Viral wart: causes, treatment

Benign neoplasms in the form of small rounded growths with a flat surface, nodules on legs or with a sharp tip, flesh-colored, appearing on the skin or mucous membranes are called differently, depending on the appearance, warts, papillomas, condylomas. Any such formation is a viral wart. And the process of epithelial proliferation begins with infection with papillomavirus infection.

Epidemiology

Statistics show that viral warts can be found on the skin of every third to fourth member of the world's population, regardless of gender and race. Clinical manifestations of HPV infection are more common in adults (about 30%) than in children and adolescents (from 3 to 9%). Children are mostly found to have vulgar warts, adults - anogenital warts, and the prevalence of venereal acute condylomas is increasing worldwide.

Papillomatosis of the oral cavity is quite common. Single large masses are characteristic of adults, women are more susceptible to this pathology (60% of cases). Children and adolescents are characterized by multiple formations. One fifth of viral warts of the oral cavity are detected in this population, more often in 7-12-year-old schoolchildren, with girls suffering from papillomatosis of this localization almost twice as often as boys. [1]

Causes of the viral wart

The abbreviation HPV is probably known to everyone nowadays. It stands for human papillomavirus. Different strains of this virus have already been discovered a lot, about two hundred. They are classified into five genera - α-, β-, γ-, μ- and η-papillomaviruses and 27 species. It is assumed that viruses of different species affiliations are characterized by a certain ability to affect specific types of tissues, the so-called tissue specificity. For example, μ-papillomavirus-1, α-papillomavirus-2, or γ-papillomavirus-4 are detected when vulgar warts appear on the soles of the feet. The last two types are detected in other localization of common warts (back of hands, feet, face), in addition, they can be caused by HPV 26, 27, 29, 57 types. [2] However, usually in those infected with papillomavirus are found DNA fragments of several pathogens at once. [3]

The cause of infection is direct contact of skin or mucous membranes of a healthy person with virus-infected areas of the epithelium of an infected person. And infection occurs when virions get on the damaged epithelial surface. It does not necessarily have to be wounds or abrasions, it is enough a small inflammation, irritation, imperceptible microcracks. Introduced viruses multiply and manifest themselves by excessive proliferation of the epithelium near the site of introduction. They do not migrate through the body to distant parts of the body. If several foci of infection appear in different places, this is more likely to indicate self-infection, which is also possible when healthy and infected areas come into contact with each other in the same person.

Outside the keratinocytes, the virion remains viable for a short time, up to three hours, and then on wet towels and underwear. Therefore, the household route of infection is not excluded, but it is very rare.

HPVs in general are very common and it seems that we have to encounter them often, but according to researchers, in the vast majority of such encounters (they say the figures are over 90%) the body copes with the infection itself and we may not even be aware of the infection. Many cases say that sometimes suddenly appearing single warts suddenly disappear on their own.

Risk factors

Risk factors for infection and disease development, in addition to the damaged epithelium, include viral load (the number of viruses that have penetrated the basal layer of the epithelium), the frequency and nature of contact with a carrier of papillomavirus, and the state of the immune status of the infected person.

Pathogenesis

Pathogenesis of morphologic changes in the epithelium can trigger any decrease in the body's defenses, such as a cold. Human papillomavirus is in the body for a long time (often years) without manifesting itself, and is activated, beginning to multiply intensely, in cases of reduced host immunity. In the infected cell, the virus can be in different forms: extrachromosomal (episomal) and embedded in the DNA of the cell (intrasomal). The first option is considered more favorable.

Under conditions favorable to virus replication in the macroorganism, keratinocyte hyperproliferation occurs under its influence and skin overgrowths appear. Basically, such conditions are: high viral load (regular contacts with virus carriers; penetration into the wound physiological fluid or skin scales, abundantly contaminated with virions) and / or infection of a person with a weakened immune system. In the second case, the introduction of single virions is sufficient for the appearance of clinical symptoms on the skin in the form of viral warts. Virus replication occurs at the level of the basal layer of the covering epithelium. [4]

In these cases, clinical symptoms of infection - viral warts - can appear quite quickly. They are most often caused by α-papillomaviruses types 2, 27, 57; γ-papillomavirus-4 and μ-papillomavirus-1. Much less frequently found in patients with viral warts are α-papillomaviruses types 3, 7, 10, 28; γ-papillomaviruses types 65, 88, 95; and η-papillomavirus-41. [5]

The response of the immune system to papillomaviruses is poorly understood. It is known that in response, infected patients produce antibodies - immunoglobulins of IgM and IgG class, specific for viral diseases. It is also believed that a more extensive pathologic process develops in patients with low immune status. [6]

Symptoms of the viral wart

Viral warts on hands, fingers usually have the appearance of small rounded elevations above the surface of the skin with a rough and sometimes dry cracked surface. They are painless, the color does not differ from the surrounding skin or slightly darker than it. Can merge into fairly large plaques. Often an impressive mother wart is visible on the skin, surrounded by smaller daughter warts. In most cases, such symptoms indicate that we are dealing with ordinary (simple, vulgar) viral warts. A characteristic, but not mandatory, sign is their symmetrical location relative to the skin fold or extension-flexion lines. They are also called "kissing" warts.

The localization of skin overgrowths is diverse. They appear not only on the thin skin of the hands, legs, face, but also on the thick skin of the palms and soles. [7]

A viral wart on the leg, foot appears when virions from an infected surface enter the damaged skin. On the thin skin of the lower limb, they look exactly the same as on the back of the hands.

If the thick skin covering the soles or palms has been infected, viral plantar warts occur. These formations are painful, as tufts of thread-like papillae sprout inside the skin, harden, resembling a callus in appearance. Often appear in places that experience pressure from shoes. Palm and plantar warts do not rise above the skin, have a granular dry surface covered with small scales. Sometimes a black dot is noticeable in the center of the plantar wart. This is a clogged blood vessel that can bleed if damaged.

A viral wart may form under the nail or around the nail bed. Such formations are characteristic of people who have a habit of biting their nails. Hangnails and cracks on the fingers increase the risk of viral warts. More often, according to experts, subnail overgrowths are observed on the hands. Growing formation leads to the fact that the nail is raised above the bed, peeling off from it. [8]

For example, a bump under the nail is most likely a viral wart, but if there is swelling and hyperemia, a bacterial infection is more likely, which could have been caused by a stabbing injury or manicure.

Viral warts may appear in the oral cavity. These are painless, mucous membrane-colored or whitish soft masses on a stalk (papillomas) that can be detected visually. In half of the known cases of viral warts in the oral cavity were located on the tongue. Another favorite localization is the palatine, less often papillomas are found on the inner surface of the cheek, on the floor of the mouth or on the gums. If you accidentally bite the wart, it bleeds.

Anogenital viral condylomas (acute warts) occur in people who are sexually active. They are spread by all types of sexual contact, are painless, and are often discovered during examinations for other reasons, as single masses in hard-to-reach places can go undetected for a long time.

Viral warts in children and adolescents usually belong to the varieties of vulgar warts. At this age, they often appear on the thin skin of the hands, papillomatosis of the oral cavity is encountered, palm and plantar warts appear, formations on the face. They are sometimes quite a lot. Parents often associate the appearance of overgrowths with the previous day's ARVI, flu, sore throat, that is - a temporary decrease in immunity. In most cases in children and young people viral warts just as suddenly disappear as they appeared.

Complications and consequences

These growths are most often itchy, and involuntary scratching can cause lesions and bleeding. Palmar and plantar growths can cause discomfort and pain. Formation under the nail - its detachment from its bed (onycholysis). Sometimes, though in rare cases, when a wart is damaged, another infection - mycosis or bacterial infection - may join the wart.

Large clusters of genital warts can block a woman's birth canal.

Also quite rarely with constant traumatization of the formation, malignant degeneration of keratinocytes is possible. [9]

Diagnostics of the viral wart

A viral wart has a rather characteristic appearance and when it is located on visible surfaces, the diagnostic conclusion is made on the basis of anamnestic data and external examination.

If atypical growths are detected, a scraping, biopsy and analysis of biological material to confirm the presence of papillomavirus DNA fragments by polymerase chain reaction are performed.

Instrumental diagnosis is not used, except for differentiating the diagnosis (dermatoscopy), taking biopsy specimens from inaccessible areas, such as colposcopy, or to assess the general condition of the patient at the doctor's discretion.

Differential diagnosis

Differential diagnosis is carried out with other diseases of the epidermis - syphilis, neoplasms, mixed skin infections, fibrous polyps, hyperplastic changes caused by chronic somatic diseases.

Treatment of the viral wart

Remedies for papillomavirus infection and warts should be prescribed by a doctor after examining the patient and establishing the origin of growths on the skin. Self-removal of warts should not be removed, because in the presence of any neoplasm there is a possibility of malignant degeneration. [10]

Conservative methods of treatment for viral warts are currently favored.

For example, in the treatment of various types of warts on thin and thick skin, local treatment is used by rubbing ointments with antimitotic, antiviral, keratolytic, caustic components into the formations. [11]

Depending on the size, localization and number of overgrowths, individual sensitivity of the patient, the doctor can prescribe a variety of ointments from viral warts.

Fluorouracil ointment 5% (cream). Its active ingredient fluorouracil is a cytostatic that inhibits the enzymatic activity of thymidylate synthetase, which catalyzes the process of cell division. When the ointment is applied to the wart, the sequence of cell proliferation in the growth is disrupted by blocking viral DNA synthesis. Active metabolites accumulate in the tissues of the wart, blocking cell division in the growths, as a result of which they disappear. The remedy is also effective in preventing recurrences and malignization.

The drug is very toxic, so even when applied topically, it is necessary to clearly adhere to the doctor's prescriptions. It is strictly contraindicated in pregnant and lactating women. Even external use can cause weakness, dizziness, dyspeptic disorders, anorexia, heart disorders. Baldness from local short-term use of the cream is unlikely, but from sunlight application sites should be protected. The drug belongs to prescription drugs.

For viral warts, the cream is applied with a spatula (cotton swab) in a thin layer directly on the neoplasm before bedtime daily for seven days. Another more gentle scheme ointment can be applied once a week for ten weeks. In any case, it is necessary to periodically scrape off the dead particles of the wart.

To treat acute condylomas genital or anal localization, the ointment is applied directly to the overgrowths or intravaginally inserted tampons soaked in the ointment.

Colchamine ointment 0.5%. Its main antitumor component is colchamine, an alkaloid of plant origin. It has cytostatic activity. The ointment also contains thymol, an antiseptic and preservative, as well as syntomycin, a component with broad-spectrum antibacterial activity. Contraindications and precautions when using the ointment are similar to the previous one. It is not recommended to apply Kolhamin ointment on mucous membranes, it also contains ethyl alcohol.

The ointment is applied for 7-10 days to the skin growths with a spatula once a day, covered with gauze and sealed with a plaster. Dressings are made daily, at the same time removing necrotizing wart particles.

When using ointments with antimitotic activity, it is recommended to periodically monitor blood counts, as they may cause leukopenia.

Viferon ointment. This product is a stimulator of local immunity, inhibits the transcription of viral DNA and due to this action prevents the reproduction of viruses, helping the body to cope with warts of any localization. Tocopherol acetate, included in the ointment, due to its ability to stabilize cell membranes and bind free radicals, increases the effectiveness of interferon many times.

The ointment is treated with the affected skin and mucous membranes every 12 hours, that is, twice a day. It is suitable for long-term use. The ointment is applied in a thin layer with a spatula, let it absorb and dry. It is not necessary to remove the residue of the ointment.

Oxolin ointment 0.25% also has antiviral activity, it produces a gentle action, which allows you to use it for warts of any localization, even on the delicate skin of the face and mucous membranes. However, its effectiveness is questioned by many experts. Ointment is applied to the growths and the skin around them from two to three times a day. The treatment process is long - from two weeks to two months.

Contraindications these antiviral ointments have virtually no contraindications, except hypersensitivity. Reactions are usually limited to a burning sensation at the application site. It is believed that they can be used by pregnant women and children of any age.

Salicylic ointment: for more delicate skin - 2%, for rougher skin (on soles) - 5%. The product works due to the keratolytic (exfoliating) properties of salicylic acid. It is not recommended for use by pregnant and lactating women and children under twelve years of age. The ointment can cause burns, so use it carefully.

Removal of warts is carried out as follows. The limb on which there are warts is steamed in a hot bath. This is especially true for palm and plantar neglected growths or large dry warts. Dry and apply a small layer of salicylic ointment with a spatula. Small formations on thin skin are simply smeared with ointment without steaming.

Apply a gauze bandage. After about 12 hours, remove the bandage and carefully peel off the top exfoliated layer of the wart, then reapply the ointment and cover with a bandage (can be under a bandage) for the next 12 hours.

The process of removing warts, especially large ones, is quite long, about a month, and requires daily effort.

To speed up the process, you can combine the use of 5% salicylic ointment with tebrofen (3%). The scheme of treatment is the same, only first exfoliating salicylic ointment is applied to the wart, then, after waiting about a quarter of an hour, on top - tebrofenova, which has antiviral activity. On its own, it is used to remove viral warts in children.

Tretinoin cream 0.05% based on retinoids is used to eliminate warts on the face. Before treatment, the skin area with warts is thoroughly washed with soap and water, dried well, then apply a pea-sized amount of cream to each wart. The procedure is done daily before going to bed. Going outdoors, protect the treated skin from direct sunlight. In general, this precaution should always be observed, even if it is not specified in the instructions.

To remove viral warts are used not only ointments, but also solutions of caustic substances: solcoderm (nitric, acetic, oxalic, lactic acid and copper trihydrate), betadine (contains iodine), trichloroacetic acid, verrukacid. Cryopharm freezing solution. The destructive action of the solutions is more effective, however, burns and scarring are also more likely if used carelessly.

There are patches and pencils for the treatment of warts, phonophoresis with interferon is used.

In a medical facility, bleomycin sulfate injections are used to treat large warts. This is a drug with pronounced cytostatic activity. Injections are made directly into the wart. Often one procedure is enough, sometimes it is necessary to make several injections at intervals of three to four weeks. Cytostatics are very toxic drugs, even their local use can lead to a number of complications. Therefore, the possibility of this treatment, the effectiveness of which is high (estimated at 92%), should be discussed with your doctor.

In the treatment of viral warts also apply means of systemic action, increasing the immunity of the body, for example, vitamin and mineral complexes, Immunal, Echinacea-Ratiopharm, Immunoplus.

Folk treatment

Viral warts have caused physical and moral discomfort in people at all times. Therefore, there are many folk remedies for their removal. Opinions about their effectiveness vary greatly, however, many people get rid of warts very quickly.

Basically, treatment with herbs is applied. However, it should be taken into account that herbs-herbs that can eliminate warts are poisonous. Therefore, the treatment should be carried out under the supervision of a doctor-phytotherapist and observe all the recommended precautions.

Perhaps the best known and easiest remedy for warts is fresh celandine juice. In summer, you need to pluck a sprig of the plant, the cut will show a bright yellow liquid. It is smeared on the wart. This treatment should be carried out daily, however, it is possible only in the summer and in places of direct access to the plant, for example, at the cottage or in the countryside.

You can squeeze the juice of celandine and dilute it with a small amount of alcohol as a preservative. This solution can also be applied to skin growths.

Apple and regular vinegar have not only exfoliating properties but also virucidal properties.

Vinegar essence is even more effective. It can be used to burn out a wart in one application, however, you should be very careful. The surrounding skin should be lubricated with petroleum jelly and drop the essence strictly on the neoplasm. It will turn white, loosen, then shrink, darken and fall off.

Many people claim that if you cover the wart with a regular band-aid, it will also disappear.

In folk medicine to combat warts use this ointment: two parts of green walnuts, carefully chopped, rubbed with one part of kerosene. Infuse for a month, squeeze the resulting liquid. Her regularly at least twice a day lubricate the warts. They should pass in about a week.

Also made daily applications of garlic gruel, which is applied to the growths under a bandage before bedtime.

In addition, the use of fruits and vegetables, freshly squeezed juices from them, vitamin teas from rose hips, leaves and shoots of raspberries and currants, citrus fruits, sprouted grains of buckwheat, wheat and other cereals will help to strengthen the immune system, and warts self-eliminate.

Folk treatments have helped many to get rid of skin overgrowths, however, before resorting to such treatment, you need to make sure that you have a viral wart and not a malignant neoplasm.

Homeopathy

Hard palm and plantar warts, dry and keratinized warts require the prescription of Antimony Sulfide (Antimonium crudum). This drug can also be prescribed for growths of other localizations - in the nasopharynx, anogenital area.

In papillomatosis of the oral cavity and throat, silver nitrate (Argentum nitricum) is prescribed; anal condylomas - hemp (Cannabis), Juniper of Cossack (Sabina); genital: for men - more often Plaunus (Lycopodium).
Hemp (Cannabis), Cossack juniper (Sabina); genital: men - more often Plaunus (Lycopodium), Red mercury sulfide (Cinnabaris), women - Cossack juniper (Sabina), Gonorrhoea nosode (Medorrhinum).

In case of flat juvenile warts, Cilantro (Chelidonium), Easter (Dulcamara), Iron (Ferrum metallicum) are indicated, in case of itchy and itchy warts - Nitric acid (Nitricum acidum), Thuja (Thuja).
Nitric acid (Nitricum acidum), Thuja (Thuja).

In the treatment of viral warts are used many drugs, the correct appointment should be made by a doctor who will take into account not only their type and localization, but many other symptoms and characteristics of the patient, as well as - determine the necessary dosage. Then the treatment will be successful and fast.

Removal of viral warts

The most effective and fastest method is destructive therapy. Surgical removal of viral warts with a scalpel is usually resorted to only in cases of atypical formations that require histological examination. [12]

If the origin of the growth is not in doubt, then radical methods of eliminating neoplasms, not related to surgical interventions, are recommended.

Electrocoagulation - removal of warts with a needle electrode by means of high frequency currents, simply - cauterization. Allows you to eliminate several not too large growths in one session. The duration of the procedure is 15-20 minutes. In place of removed warts remain dry crusts, falling off on the second or third day after the procedure. It is considered a fairly gentle method, used on the face and any other available places.

Cryodestruction (freezing with liquid nitrogen) - a cryoprobe with a nozzle of the required diameter is pressed tightly against the neoplasm for a period of one to five minutes. If necessary, for example, the large size of the growth, removal of viral warts with liquid nitrogen is repeated a week or ten days after the previous procedure. [13], [14]

More modern methods are the removal of viral warts by laser, that is, their layer-by-layer vaporization. The time of the procedure, as, in fact, in other cases, depends on the size and number of warts. It is possible to get rid of all formations in one session.

Another modern method is radiosurgical destruction using high-power electromagnetic waves that cause tissue destruction at the point of contact with the radionuctor electrode. [15]

The latter two methods may result in scarring where large warts have been removed.

After removal, the patient is prescribed a course of antiviral drugs to prevent recurrence of the disease.

No method guarantees that warts will not reappear. Firstly, it is possible to become infected again, and secondly, the surrounding tissue may have become infected.

Prevention

The best way to prevent HPV infection is to strengthen the immune system, then even if warts appear, they will be isolated and after some time will disappear themselves.

Healthy lifestyle, nutritious diet, compliance with the well-known sanitary and hygienic norms - there is no other prevention today.

Forecast

Our immune system handles the human papillomavirus on its own in most cases.

If the warts do not go away and their number increases, it is necessary to consult a doctor with this problem. Although modern medicine does not guarantee complete eradication of the virus, it has an extensive arsenal of means of assistance in cases of infection.