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Warts in children on the hands and feet: causes, treatment
Last reviewed: 23.04.2024
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Warts are among the three most common skin diseases, and most often skin warts appear in children and adolescents.
Warts are contagious, and children with their insufficiently mature immune systems are most susceptible to infection.
Epidemiology
Skin warts are contagious and occur in 7–10% of the population — regardless of age, but most cases of wart formation occur between the ages of 12 and 16, affecting up to 15–25% of children and adolescents. But in early childhood, they appear extremely rare.
According to statistics from the American Academy of Dermatology, vulgar viral warts in children are diagnosed in 10-20% of cases of treatment for skin lesions.
The most common types of warts in children and adolescents are flat (on the face), plantar (on the feet) and common, that is, vulgar (on the hands, elbows and knees).
Causes of the baby warts
In both adults and children, the infectious wart is small but noticeable
Education that occurs on the skin of some parts of the body - has the same reasons that lie in the defeat of the epidermal layer by the human papillomavirus (HPV) of the Papovaviridae family. For more details, see - Human papillomavirus
This tissue-specific DNA virus is distributed in the skin and mucous membranes, and there is indirect evidence that it lives on our skin and can persist for a long time in the squamous epithelium without causing any damage.
Different strains (types) of HPV cause different types of warts - depending on their location or visual features. For example, strains 1, 2, 4, 27, and 57 tend to infect the soles of the feet, and then verruca plantaris, a plantar wart in a child, may appear.
HPV strain 2 also "took a fancy" of the palms of the hands, and when its virions replicate into the nuclei of keratinocytes of the skin, warts appear in the child’s hands or fingers. At the same time, HPV 2, 7, 22 types can cause common or vulgar warts (verruca vulgaris).
And if flat warts appear in children and adolescents, called adolescents, then, most likely, this is the result of skin damage to the papillomaviruses of the 3, 10, 28 and 49 strains.
According to dermatologists, warts can appear on the face, forehead, nose, chin, lips, child’s mouth. In the latter case, we are talking about focal epithelial hyperplasia associated with HPV types 13 and 32.
And rare cases, when an oral papilloma or a wart on a leg is detected, are associated with HPV types 6, 7, 11, 16 or 32.
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Risk factors
Today it is known that the risk factors for the activation of human papillomavirus are a decrease in immunity due to any other infections (for example, influenza or frequent tonsillitis), stress or malnutrition. It is still believed that infection from an infected person and personal hygiene are important in the appearance of warts.
Indeed, HPV can survive for months and at low temperatures without a host; therefore, an infectious wart can appear even after contact with objects used by a person with HPV, and a person with plantar warts can spread the virus by walking barefoot.
True, now doctors are convinced that if a child’s wart grows, this is evidence of a decrease in the functions of its immune system, which is manifested in the absence of a local immune response to HPV infection mediated by T-cells.
Any damage to the skin (i.e., violation of the epithelial barrier) and their increased humidity (in particular, on the feet and palms), which facilitate the introduction of the virus into epithelial cells, increases the risk of growth of the wart.
Pathogenesis
Papillomavirus virions, via receptor-mediated endocytosis, penetrate epithelial cells of the basal layer of stratified epithelium.
From polycistronic mRNA, the virus replicates its genomes in the nuclei of infected host cells, with the formation of an episomal form. When this happens, the cascade of expression of the viral gene is activated, and several dozen extrachromosomal copies of viral DNA are formed per cell at once.
And the pathogenesis is due to the fact that the life cycle of HPV is associated with the differentiation of skin cells, and the dominant type of cells in the upper layers of the epidermis — keratinocytes, which begin to divide and synthesize too much keratin fibrillar protein — is most affected. As a result of hyperkeratosis initiated by the virus, a gradual local thickening of the epidermis occurs - in the form of a wart.
According to the version adopted today, viral warts in children are formed more often than in adults, since proliferative processes in the skin cells of children and adolescents (up to about 18 years old) are characterized by increased activity - under the influence of growth hormone (GH), insulin-like growth factors (IGF -1 IGF -2) and epidermal growth factor (EGF), and also due to the higher susceptibility of skin growth hormone receptors (IGF-1 and IGF-2), vitamin D receptors and nuclear retinoid alpha and gamma receptors.
Symptoms of the baby warts
The first signs of damage to the HPV epithelial cells of the basal layer do not appear immediately, on average, within two to six months. Contrary to popular belief, warts do not have "roots." They grow only in the upper layer of the skin and in the process of growth can displace the underlying layer of the skin - the dermis, but the warts do not germinate, and their underside is smooth.
Warts usually grow from the skin in the form of a cylinder, on the thicker skin of such structures, tightly pressed to each other, there may be several, and they merge, giving the surface a characteristic mosaic look.
Vulgar warts in children have the form of cornified seals up to one and a half centimeters in diameter, which rise above the surface of the skin. Sometimes there are external symptoms in the form of tiny black dots in the wart. These are the capillaries which are embedded into it clogged up by coagulated blood.
A wart may be rough or grainy to the touch, it may itch, in some cases warts can cause pain or spread to other parts of the body, for example, a wart can appear on the abdomen.
Flat warts in children are most often found on the hands and face; such warts on the arms (and the back of the hands) are smoother, smaller in size. Branched warts are distinguished by the fact that several formations in a limited area of the skin (often on the face were poured on the upper limbs) are similar in shape to a twig or leaf of a fern.
But the wart on the finger of a child can often look like a blister, but only dense. There are also sub- and perigungular warts - formed under the nail, around the nail or on the cuticle. It is more difficult to treat them than warts in other places.
Plantar warts on the legs, foot, and heel in children usually appear very dense formations in the form of plaques of yellow, gray or light brown color, covered with the black dots already mentioned above. Such a wart due to pressure "grows" into the deeper layers of the skin; it can cause discomfort and even be painful when moving. Mosaic warts predominate on the soles of the feet - under the toes. For details, see - Warts on the legs.
A hanging wart or a wart on the pedicle, which can be in the form of a villous growth near the eyelids of the lips, is extremely rarely diagnosed. The second type of elongated wart with a leg - acrohordon or filamentous wart in a child is not formed.
If a red wart has grown in a child aged 2-12 years, then most likely it is a skin lesion of a poxvirus, a molluscum contagiosum virus, when a whitish pimple resembling a wart is detected on a red background. Or it can be a benign and non-dangerous vascular tumor - hemangioma, resembling a birthmark (nevus) of red color.
Complications and consequences
Fortunately, warts do not harm the health of children. But a child may inadvertently damage a wart, for example, tear it off, then the most likely consequences and complications are manifested by bleeding and the addition of a secondary infection - with the development of inflammation, possibly purulent.
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Diagnostics of the baby warts
Warts are identified by the appearance and change of the papillary lines of the skin, which dermatologists consider when examining the patient's skin. Also helps instrumental diagnostics - visualization using a dermatoscope.
Genetic amplification methods in combination with genotyping can determine the specific type of HPV, but for skin warts in children and adolescents, this does not matter and does not affect the choice of therapy.
How is the diagnosis of warts, read the publication - Warts: causes, symptoms, diagnosis, treatment
Differential diagnostics with possible ultrasound of the affected skin is intended to distinguish a wart from corns, seborrheic keratosis, focal or diffuse keratoderma, epidermal nevus, molluscum contagiosum or hemangioma.
Also, when a wart in a child turns out to be a mole formed after birth, which continues to grow intensively and becomes more dense, the possibility of amelanotic melanoma should be taken into account.
Treatment of the baby warts
Flat warts in children usually go away on their own: within two years in 40% of children (according to other data, in 78%) without any treatment they disappear.
The question arises: is it worth removing warts in children? If the child does not pass the wart, spoils the appearance or, especially, causes physical discomfort, it is necessary to get rid of it.
What doctor treats warts? All skin problems, including warts, should be referred to a dermatologist.
How to remove a wart in a child, and what medications for warts are recommended by dermatologists?
First of all, salicylic acid from warts, acting as an effective keratolytic agent, is recommended externally (by lubricating the wart with a patch applied). It should be applied daily for one to two months. Salicylic acid preparations are available in a variety of ways, including gels and ointments, and they often also include lactic acid, resorcinol, urea. Useful information in the material - Treatment of warts
When a small flat wart is advised to use a pencil with silver nitrate (lapis), but there is no convincing evidence of the effectiveness of this tool.
What are the use of ointments for warts in children (Tretiin, Fluorouracil, etc.), read in detail in the article - Ointments from warts.
Homeopathy offers Cantharidin - an extract of the Spanish fly, the application of which on the surface of the vulgar wart leads to the formation of a crust, together in which (after some time) the wart is removed from the skin.
To kill the virus, apply external antiviral drugs (including Imiquimod), all the details - in the material Ointment from papillomas.
As a systemic immunomodulating agent, the drug is used in tablets Levamisole (Adiafor, Dekaris, Levazole, Nibutan and other trade names), the dosage of which is determined by the doctor.
As the main means of warts alternative treatment includes: garlic, onions and raw potatoes (in the form of compresses under the bandage); cauterization of the wart with an alcoholic tincture of iodine and concentrated hydrogen peroxide solution. Since flat warts are often found on the face, it is recommended to consult a doctor before using a home remedy that can cause skin burns or leave a scar.
And herbal treatment involves applying a dandelion peduncle on the wart of the juice of celandine and the milky juice. Also read - How to get rid of warts?
Removal of warts in children is usually carried out in one of three ways:
- laser wart removal, in more detail , how to carry out wart removal with laser in children and adults, see - Removal of warts
- electrocoagulation or cauterization of warts in children using electric current;
- cryodestruction of warts, that is, removal of the wart in a child with liquid nitrogen. More on this method - removal of warts with nitrogen
Prevention
Although there is no 100% guaranteed way to prevent warts, prevention can be training children to wash their hands regularly with soap and water; use only your own towel; wear waterproof slippers on the beach, in the pool, in the gym changing room (to protect against plantar warts and other skin infections).
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