INTRODUCTION:

A wart is a small growth with a rough texture that can appear anywhere on the body.It can look like a solid blister or a small cauliflower [1]. Wart generally caused by virus.These virus are generally known as “HUMAN PAPILLAOMAVIRUS” (HPV). Human papillomavirus is a group of non-eveloped double-stranded deoxyribonucleic acid (DNA) viruses belonging to the family papovaviridae.[1] The virus will peneterate both the cutaneous and mucosal epithelium in search of the appropriate cellular host.[1] Till date, there are more than 120 distinct subtype of HPV have been identified with approximately, 40 different subtypes capable of infecting the anogenital tract [2].

These can grossly subdivided into following 3 catagories

1) Low risk: HPV Type 6 and 11 are considered as low risk virus.[2]

2) Intermediate risk: HPV Type 31,33,45,51,52,56,58 and 59 are referred as intermediate risk virus.[2]

3) High risk: HPV Type 16 and 18 are referred as high risk virus [2]

Wart have different names depending on which location/organ are infected by ‘’HUMAN PAPILLAOMAVIRUS’’.

Different names based on their location:-

A) Common wart [2].

B) Plantar wart on feet.[2]

C) Periungal wart on fingernails.[2]

D) Filiform wart on eye lips [2].

E) flat wart on face [2]

F) Genetial wart: i) Anal wart [3]

A) Common warts:

Figure-1

HPV types 2 and 4 (most common); also types 1, 3, 26, 29, and 57 and others. These warts are small grain like skin growths, which occur mostly on your fingers, palms or hands. They are rough to touch, and often appear in a pattern of tiny black dots which are known as seeds, thatare nothing but small, clotted blood vessels. Common warts usually appear in solitary or in groups on hands, palms or fingers. Although they may grow on any part of the body, but usually grow in areas that comes in constant contact with other people, if you look at it, it may appear to be rough, grayish brown, dome-shaped growths.[2]

Treatment:

1) Salicyclic acid: These acid are thought to prompt the body’s immune system to fight off the virus. [2]

2) Cryotherapy: Liquid nitrogen is applied to the infected skin to freeze off the common wart. The freezing causing blister to form.To prevent infection,the blister can be covered with bandage and after a week the patient can remove dead skin [2].

3) Laser treatment: Laser removal is another form of surgical removal in which a directed laser beam is used to remove the wart tissue. But it is expensive treatment and leave some scar.[2]

4) Cantharidin: It is less cold than “CRYOTHERAPY” but similar to cryotherapy [2].

5) Burning with electric needle [2]

6) Surgery also have method to remove eart completely.[2]

B)PLANTAR WARTZ:

Figure-2

It is also known as "VERRUCA PLANTARIS". It is wartz caused by HPV which enters the human body through tiny cuts and breaks through the skin occuring on soles or toes of feet.It include small fleshy and gruinly bumps on the soles of the feet. Gray or brown lumps with one or more black points which are small clotted blood vessels and also pain and or tenderness while walking.[2]

Treatment:

1) Cryotherapy: Liquid nitrogen is applied to the infected skin to freeze off the plantar wart. The freezing causing blister to form. To prevent infection, the blister can be covered with bandage and after a week the patient can remove dead skin.[3]

2) Burning with electric needle.[3]

3) Cantharidin: It is less cold than “CRYOTHERAPY” but similar to cryotherapy. [3]

4) Salicyclic acid: These acid are thought to prompt the body’s immune system to fight off the virus.[3]

5) Laser treatment: Laser removal is another form of surgic al removal in which a directed laser beam is used to remove the wart tissue.But it is expensive treatment and leave some scar.[3]

6) Injecting candidia antigen (allergy causing protein).[3]

C) PERIUNGUAL WARTS:

Figure-3

Periungal wartz are warts that cluster around the fingernail or toenail. They appear as thickened, fissured cauliflower-like skin around the nail plate. Periungual warts often cause loss of the cuticle and paronychia. Nail biting increases susceptibility to these warts.[1]

Treatment:

1) Pulsed dye lasers have also been used for the treatment of periungal wart [3]

2) Intralesional bleomycin: Intralesional bleomycin has been used for treatment of peringual wart.[3]

3) Cryotherapy: Liquid nitrogen is applied to the infected skin to freeze off the periungal wart. The freezing causing blister to form.To prevent infection,the blister can be covered with bandage and after a week the patient can remove dead skin.[3]

4) Salicyclic acid: These acid are thought to prompt the body’s immune system to fight off the virus.[3]

5) Sugery also have method to remove wart completely.[3]

6) Carbon di-oxide (CO2) laser therapy.[3]

Some reactions during treatment: Temporary or permanent nail dystrophy and scarring have been reported in patients treated with carbon di-oxide lasers.[3]

D) FILIFORM OR DIGITATE WART:

Figure-4

Filliform wart have skin colured finferlike projections and most typically form on the face, neck, eyelids and lips. However, filliform wart are not limited to the face.they can also crop-up in other areas with thin skin tissue such as armpitz and certain areas of leg.[3]

Treatment:

1) Cryotherapy: Liquid nitrogen is applied to the infected skin to freeze off the filiform wart. The freezing causing blister to form.To prevent infection,the blister can be covered with bandage and after a week the patient can remove dead skin, [3]

2) Cantharidin: It is less cold than “CRYOTHERAPY” but similar to cryotherapy.[3] 3) Salicyclic acid:-These acid are thought to prompt the body’s immune system to fight off the virus [3].

4) Laser treatment: Laser removal is another form of surgical removal in which a directed laser beam is used to remove the wart tissue.But it is expensive treatment and leave some scar.[3]

E) FLAT WARTS:

Figure-5

It is technically known as Verruca plana, are reddish-brown or flesh-colored, slightly raised, flat-surfaced, well-demarcated papule of 2 to 5 mm in diameter. Upon close inspection, these lesions have a surface that is "finely verrucous". Most often, these lesions affect the hands, legs, or face, and a linear arrangement is not uncommon. At histopathology, flat warts have cells with prominent perinuclear vacuolization around pyknotic, basophilic, centrally located nuclei that may be located in the granular layer. These are referred to as "owl's eye cells.[1]

Treatment:

1) Cryotherapy: Liquid nitrogen is applied to the infected skin to freeze off the flat wart. The freezing causing blister to form.To prevent infection,the blister can be covered with bandage and after a week the patient can remove dead skin.[2]

2) Cantharidin: It is less cold than “CRYOTHERAPY” but similar to cryotherapy. [2]

3) Salicyclic acid: These acid are thought to prompt the body’s immune system to fight off the virus.

4) Laser treatment: Laser removal is another form of surgical removal in which a directed laser beam is used to remove the wart tissue. But it is expensive treatment and leave some scar.[2]

F) GENETIAL WARTZ:

Figure-6

It is also known as “CONDYLOMATA ACUMINATA” (CA). It is generally caused by HPV Type-6 and 11. These virus rarely give rise to cervical cancers but are responsible for 90% of cases of genetial wartz. It is generally transmitted by sexually.[2]

Treatment:

1. Podophyllotoxin 0.05% solution or gel and 0.15% creams (Grade A) [2]

2. Imiquimod 3.75% cream (Grade A) [2]

3. Imiquuuimod 5% cream (Grade A) [2]

4. Cinecatechins 15% ointment (Grade A) [2]

5. Trichloroacetic acid (TCA) 80-90% solution (Grade B) [2]

6. Cryotherapy: Liquid nitrogen is applied to the infected skin to freeze off the plantar wart. The freezing causing blister to form. To prevent infection,the blister can be covered with bandage and after a week the patient can remove dead skin.[2]

7. Electrosurgery (Grade B) [2]

8. Surgical scissor excission (Grade B) [2]

9. Carbon dioxide (CO2) laser therapy (Grade B) [2]

Vaccines:

1) Gardasil (HPV-4): Use in the female age between 9-26 and Also prevent of precancerous or dysplastic lesions caused by HPV-6, 11,16 and 18. [2]

2) Cervarix (HPV-2): Use in females in age between 10-25 years and fight aginst HPV 16 and 18. [2]

Common Causes:

1) Touch: HPV can be spread between people when one person touches a wart or an HPV-infected area on another person.It can also spread from one area of the body to another when a person first touches an infected area then touches another part of his or her body. HPV can spread especially quickly through areas of broken skin.[3]

2) Contact through object: HPV can live in environment such as showers floors, concrete surrounding pook and even shoes.[3]

3) Sharing clothing: HPV can spread through clotting towels and other fabrics that come into contact with a wart or another infected area.[3]

Some Common Precautions:

1. Wash your hands thoroughly and regularly.[3]

2. Carry a hand sanitizer [3]

3. Air dry your hands after using public emergency facilities [3]

4. Clean up the equipment before using it, in gyms [3]

5. Be careful while coming in contact with an infected person [3]

6. If you have Cuticles get them treated as well [3]

7. Cut your nails properly [3]

8. Take bath on regular basis [3]

9. Eat Healthy Diet to keep your Immune System Strong [3]

10. If you have any cuts on your hand or fingers, you should treat it properly.[3]

i) Anal Wart:

Anal warts are HPV infections that occur on around the anus, inside the rectum or on the buttock. They’re also a form Genetial warts. While genital warts are spread through sexual contacts, anal warts are similar. In young people, HPV can go away by itself and may not show up any symptoms. However, the virus sometimes remains and leads to warts in the genitals, including the anus. In most cases, anal warts are painless, but they become irritating if they get bigger. Besides, they can spread to different parts surrounding the anus over time. HPV can be passed even if it never shows up symptoms. So, it’s important to know warning signs of anal warts in order to avoid and remove them as soon as possible.[2]

Signs and symtoms:

· Small bumps that are difficult to notice appear inside or around the area of the anus [1]

· These bumps are clustered together that look like cauliflower [1]

· They’re yellow, light brown or peach- colored [1]

· Painless and discomfort [1]

· In severe cases, itching, bleeding and discharge from the anus can occur [1].

Causes:

1) Constipation: You may not think about this cause. But, in some cases of serious constipation, straining results in tears in the areas around the anus. This increases your risk of contracting anal warts. To reduce constipation, you should eat more vegetables and fruit. [1]

2) Non-sexual contact: No need to perform sex, you can also get anal warts. If you get HPV on your hands and touch to areas surrounding the anus, you may get the infection. So, you should avoid “hand job” if you or your partners have HPV infection. Besides, practicing good personal hygiene is a good way to reduce the risk.[1]

3)Anal Sex: Unprotected methods during anal sex gives you more risks of contracting the HPV infection [1]

REFERENCES:

1. The Journal of Clinical and Aesthetic Dermatology by Valerie. R. Yanofsky, Rita. V. Patel and Gary Goldenberg in 2012 Jun;

2. Therapeutics Approaches in The Management of Plantar Wartz by G.K. Sudhakar, Vasudev Pal, Arvind Pal, Venkatesh Kamath Publish on 21-12-2013 and Publish by Asian Journal of Biomedical Pharmaceutical Science.

3. Khalid.M. Alghamdi Md And Huma Khurram Md,2011 By The American Society For Dermatologic Surgery Inc. Published By Wiley Periodicals Inc.

Received on 23.10.2019 Modified on 30.12.2019

Asian J. Res. Pharm. Sci. 2020; 10(1):31-34.

DOI: 10.5958/2231-5659.2020.00007.7