1]What are warts?
Warts are intraepidermal tumors of the skin and mucosa caused by infection with the human papilloma virus ,which are small 50-55-nm-diameter DNA viruses.This virus can infect and cause disease at any site in skin or mucosa. Warts can be broadly divided into cutaneous warts, genital warts,oral warts and laryngeal warts.
2]Which Type Of People Warts are Common?
Common in People whose immunity level is low.
3]What age warts can occur?
Warts occur at any age. The incidence increases during the school years to reach a peak between the ages of 12 and 16 years .
4]WHAT ARE THE TYPES OF WARTS?
A] Common warts -are firm papules with a rough, horny surface, less than 1mm to over 1cm in diameter, and by confluence form large masses.Commonly situated on the backs of the hands fingers,shaft of penis.They are usually symptomless, but may be tender on the palmar aspects of the fingers when fissured.When growing beneath the nail plate,they may disturb the nail growth.
B] Plantar warts – plantar wart appears as rounded lesion, with a rough, keratotic surface surrounded by a smooth collar of thickened horn. Mostly seen beneath the forefoot ,toes and heel. Pain is a common symptom.
C] Flat warts–are smooth, flat or slightly elevated and are usually skin-coloured . They are round or polygonal in shape and vary in size from 1 to 5mm.. They are seen on face, backs of the hands and the shins .
D] Filiform and digitate warts –Filiform and digitate warts occur commonly in the male, on the face and neck and scalp irregularly distributed, and often clustered.
E]Anogenital warts- or condyloma acuminatum They are often asymptomatic, but may cause discomfort, discharge or bleeding. They are soft, pink, elongated and sometimes filiform or pedunculated. Large malodorous masses may form on vulvar and perianal skin.
5]HOW WARTS ARE TRANSMITTED?
Warts are spread by direct or indirect contact. Impairment of the epithelial barrier function, by trauma greatly predisposes to inoculation of virus..
A] Plantar warts are commonly acquired from swimming pool or shower-room floor.
C ] Hand warts may spread widely round the nails in those who bite their nails .Occupational handlers of meat, fish and poultry have high incidences of hand warts.
D] Shaving may spread wart infection over the beard.
F] Genital warts . – IN ADULTS commonest in sites subject to greatest coital friction in both sex.
Infection from the mother’s genital tract and sexual abuse are regarded as a frequent source of childhood anogenital warts-
6] DO WARTS CAN BE TRANSMITTED THROUGH SEXUAL INTERCOURSE?
Anogenital warts can transmit through sexual intercourse
7] HOW MANY DAYS AFTER CONTACT WITH THE PERSON U CAN GET THE DISEASE?
Between a few weeks and more than a year.
8}WHETHER WARTS CAN CHANGE TO NEOPLASIA?
Warts are initially benign. A small percentage can progress to neoplasia.
9]How diagnosis warts?
Clinical diagnosis is sufficient.but atypical,subclinical and dysplastic lesions need
B]Detection of virus particles by electron microscopy
C]Immunohistochemistry or immunocytochemistry using type-common or type-specific antibody
D]DNA hybridization on tissue extracts
E]Polymerase chain Reaction
10]WHAT ARE THE PRECAUTIONS TO BE TAKEN NOT TO SPREAD WARTS?
1]Plantar warts should be covered with adequate plaster strapping, or the foot with close-fitting rubber ‘verruca socks’, at swimming pools or communal baths or showers.
2]Avoid nail bitting
3]Cleaning of baths after use
4]Avoid sharing towels
5]Vulvar warts may be so large in pregnancy as to obstruct vaginal delivery and require caesarean section.
6]Cervical smear examinations at annual intervals, should be advised both for female anogenital warts patients and for female partners of male patients. This is important if an HPV type known to be associated with neoplasia.
7]Considering the high sexual infectivity of anogenital warts,it is usual to advise abstention from intercourse or use of condoms until visible lesions are clear or some suggest 12months thereafter .In stable relationships, infection of the partner will already have taken place, and it is not known whether the patient can ever be deemed free of infectivity.
8}In children with anogenital warts, consideration should be given to the possibility of sexual transmission and the advisability of referral to a child abuse specialist.
11]HOW THE TREATMENT SHOULD BE DONE?
The routine treatment of every wart is unnecessary and undesirable. Before specific treatment , explain to the patient or parent that warts can be expected to resolve spontaneously without trace
Treatments like topical preparations and surgical approch for warts involve destruction of the area of epidermis infected with the virus.. Other therapies aimed at modifying growth of the epidermis or to stimulate an immune response require either a topical or a systemic approach.
1}Destruction by electrocautery,electrosurgery and curettage.
2]Cryotherapy with liquid nitrogen
3]Keratolytic therapy with salicylic acid and lactic acid
4]TOPICAL Podophyllin or podofilox ,cytotoxic agent
5]Occlusive tape like duct tape
6]Painting with trichloro acetic acid,cantharadin etc
8] Carbondioxide laser surgery
9]topical imiquimod is an immune response modifier that has anti viral and antitumor activities.
10]Topical 5-fluorouracil 5% cream
11]Topical Cidofovir gel,an antiviral agent
12]contact immunotherapy with Dinitrochlorobenzene.
15]oral cimetidine and etretinate and
16]HPV VACCINATION NOW AVAILABLE