nhsManagers.net | Briefing | 26 January 2017

Medicine for Managers

Dr Paul Lambden BSc MB BS BDS FDSRCSEng MRCS LRCP DRCOG MHSM FRSM

Warts and verrucae come in a variety of sizes, shapes and in virtually any location. Both are caused by the Human Papilloma Virus (HPV) and are distinguished by location. Warts affect the top layer of the skin and the virus normally enters the body through an area of broken skin. They develop almost anywhere and the virus stimulates the surface layers of skin to proliferate and the wart is formed.

Warts tend to be spherical and dome-shaped and they may be smooth or roughened

and scaly and some have a fronded appearance

They vary in size from a millimetre to a centimetre or more in diameter and may be solitary or in clusters. They are most commonly found on the hands and knees. They are very common and the actual incidence is not known. They are most common in children and young adults but any age group may be affected. They are often tender to touch. If untreated, in children, about half of all warts disappear within a year and most within two years. In

Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.

Warts and verrucaeIt was only realised in the 1950s that warts and verrucae were caused by a virus. We have virtually all had them and they are harmless lumps that appear on the skin, sometimes singly, sometimes in clusters, which usually go away on their own after a period of months or sometimes years. Warts can spread round the body and can be passed from person to person.

adults they may take longer to disappear; anything up to ten years.

Verruca (plural verrucae - derivation unknown) are plantar warts (that is to say they develop on the soles of the feet and around the toes. They are commonly white often with some scaling but frequently have black dots within them. They can be very painful if they are located on the weight-bearing part of the foot or if they contact the shoe.

Sometimes they may become very large

Warts and verrucae are more likely to develop if the immune system is weakened for any reason

Genital warts are small, often fleshy outgrowths which appear singly or in clusters around the genital area. Also caused by the HPV they are transmitted during intimate sexual activity as a result of skin-to-skin contact. They are usually treated at a genito-urinary medicine clinic and are outside the scope of this item.

How are warts acquired? They are normally spread by skin-to-skin contact or by contact with contaminated objects such as towels and floor areas

(particularly in changing rooms), the areas round swimming pools and showers used communally or in hotel rooms. Skin is vulnerable to infection if it is wet or damaged.

Treatment of Warts and Verrucae Most warts and verrucae will spontaneously resolve eventually without treatment. There are a variety of treatments when treatment is required, either because they are painful or because they are cosmetically unacceptable.

The pharmacist can advise on proprietary preparations for warts and verrucae. Commonly available preparations include: Salicylic Acid as gels and creams or medicated plasters. The acid acts as a chemical cautery destroying the top layer of skin. Care should be taken to avoid getting it on healthy surrounding skin. The affected area should be treated with a pumice stone twice-weekly to remove dead skin. Dimethyl ether propane is available as a spray which is designed to freeze the wart. Such sprays may work for small single warts but is less effective with larger clusters.

In some circumstances it may be necessary to obtain medical advice from the GP, particularly:

• If the wart(s) is on the face • If there is doubt that the lesion is in

fact a wart, particularly if it bleeds or becomes ulcerated

• If there are repeated episodes of wart infection.

Warts may be treated with liquid nitrogen which is an effective technique for destroying them. The liquid nitrogen is applied, either on cotton wool or through a probe, for approximately twenty seconds. The wart may be destroyed with one application or it may need to be repeated up to about four times.

Sometimes it proves necessary to treat warts surgically either by scraping the

Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.

warts off using a curette under local anaesthetic or by employing a laser to destroy the wart and its blood supply.

Throughout medical history remedies for warts have been reported. Ancient Egyptian texts suggest that cautery was employed and the mummified remains of an Egyptian courtier from about 2400 B.C. shows the presence of warts. Celsus described warts and the Greeks and Romans knew about genital warts and their transmission.

Some of the more surprising techniques have included:

• In ancient Rome an individual who was engaged to chew them off fingers and toes!

• In medieval times, application of spiders webs or a mixture of ashes and pig faeces.

• During the time of Henry VIII, the application of a dead mouse was believed effective. Indeed Henry VIII granted legal status to anyone employing techniques for wart removal

• A traditional folk remedy was to apply the sap of the greater Celandine plant

• In The Adventures of Tom Sawyer,

Mark Twain wrote of the use of “spunk-water” (water collecting in the hollow of a tree stump) as a remedy, followed by walking eleven steps with the eyes shut, turning round three times and walking home without speaking.

• Rubbing a wart with a cut potato or an onion which must then be buried is favoured in many places

• Cutting the head off an eel and rubbing the wart with the blood (followed by buring the eel’s head) may be more fatal for the eel than for the wart

• A modern farming remedy is to cover the wart with Duct Tape and pull it off after three days. Allegedly the wart peels off with it

A long-standing tradition is that touching a toad causes warts.

Although toads may have a superficial resemblance to warts sometimes, toads do not carry wart virus and cannot have any influence on the condition.

paullambden@compuserve.com

Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.