Periungual wart: how to get rid of it effectively?

Perhaps, a periungual wart is the most uncomfortable formation that can appear on the fingers and toes. Not only does the growth look completely unaesthetic: it can itch or even hurt, get damaged, bleed, etc. How can this problem be solved?

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Epidemiology

A wart associated with the human papilloma virus is an extremely common skin problem that is characterized by a long course with a high probability of relapse. Human papillomavirus infection is often latent, manifesting itself in only 3-9% of pediatric patients and 28-30% of the adult population. Overall, the virus is present in approximately 80% of people worldwide.

There is no gender or racial preference for viruses. Periungual warts can appear at any age, from children to the elderly.

Causes periungual wart

A periungual wart begins to grow actively after a microtrauma of the area near the nail, against the background of weakened immune protection. Most often, the neoplasm grows in close proximity to the nail plate, but it can also “get under” it, which causes particular discomfort.

Periungual warts are always a consequence of the penetration of the papillomavirus into the body, which, unfortunately, is extremely common and is present in eight out of ten people.

Not all "owners" of a viral infection develop periungual warts. As we have already said above, certain conditions are necessary for their development: for example, a sharp drop in immunity against the background of microdamage to the skin or systematic high humidity.

A person's immune defense can weaken not only under the influence of various diseases or hypothermia, as many people think. Stress, serious conflict situations, overwork, lack of sleep, as well as poor monotonous nutrition and hypovitaminosis can reduce the protective qualities.

Risk factors

The papilloma virus is highly contagious, so it is very difficult to avoid infection. In addition, there are a number of factors that increase the risk of infection and the manifestation of a viral infection:

• the presence of bad habits, unhealthy lifestyle;
• promiscuous sexual relations;
• ignoring compliance with individual hygiene rules – for example, when visiting public baths, gyms, etc.;
• endocrine system diseases, metabolic disorders, weakened immunity;
• frequent and long courses of antibiotics or other medications that negatively affect the quality of immune protection;
• hormonal imbalances, changes (in particular, adolescence, pregnancy).

Pathogenesis

The causative agent of periungual warts is considered to be the human papilloma virus - a DNA-containing viral infection. To date, about two hundred genotypes of this virus have been identified and described. Infection occurs through contact and household means: the risk of infection increases especially with various microdamages to the integumentary epithelium. The probability of infection depends on certain factors: the degree of viral load, the nature of contact with the carrier, the general health and immune system of the person are important.

In the cellular structures of the basal layer, a viral infection can persist for a long time without revealing itself. When favorable conditions arise, the mechanism of viral replication is triggered. As a result of this process, cellular differentiation is disrupted, and the tissues undergo morphological changes: a periungual wart is formed.

Symptoms periungual wart

A periungual wart is an extremely unpleasant growth on the skin of the fingers, in close proximity to the nail, in appearance and sensation. In some patients, warts develop immediately under the nail plate, which causes additional inconvenience and discomfort. The nail may become uneven, rough, sometimes peeling and disintegrating.

A newly formed wart usually does not hurt. But, having reached a large size, or having “crawled” under the nail, it quite often provokes a constant pain syndrome.

Over time, the nail plate becomes brittle, deteriorates, and exfoliates. Often, other fingers are involved in the process, and the problem worsens.

The first signs of wart formation may manifest themselves as local itching, tingling, and skin tension. In some cases, the temperature may increase slightly - to subfebrile levels. A small nodule with a granular surface appears on the skin, and over time it becomes covered with layers of hyperkeratosis. Any attempts to scrape off or remove the growth end in bleeding. In the future, the formation grows even more intensively.

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Complications and consequences

Complications may occur in some patients under the influence of such factors:

• individual characteristics of the organism;
• general health;
• a large number or large size of warts;
• lack of treatment, self-medication, improper treatment of growths.

The main adverse effects and complications of periungual warts are:

• pain syndrome, bleeding, frequent damage to formations;
• the appearance of cicatricial changes, the spread of damage to healthy tissue;
• the addition of a bacterial infection, suppuration, tissue inflammation;
• malignancy (a rare complication involving malignancy of a periungual wart).

Diagnostics periungual wart

When starting diagnostics, the doctor will first carefully examine the disturbing growth on the skin, pay attention to its multiplicity, pain when pressing, and changes in the shape of the nails. As a rule, experienced doctors can diagnose a periungual wart already at this stage. However, to exclude other diseases, including oncological ones, additional diagnostic procedures may be required. Specialists recommend conducting a histological analysis to determine the structural features of the growth.

It is also recommended to consult with an immunologist and surgeon.

Differential diagnosis

Differential diagnosis of periungual wart is carried out with epidermal verrucous nevus and basal cell carcinoma.

A verrucous nevus is usually a solitary formation and is detected in childhood. It has a brownish tint and may contain hair follicles.

Basal cell tumor, or basalioma, is found mainly in elderly patients. Such a growth has an infiltrated base, and at the edges there is a characteristic peripheral thickening of small nodules. In the center there is a depression covered with a crust: after removing the crust, a bleeding ulcer is exposed.

Treatment periungual wart

Many people underestimate such a problem as a periungual wart – and completely in vain. As practice shows, over time the disease worsens, and no healing or moisturizing ointments will help, since the process goes too deep. There is only one way out: see a doctor who will conduct diagnostics, exclude other possible pathologies, and then prescribe the necessary treatment. Most likely, not only local, but also systemic effects on the body will be required.

Treatment will be more complicated if the periungual wart has already managed to penetrate under the nail plate. Most often, the surgeon recommends removing the nail and the wart itself. There is nothing irreparable about this: the plate will soon grow back and will be healthy and renewed.

As a drug therapy, the doctor can prescribe all sorts of antiviral drugs, vitamin complexes, immunostimulants. Local treatment involves the use of antiviral ointments or agents that cauterize or destroy the wart.

• A solution of 1.5% zinc chloropropionate with 50% chloropropionic acid is very rarely used today, applied to the periungual wart with a special pointed instrument. This method is a type of chemical destruction of pathologically altered tissues.
• Nitric, acetic, lactic, oxalic acids in combination with copper nitrate trihydrate is another type of chemical action on the wart.

Currently, most medical professionals prefer physical methods of destruction, since they do not cause toxic side effects, are safe and effective.

Medicines

Depending on the situation, the doctor may prescribe the following medications to a patient with periungual warts:

Malavit	A local complex biopreparation in the form of a solution for compresses. A cotton pad is moistened in the solution and applied to the periungual wart overnight. Polyethylene is applied on top and fixed with a plaster or bandage. The bandage is removed in the morning. The effectiveness of the drug is due to its antibacterial and antiviral properties. Side effects - allergy.
Panavir	An external gel preparation capable of raising the level of local immunity and fighting off viral infections, preventing the reappearance of warts. The product penetrates deep into the tissues. With regular application, it helps to eliminate growths: the frequency of application of the gel is twice a day, for at least ten days. The product is safe and does not cause side effects.
Imiquimod	A cream preparation that stimulates local immune protection. It is applied to the area of the periungual wart before going to bed, every other day. Complete disappearance of the growth is expected in a few weeks. Possible side effects are redness and irritation in the area of application, which is not a reason to stop treatment.
Isoprinosine	Tablets with immunomodulatory properties. Tablets are taken in an individually selected dosage, in three courses with an interval of one month. Side effects may include headaches, sleep disorders, digestive disorders. If side effects are pronounced, then treatment with the drug is stopped.
Viferon	An external antiviral ointment that kills the papilloma virus. The ointment contains the synthesized protein substance interferon, tocopherol and peach oil. Such components fully provide a regenerating and antiviral effect. The ointment is applied to the wart up to 4 times a day for 1-4 weeks. No side effects were observed. The drug can be used at any age.

Vitamins

It is extremely important for people diagnosed with periungual warts to maintain the quality of their immunity. Sometimes such a step allows not only to prevent the appearance of new warts, but also to get rid of existing growths.

Doctors recommend paying attention to such popular vitamin complexes to improve the level of immune protection:

• Multitabs Immuno-plus contains essential vitamins, including vitamin D and folic acid;
• Vitrum is a classic vitamin complex with a fairly extensive microelement composition;
• Centrum – has a rich vitamin composition and has antioxidant properties;
• Complivit, Undevit are inexpensive, but no less high-quality vitamins with a basic composition that is well absorbed by the body.

In addition to vitamin and mineral complexes, experts advise paying attention to drugs with immunostimulating properties. These include Immunal, echinacea extract, etc.

Physiotherapy treatment

Physiotherapeutic methods can help get rid of small periungual warts quickly and effectively. For example, the following methods are especially popular:

• Cryotherapy – involves the impact of liquid nitrogen on the formation. The cold simultaneously destroys the viral infection and disrupts the structure of the wart tissue. This method is quite effective (estimated at approximately 75-90%, the risk of recurrence of the growth is 15%), but is not suitable for use in small children, pregnant women and patients suffering from diabetes.
• Electrocoagulation is a medical procedure that involves removing a protruding periungual wart using a special loop instrument through which a high-frequency current passes. The positive effect of the procedure is estimated at approximately 85-90%.

Treatment at home

In some patients, periungual warts disappear on their own after some time after they appear. But experts advise: if self-healing does not occur within two years, or additional painful symptoms appear, then you should seek help from a doctor. Contacting a doctor should be mandatory in the following cases:

• if a single periungual wart is replaced by multiple growths;
• if the wart increases in size, “crawls” under the nail, spreads, capturing other healthy areas of skin;
• if the growth starts to bleed and cracks appear on it;
• if the color of the wart changes;
• if pain or severe discomfort appears.

If these symptoms appear, there can be no talk of self-treatment of periungual warts. This should be done by a doctor.

If the growth is single and small in size, then it is permissible to use folk methods after consultation with a medical specialist. Such consultation is necessary, first of all, in order to identify the periungual wart and exclude the presence of oncological problems.

Folk remedies

Any treatment of periungual warts, even if it is a folk method, must be combined with strict adherence to the rules of personal hygiene: hands and feet should be thoroughly washed and dried no less thoroughly.

Additionally, you can try using the following traditional medicine recipes:

• Rub the wart with a cut garlic clove or bulb, 2-3 times a day (necessarily once - at night). The duration of such treatment is from one to four weeks. After the growth falls off, the juice of onion or garlic should be applied for another week, for the final destruction of possible remaining roots of the neoplasm.
• Using a cotton swab, lubricate the periungual wart with acetic acid or essence. Do this up to 2 times a day, very carefully, so that the product does not burn healthy, unaffected tissue.
• Large periungual warts are removed as follows: mix a pinch of flour with a drop of acetic acid. Cut a hole in the center of the adhesive plaster to fit the size of the growth, then stick the plaster to healthy skin so that it is not damaged during treatment. Apply the prepared mixture directly to the hole (that is, to the wart) from above, then additionally fix this place with a plaster (whole, without a hole). This manipulation is usually performed before going to bed, and the plasters are removed in the morning. It is claimed that this treatment allows you to remove warts in 3-7 days.
• Rub castor oil into the area of the periungual wart. Repeat the procedure daily, twice a day, for 8-12 weeks. As a result, the wart disappears gradually and painlessly.
• Every night, soda or salt baths are made for the affected fingers. To prepare them, take one tablespoon of baking soda or 5 tablespoons of sea salt per 500 ml of warm water. Keep the fingers in the solution for about 15 minutes. After this, the solution is not washed off, the skin is blotted with a paper napkin, and a cut aloe leaf is applied to the wart. Fix with a plaster, which is removed in the morning. Presumably, the periungual wart disappears within 7-10 days.

Herbal treatment

• Apply fresh celandine juice to the periungual wart. Cover the entire growth with juice, twice a day, until the skin is completely clear.
• Instead of celandine juice, you can use dandelion juice, but in this case the frequency of daily application should be increased to three times.
• Treat the periungual wart with agave juice three times a day. At night, you can make a compress from this remedy: soak a small square of gauze in juice, apply to the growth, place a small square of cellophane on top and fix with a band-aid. Repeat the procedure daily.
• Fresh plantain juice is dripped onto the wart 2-3 times a day. At night, plantain leaf pulp can be applied to the affected area of skin under a plaster. Treatment continues until the problem is completely eliminated.

Homeopathy

The use of homeopathic preparations to eliminate periungual warts has a number of features. For example, such remedies can be used both to get rid of a single growth and its multiple manifestations. Homeopathy can be prescribed to both adults and children without any problems, since such preparations are safe. Homeopathic remedies can be used both independently and in combination with other types of treatment - for example, medications or folk remedies.

What means are we talking about:

• Antimonium kurdum is prescribed for the removal of hard, keratinized periungual and subungual warts.
• Causticum - used for large soft growths located on a wide base, as well as for bleeding warts.
• Thuja - used to remove multiple neoplasms, as well as with frequent re-growth of warts.
• Gepar sulfur is suitable for getting rid of flat periungual warts.

The exact dose of each of the indicated drugs will be prescribed by the doctor, based on the constitutional characteristics and other signs of the disease.

Surgical treatment of periungual warts

The help of a surgeon is usually resorted to when the periungual wart is of significant size, when there is a suspicion of its malignancy, or when it is in an inconvenient (subungual) location.

Surgical excision always involves capturing not only damaged tissues, but also a small amount of healthy tissue. This helps prevent the wart from re-forming in this area. The main advantage of this method over laser removal or liquid nitrogen treatment is that the material obtained can be sent for histological analysis. Such a study is necessary to study the structure of the growth and exclude malignancy of the process.

The surgical technique may vary, depending on the location and size of the wart. Most often, removal is performed with the application of suture material: the surgeon treats the skin, injects an anesthetic, excises the growth and nearby healthy tissue. Since deep skin layers and vessels are affected, suturing is a must.

Wound healing after such an operation occurs within 1-2 weeks and largely depends on the general health of the patient, the individual characteristics of his body, as well as the quality of postoperative care.

Perhaps the only drawback of surgical removal of a periungual wart is the formation of a scar. Its size depends mainly on the initial scale of the intervention, as well as on the qualifications of the operating doctor. In general, surgical removal of such growths is a completely standard medical procedure, which is considered one of the most radical methods of getting rid of pathological neoplasms.

Laser removal of periungual warts

Laser removal is the most common, safe and reliable way to get rid of periungual warts. The entire removal process occurs through evaporation and tissue coagulation, which helps avoid bleeding and damage to healthy tissue.

Laser removal does not require any special preparation for the patient. At the same time, post-procedure care is also quite simple:

• For 2-3 weeks after removal, do not expose your skin to ultraviolet light;
• until the skin is completely cleansed, you cannot visit a sauna or even a swimming pool;
• You cannot remove the formed crust on your own or treat the wart site with aggressive liquids.

As a rule, the laser procedure is a one-time procedure, and does not require repeating. If the growth is large, surgical removal is preferred.

Prevention

For people who want to avoid periungual warts, there are a number of recommendations:

• You should not walk barefoot on public beaches, in baths and swimming pools – be sure to wear rubber slippers.
• It is important to avoid damage to the skin, and if scratches or cracks appear, they should be immediately treated with any disinfectant solution.
• It is necessary to avoid excessive moisture in the hands and feet: shoes should be of high quality and dry, and when working in conditions of high humidity (for example, when cleaning, washing, washing), protective gloves should be worn on the hands.
• If even one wart appears, it should be removed as quickly as possible to prevent further spread of the growths.
• It is necessary to get rid of the bad habit of biting your nails and tearing off snags and cuticles: this is an important condition for preventing the appearance of periungual warts.

Forecast

Sometimes periungual warts tend to heal on their own. However, you shouldn't hope for such an outcome, especially if the growth has existed for more than 2 years, or begins to bother with pain or intensive growth. It is important to remember that the neoplasm should not be damaged, injured, or attempted to be removed on your own, without first talking to a doctor. To avoid complications, it is recommended to contact a dermatologist or surgeon as soon as possible.

In general, periungual warts have a favorable prognosis, provided they are treated promptly and completely.