Viral Warts

Viral Warts

• Warts (or verrucae), are benign growths on the skin or mucous membranes that cause cosmetic problems and discomfort.

• Are seen in all ages but commonly appear in children and teenagers.

• Viral warts (verruca) are due to infection of the skin and mucus membranes by human papilloma virus (HPV).

• More than 80 different types of HPV are identified.

• Have affinity for different tissues of the body as type 36 & 38 for the skin and usually they are benign.

• While type 16 & 18 have affinity to mucus membranes and can change into cancer

Clinical types of viral warts (Verrucae)

1. Skin Infections:

• i. Common warts (verruca vulgaris),
• ii. Flat warts (verruca plana).
• iii. Plantar or foot warts (verruca plantaris).

2. Mucous membranes infection:

• Ano-genital warts (condyloma acuminata).

Pathogenesis

• Incubation period is 2 - 9 months
• Excessive proliferation of skin growth slowly develops
• More than 50% disappear within 2 years without treatment.
• HPV is passed from person to person by direct or indirect contact, and from one body location to another on the same person
• The virus enters the body through:
  • Area of skin that is moist, peeling, or cracked
  • Sexually transmitted as in Condyloma acuminita.

Skin viral warts – Clinical features

1- Common warts

• Appear most often on tops of fingers and hands
• As rough, thick, papules
• Develop as solitarily or in large numbers
• Small satellite warts may surround the original lesion (because the virus is usually present in a one-cm radius surrounding the wart)

2- Flat warts

• Are small, slightly elevated, flat-topped, pink or tan papules
• Are smoother than the common wart
• They occur primarily on the face, arms, and legs
• A person can have several, even hundreds of them

3- Plantar warts

• Occur on the soles of the feet
• Often thick and callused, grow inward,
• Can be painful

Mucosal viral warts - Clinical features

• Ano-genital warts (condyloma acuminata)
  • Are gray in color that grow in mucous membranes
  • Vary in size from small, shiny papules, to large lesions
  • Can extend internally into the vagina and cervix, the rectal area, and inside the urethra
  • Are painless, but there can be itching and burning

Diagnosis

• Is clinically
• No specific investigation is done

Treatment

• Common warts, especially in children, have a high rate of spontaneous remission, but without treatment, spread can occur
• Treatment is by physical or chemical destruction of the lesion

1) Physical destruction:

1. Curettage: warts are anesthetized and then scraped with a curette
2. Cautery: electrical burning of lesions
3. Cryotherapy by Liquid nitrogen
4. Surgical removal or excision
5. LASER is used also for removal of warts

2) Chemicals destruction:

1. Podophyllin:
   1. Used for mucous membranes especially genital warts ,should be used cautiously as it is toxic.
2. Salicylic acid in high concentrations
3. Silver nitrate in form of pencils

Linear lesion, localized papules

Cryotherpy