Warts & All

Warts come in all shapes and sizes and can be flat, bumpy, smooth, textured like cauliflower or contain tiny pin dots. Most HPV types are benign with the important exceptions of types 16 and 18, the cause of 70% of cervical cancer cases, along with eleven other cancer-associated types, all of which we discussed in last week’s posting.

How contagious is contagious?

Warts enter the system through tiny cuts or abrasions in the skin that may not even be visible to the naked eye. We’re not sure why some people get them and others don’t but we do know that warts are more common in children, in those with compromised immune systems, or in those who are under stress.

Though all warts are contagious, different HPV types are more so than others. The strains causing plantar warts on the bottom on the feet (strains 1, 2, 4 and 63), for example, are so virulent and can stay alive on a floor for up to 20 months. And you can actually reinfect yourself as you’re walking. For plantar wart prevention then, flip flops are your first line of defense:

• wherever you’re barefoot in public, at the gym, in a sauna or at a swimming pool
• if you yourself, your partner or family member is infected
• when you travel. I can’t tell you how many cases of plantar warts we see in patients who have traced their source back to hotel bathrooms around the world. And this contagion isn’t just restricted to fleabag flophouses either (hardly the places that my patients enjoy frequenting, btw) but top tier spas, hotels and resorts. It’s the perfect (wart) storm because long distance travel, by its very nature, stresses the body and leaves it vulnerable.

Unfortunately, the vaccines so effective for genital warts have no effect on other HPV types. So if you or a family member find yourself sporting a wart, your choices are to leave it alone since many warts go away by themselves, particularly in children, try to treat it yourself or go pro.

DIY wart removal

Much of the time, the over the counter anti-wart remedies are very effective and I always recommend this as the first course of action. Follow the directions to the letter.

And believe it or not, covering your wart for several days with duct tape or gaffer’s tape does work too. We’re not sure why but the HPV virus may need oxygen to survive and this action starves it of that. Here’s how to do it:

1. Cover the wart with a piece of tape that’s ¼” larger that the lesion itself. In the case of a finger, just wrap it around. Leave it on day and night without moving it.
2. After 6 days, remove the tape and abrade the area with a new or bleach-sterilized pumice or file.
3. Replace the tape.
4. Repeat as many times as necessary until the wart is gone but then repeat one more time just to be sure.

Professional necessity

Warts in clusters (mosaic warts), stubborn recurring cases, those on the face or plantar warts are going to need professional intervention at the doctor’s office. Having us treat the face is a safety measure; though warts don’t usually cause scarring it’s better to be safe than sorry. And because stubborn plantar warts often come in clusters and can be extremely painful as they grow deep into the foot’s surface, they can be vanquished easier with professional tools, techniques and medicines.

In the early days of lasers, we dermatologists were very excited about using this new technology to burn off warts. Unfortunately however, we didn’t realize that the spume (that is, the smoke from the burning wart tissue) was dispersing HPV into the air and some laser providers were subsequently getting warts on their faces. Once this started to happen, we returned to the tried and true of shaving and freezing.

How we usually treat warts in the office is to first shave them down and then apply a quick spritz of -346°F (-210°C) liquid nitrogen to kill the virus- infected tissue. We’ll then send you home with a topical medication or the prescription retinoid Tazorac. Stubborn cases may require multiple treatments but in the end, we shall prevail and the warts will be gone.

Oh and for the record, you can’t get warts from a toad unless you yourself are a toad and your mother was too.

HPV is all over the place but warts don’t have to live on your skin.

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