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Warts / Verrucae

Overview

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  • Warts are double-stranded DNA proliferations on the epidermis that are benign and are caused by human papillomavirus (HPV) infection.

  • This virus causes cutaneous and mucous membrane infections.

  • The number of distinct HPV strains exceeds 150. DNA hybridization establishes novel subtypes. Certain subtypes have distinct clinical and pathological presentations and are associated with a specific location.

  • The mode of transmission is through direct contact, frequently occurring at locations afflicted with minor skin tears, abrasions, or other forms of trauma. Infection requires the exposure of basal epithelial cells to the virus.

  • The method of local transmission is frequently autoinoculation.

 

Causes

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The Human Papillomavirus (HPV) contributes to the development of warts, which are also called verrucae. Epithelial hyperplasia accompanied by surface hyperkeratosis of varying degrees is a frequent manifestation of HPV infection on the skin, but less frequent in the mucous membrane. Certain head and pituitary cancer-causing HPV cause invasive and intraepithelial neoplastic lesions, such as cancer of the vulva, anal, and cervical regions.

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Treatment

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Warts are often treated by removing the virus-infected epidermal region. Treatments might be topical or surgical. Additional treatments aimed at altering epidermal development or stimulating an immunological response necessitate either topical or systemic treatment.

Infected tissue can exist several millimeters below the skin surface. Treatment modalities deliver precise highly controlled energy dose that rapidly elevates tissue temperature and create localized cell destruction. Treatment utilizing microwave technology has advantages with no smoke or plume, which reduces many of the hazards associated with other energy-based treatments. As microwave energy travels into the tissue, the water molecules try to align with the microwave field causing them to collide and create friction (Hagon et al., 2023). The heat generated quickly destroys all infected tissue and create a highly accurate zone of treatment. In just seconds, the treatment is complete, and the healing cascade begins immediately. Treated tissue is quickly repaired, replaced and regenerated.

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Local Destructive Therapy

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The destructive or ablative treatments that are commonly advised for genital warts consist of the following: cryotherapy, trichloroacetic acid (TCA) or bichloroacetic acid (BCA), electrosurgery, excision by scissors or shave, curettage, laser vaporization, or curettage excisional procedure. Local agent injection or topical application is typically adequate when anesthesia is required (Truong et al., 2022).

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Caustics

Monochloroacetic acid, trichloroacetic acid, silver nitrate, cantharidin, phenol, and other highly irritating compounds can be utilized effectively but may produce painful reactions (Basavarajappa et al., 2021). In the treatment of genital warts, cryotherapy is somewhat more successful than trichloroacetic acid (Habif et al., 2018).

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Retinoic Acid

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This medication can be used topically in plane warts; however the best outcomes are claimed for greater concentrations, and discomfort is prevalent; 85% of 25 children with plane warts treated with 0.05% tretinoin cream had their warts eradicated, compared to 32% of controls (Kore & Anjankar, 2023).

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Cimetidine

The use of oral cimetidine for wart therapy in adults has shown inconsistent results. In open investigations with high-dose cimetidine (30-40 mg/kg/day for 3-4 months), two-thirds indicated improvement or full remission without relapse of warts (Zhu et al., 2022).

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Retinoids

Oral retinoids, which reduce epidermal proliferation, can assist in debulking warts, but the infection may persist, making relapse more likely. Etretinate, acitretin, and isotretinoin have all been shown to be effective in treating widespread and hyperkeratotic warts in immunosuppressed patients.

Oral retinoid therapy has the potential to treat hyperkeratotic warts in otherwise healthy individuals. This effect may be temporarily beneficial, such as decreasing pain or impairment caused by severely hyperkeratotic warts or making other therapies more effective (Kore & Anjankar, 2023).

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REFERENCES

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Basavarajappa, S., Subramaniyan, R., Dabas, R., Lal, S., & Janney, M. (2021). A Comparative Study of Topical 5% 5-Fluorouracil with Needling versus 30% Trichloroacetic Acid with Needling in the Treatment of Plantar Warts. Indian dermatology online journal, 12(3), 412-416. doi:https://doi.org/10.4103/idoj.IDOJ_507_20

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Habif, T. P., Dinulos, J., Chapman, M., & Zug, K. (2018). Skin Disease Diagnosis and Treatment (Fourth ed.). Elsevier.

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Hagon, W., Hagon, J., Noble, G., Brenton-Rule, A., Stewart, S., & Bristow, I. (2023). Microwave therapy for the treatment of plantar warts. Journal of foot and ankle research, 16(1), 37. doi:https://doi.org/10.1186/s13047-023-00638-8

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Kore, V., & Anjankar, A. (2023). A Comprehensive Review of Treatment Approaches for Cutaneous and Genital Warts. Cureus, 15(10), e47685. doi:https://doi.org/10.7759/cureus.47685

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Truong, K., Joseph, J., Manago, B., & Wain, T. (2022). Destructive therapies for cutaneous warts: A review of the evidence. Australian journal of general practice, 51(10), 799-803. doi:https://doi.org/10.31128/AJGP-01-22-6305

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Zhu , P., Qi, R., Yang, Y., Huo, W., Zhang, Y., He, L., . . . Gao, X. (2022). Clinical guideline for the diagnosis and treatment of cutaneous warts. Journal of evidence-based medicine, 15(3), 284-301. doi:https://doi.org/10.1111/jebm.12494

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