Warts are mostly small growths on the surface of the skin, often round and with rugged outer area and flat top. They are often redder or browner than the surrounding skin. They are often seen in groups. They appear gradually, grow to some size, and then remain at that size for a long time. Eventually the wart may fade away and disappear, but not allways. in addition to the common type, warts can occure in many other shapes:

- Flat warts - a small, smooth flattened wart, flesh coloured, sometimes in large numbers, common on the face, neck, hands, wrists and knees

- Filiform or digital warts - a finger-shaped wart, most common on the face, especially near the eyelids and lips.

- Compressed warts - These are formed on pressure-points, usually the soles of the feet. They are hard and flattened lumps, often with dark spots in the middle.

-Mosaic-warts - These are found in a great number tightly clustered and are hard and flattened lik plantar warts. They are common on the hands and soles of the feet.

- Genital warts - warts found on the genitalia are so called. They are often found in the inner aspects of the genital lips and around the rim of the penile head, but can spreda backwards to the anal area and in the rest of the pelvic region. They vary considerably in size, shape and number. Filiform types are common, so is the flattened type. They can also attain highly irregular shapes and grow to large masses.

Warts are caused by a virus infection, by human papiloma virus or HPV, which are found in approximately 100 strains, of which number 1, 2 and 3 cause most warts. Warts are contagious by contact with the skin of an infected person. Warts are common in school-aged children due to the high frequency of contact with other children and adults during shool-time.  The incubation time is 1-8 months.

It is often said that people with warts going barefooted in clothing rooms, douches and gymrooms can stck contagious material to the floor and thereby indirectly transfere the virus to other persons. It is however difficult to find good scientific research that support this view.

Genital warts are often, but not allways sexually transmitted. Even small children can get genital warts without any sexual contact, probably because of transmission from the fingers to the genital area.

There are many types of human papilloma virus. All the rypes can infect all body areas, but the different types still prefere certain areas like the fingers, the feet or the anogenital region.

Type 1 usually causes deep compressed warts on the soles of feet (plantar) and the palms of the hands (åalmar).

Type 2 causes common warts on the most usual places but also  filiform warts, plantar warts, mosaic plantar warts.

Type 3 causes flat or plane warts on usual places.

Types 6, 11 and sometimes types 16, 18, 30, 31, 33, 34, 35, 39, 40 and others cause anogenital warts.

Human papilloma viruses can also cause cancer. HPV types 16 and 18 currently cause about 70% of cervical cancer cases, and also cause some vulvar, vaginal, penile and anal cancers.[

HPV may also cause  oral cancer, laryngeal cancers, tracheal and lung cancers

THE PREVENTION  AND TREATMENT OF WARTS

Some incidents of may be avoided by protecting the feet and hands from comming in contact with the virus, for example by holding baths, douches and athletic areas in schools and other public institutions clean and allways wearing some type of footware in such areas.

However, you can find people with warts everywhere, and totally avoiding skin contact with infected people and totally avoiding coming in contact with deposited contagious material is difficult. The measures necessary to totally avoid contact with wart-causing virus will be too cumbersome to be practicle.

Daily and frequant wash of hands and feen and daily wash of floors and utensiles is important. People having warts on their feet should wear some footwear to avoid contamination of floors. People having warts on the fingers should have gloves on their hands when they care for special sensitive areas of children and patients, like the genitals.

The vaccine Gardacil is intended to prevent  HPV types 16, 18, 6, and 11 from infecting and thereby preventing anogeital warts and cancer caused by these strains. It may also  prevent infections to other strains of anogenital warts through cross protection.

Several physical methods are used to treat warts. These methods has the aim of destroying or removing all the cells that the wart consist of and infected cells in the surroundings. In order to do so the methods must work somewhat deeper than the wart itself and somewhat around the wart in all directions.

Heating with lasers or with infrared waves is a common surgical method to remove warts. These ,ethods work partly by coagulating blood in the tissue and partly by boiling the water within the tissues.

Freezing the warts with liquid nitrogen or with substances that evaporate rapidly is another common method.

Electrosiccation where one uses electricity to dissolve and coagulate wart tissue is still another physical mehtod.

Surgery where the warts and some surrounding tissue is cut out is sometimes used. Usually the surgical methods used is scooping or scraping.

Dissolving the wart by means of media containing salicylic acid is a much used method and seems to be equally good as the other methods. The medium must be applied repeatedly during a longer time, and after each time dead tissue must be scratched off. Media containing lactic acid,  formaldegyde and silver nitrate are used much the same way.

Warts can be dissolved by applying  podophyllum resin paint, consisting of  podophyllum resin I.P.'66 (20% w/v), benzoin I.P. (10% w/v), aloes I.P. (2% w/v), isopropyl alcohol I.P. to make (100% v/v). (Prescription bound in US.)

There are certain topical or injected media that can be used to strengthen the immune system's responce against the warts.

Injection of Candida, mumps, or Trichophyton antigens at the place where the warts are may stimulate the immune responce against the warts. (Experimental treatment.)

Imquimode is a topical preparation that enhances interferone responce and thereby strengthens the responce of the immune system against the warts. (The drug is not appoved for treatment against common warts in US .)

Dinitrochlorobenzene (DNCB) used topically  induces an allergic immune reaction that result in attack on the vra caiseing warts. The drug is a mutagen and must therefore be used cautiously. (Prescription bound in US)   

Fluorouracil inhibits DNA suntesis and can be used as a topical medium against warts. (Experimental drug not well proven)

Bleomycin, cytostatic antibioticum,  can be injected at the site of the wart to make the wars shrink. The drug is however dangerous if not used very cautiously because it can cause Reynold's fonomenon and necrosis of the fingers. (Not US approved for this treatment.)

Cantharidin, a substance found naturally in many members of the beetle family can be used as wart treatment by causation of dermal blistering. Either used by itself or compounded with podophyllin. (Not US approved)

Herbal treatment of warts has the aim of making the environment hostile for the wart virus, and to stimulate  the bodie's defence aginst the wart virus. These products can also contain ingredients that gently dry out the wart.

Many of the topical treatment methods are combined with repetitive scraping away dead wart tissue and then there must be reapplication of the topical medium several times over a period.

Here are two pictures showing warts on a finger and under a toe. The warts under the toe appear flat because they are pressed down in the skin from the pressure against the toe.