves a small superficial wound which may need cauterisation to stop any bleeding and tidy the wound. The whole procedure takes about 20 minutes. No stitches are needed and healing takes about 1 to 2 weeks. Mainly for moles and skin tags removal.

Elipse excision – a deep excision that removes the mole more completely. The resulting wound requires stitches which can be either dissolvable or non-dissolvable depending on the site of removal. The treatment takes about 20 minutes. Generally, it is a method to remove deep moles and Cyst.