Family health


Straightforward treatments for a bumpy little problem

By Michelle Villett

Seven-year-old Jessica Gormley was distraught when she discovered a wart on her toe. “Although it didn’t hurt, it was really visible and looked awful,” says her mother, Barb, a Toronto fitness trainer. After an unsuccessful attempt to banish it with a drugstore wart remover, the Gormleys opted for a low-tech method. “I’d heard about using duct tape, so I cut a small square of it and we left it on. Three weeks later, I pulled it off. The wart had shrivelled up and came out!”

If only all warts were so easily eradicated. According to Henry Ukpeh, a clinical associate professor of paediatrics at the University of British Columbia, five percent of children will sport warts before age 11 and, in many cases, the warts come back even after repeated treatments. What gives?

“All warts are caused by different types of the human papilloma virus (HPV), which is spread by skin-to-skin contact,” says Ukpeh. HPV infects healthy skin cells, but instead of destroying them, it triggers them to grow, resulting in non-cancerous skin growths we call warts. Some kids are more likely to catch the virus than others. “The most common predisposition is if you have eczema,” says Jaggi Rao, an Edmonton dermatologist and an associate clinical professor of dermatology at the University of Alberta. Eczema weakens the skin’s barrier, which normally keeps viruses like HPV out.

The good news is that most warts aren’t a big deal, says Rao. (But always see a doctor if a wart is sore or bleeding, changes appearance or doesn’t respond to treatment.) Most warts will disappear on their own within 12 to 24 months, says Ukpeh, but since they’re contagious, it’s best to treat them with over-the-counter or doctor’s office treatments. Here are five of the most common warts and how to fight them — fast!
Common warts

Raised, with a rough, scaly surface and white or flesh-toned. Usually found on hands, fingers, arms and soles of the feet.

First line of defence Try an over-the-counter salicylic acid formula. (An ointment sticks to the skin best.) “It irritates and softens skin, then kills the viral cells,” says Rao. “Eventually, the skin will become white and peel off.” Although he doesn’t advocate using just duct tape alone, Rao says covering the wart prevents spreading the virus and may help the medication penetrate. “You can use Band-Aids or any type of tape,” he says.

See a doctor If the wart hasn’t disappeared after four to six weeks of treatment, your dermatologist can prescribe a higher concentration of salicylic acid, says Rao. Although it can be painful, cryotherapy treatment (also known as liquid nitrogen) can also give common warts the cold shoulder. “The nitrogen is applied for 10 to 30 seconds and freezes the area,” says Ukpeh. The cold triggers a tissue injury, and the immune system responds by destroying the wart.

Plantar warts

Found on the soles of the feet, they’re light brown or flesh-coloured with tiny black dots inside them. (The dots are capillaries, which bring blood to the tissue, helping the wart survive.)

First line of defence Because the entire weight of the body is on them when you’re standing or walking, plantar warts can hurt. A salicylic acid treatment in a patch or bandage provides some cushion so they’re less painful, says Ukpeh. Non-prescription freezing treatments can also help, although they’re not as effective as in-office cryotherapy.

See a doctor For stubborn plantar warts that don’t respond to treatment after one or two months, Rao recommends seeing a dermatologist for cryotherapy or laser therapy. “The carbon dioxide laser turns solid wart cells into a gas, which is then removed by a vacuum,” he says. It’s effective on older warts, which contain mostly dead skin cells and don’t respond to immune-stimulating treatments. The downside? It leaves a wound that needs daily dressing changes for two weeks and takes up to 12 weeks to heal.

Flat warts

Smaller and smoother than the other types of warts, these are skin-coloured and appear on the face and legs.

First line of defence Although salicylic acid treatments are not as effective on flat warts as on common and plantar warts, they’re a good first step. But because of the risk of scarring, see a doctor for treating flat warts on the face.

See a doctor Flat warts have a tendency to recur — so if they don’t respond to treatment (or they’re on the face), a doctor can prescribe an antiproliferative agent, which stops the wart’s growth. Ukpeh recommends a four- to six-week course of retinoic acid (which is also used for severe acne), while Rao prefers imiquimod cream (marketed as Aldara), an immunotherapy medication. “You put it on the wart three times a week, and it stimulates the immune system to send cells to the area to attack and kill the virus,” he says.

Periungual warts

Rough and irregular, they occur mostly in nail-biters and appear around or underneath the fingernails.

First line of defence Try a drugstore wart remover and a Band-Aid to prevent spreading. And start early: You don’t want the virus to get under the nail, as this can lead to breakage and even fungal and yeast infections.

See a doctor Periungual warts can be extremely resistant to treatment, so if you don’t see results after four to six weeks, your doctor can prescribe something stronger.

Filiform warts

Long and narrow growths that appear on the eyelids, face, lips and neck.

First line of defence Because of their location, it’s best to see a doctor for removal. (Over-the-counter treatments can lead to burns or abrasions around the warts.)

This article was originally published on Apr 06, 2009

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