Treatment of viral warts and planetary warts
Viral warts, 'baradavka' in Russian, 'verruca' in Latin
The term 'wart' is a general term describing a group of non-cancerous skin growths. Included in this group are viral warts caused by a viral infection in the superficial layers of the skin and seborrheic warts (also called seborrheic keratoses) which are benign skin tumors whose cause is unknown. . In the family of papilloma viruses, more than 150 different strains have been identified to date, the differences in their properties are small but significant and affect the locations in the body where they are expressed and other properties such as carcinogenicity (the ability to cause the development of cancer). The warts usually stand out from the skin, are stiff and rough to the touch, and usually match the skin tone but can also be dark, flat and smooth to the touch. The shape of the warts is usually related to the place on the body where they grow.
The virus that causes warts, penetrates the skin cells and causes them to divide at a much higher rate than in the surrounding skin, interfering with the maturation process of the skin cells, which causes them to remain stuck to each other and form the characteristic structures of warts. An increased blood supply from the skin is directed to the bases of the warts, which enables their rapid growth. Inside the skin cells that make up the warts are billions of virus particles that are actually ready to move from skin to skin and thus spread and infect other places and people. The papilloma virus has a very high infectivity and in fact close to 90% of the population can find evidence of infection by the virus, even though the infection is often hidden and most of the population does not suffer or express the warts themselves while another part of the population has a built-in tendency to develop warts too easily.
It should be emphasized that the virus is only contagious when it is found in its active form and causes the formation of clinical warts. Another important feature of the virus that causes its survival and the persistence of the problem is its unique ability to escape the patients' immune system. The virus hides in the superficial layers of the skin and thus prevents the formation of an effective immune response against it. When the immune system detects its presence and develops antibodies and an effective immune response against it - the warts and the virus disappear. In some cases the virus goes into an inactive or contagious form where it can remain in the skin for many years and possibly even for life.
On the other hand, when there is suppression of the immune system as a result of medication to suppress the immune system (such as in organ transplants or cancer patients) or as a result of a disease (AIDS and cancer) warts may appear in large numbers and behave in a very violent manner. There is a suspicion, which so far has not been confirmed, that the carcinogenic viruses are related to at least some of the cases of skin cancer of the squamous cell type.
There are 4 types of viral warts caused by HPV:
Common Warts
Plantar warts (warts on the feet)
Flat warts
Warts around, in, or on the genitals
Common warts 'Verruca vulgaris' They usually appear on the fingers, around the fingernails and on the back of the hands, spreading especially in places that are damaged due to biting the fingernails, damaged skin from work and handling, and look like they have peppercorns which are actually tiny blood clots trapped in the growing warts. These warts are probably caused by transmission by direct contact from hand to hand or by contact with objects that have been touched and on which viruses remain, those who have active warts.
Plantar warts 'Verruca plantaris' They are common warts that appear on the feet and can appear in the form of single warts or in the form of a cluster of warts covering an area in a form called "mosaic" in the professional jargon. When the calluses are discovered at an early stage, they are actually just a hard spot on the skin of the foot and are often mistaken for thinking that it is a thorn that penetrated the foot or a corn callus which is a callus that forms in the skin of the foot in response to the pressure of the shoe. In contrast to common warts - these warts usually do not form a defined growth that stands out from the skin and in fact the form of their growth (probably due to the pressure exerted on them by stepping) is by spreading inwards in the skin of the foot. The warts can cause pain and even difficulty walking, similar to a stone that has entered the shoe but cannot be removed since it is fixed to the skin. These warts are caused by the transfer of viruses from one foot to another, usually in public places where the floor is damp or wet and many people walk barefoot (such as public showers, by the pool or in gyms). The viruses that fall from the foot of a person suffering from warts infect other people's feet. Therefore, an especially important preventive measure is to make sure to use flip-flops, especially in places where many people walk barefoot and especially on a damp floor .
Flat warts 'Verruca plana' They are flat and smooth warts and much smaller than the other warts. They usually appear in clusters of dozens of warts and the shade is usually the skin tone and sometimes in those with dark skin a little lighter and in light skin a little darker than the surrounding skin. They often appear on the skin of the face - mainly in children, in men in the shaving area of the face, in women on the legs and sometimes appear in this way on the back of the hands. Apparently, the cause of the spread of these warts is repeated injuries to the skin, for example when shaving, which both injures the warts and also injures healthy skin, thus causing the warts to spread. When these warts appear on the nose they are often very stubborn and return time and time again.
Genital warts 'Condyloma accuminata' (also known as 'conical warts') They are warts that appear on or around the genitals and are usually transmitted by sexual contact following close and repeated physical contact. In special cases, they can be found on the skin of newborns or babies in the first months of their lives who were born vaginally to a mother suffering from genital warts in or around the vagina. They are usually skin colored, and they can be soft or rough, single or in groups. Common locations are on the surface of the penis, the head of the penis or the scrotum in men and on the surface of the vaginal lips, the inner walls of the vagina and on the cervix inside the vagina, in women. In both sexes, these warts may appear around the anus - usually in the context of having anal sex. Some of the strains that cause genital warts are carcinogenic strains - these are cancer-causing strains, and in women infection of the cervix by these viruses is the main and almost the only cause for cervical cancer. It should be noted that since the year 2000 there has been a vaccine against the viruses that cause cervical cancer and it is given to women in Israel as part of the vaccination program for girls at the age of 14. The vaccine can be given up to the age of 28. There are discussions about vaccinating boys and men to create complete immunity in the population.
The treatment of warts
In many cases the warts can disappear without treatment following the awakening of an effective immune response, an event that happens mainly in children. In adults, on the other hand, warts can persist for many years and show great resistance to the various treatments. It is important to note that the effectiveness of all treatments for warts is relatively low, while the “placebo" treatment has an effectiveness that in some cases reaches up to 50%! The decision on which warts to treat and which ones do not need to be treated is often based on the degree of physical, functional or aesthetic disturbance caused by the wart, and on the desire to prevent growth, spread and infection of the wart to other parts of the body and to other people with which the patient suffering from the warts is in contact. Another consideration that is especially important for flat warts on the face and the back of the hands is that these warts go away in the vast majority of cases on their own and without any symptoms, while the treatments, especially the physical treatments, may cause scars that will remain for many years and sometimes even for life. The treatment options are many and varied: Liquid nitrogen treatment has been proven in studies and reviews to have the highest efficiency and the best cost benefit ratio.
Liquid nitrogen freezes the warts to very low temperatures which destroy the cells containing the viruses and after proper treatment the warts dry up and peel off and eventually the skin heals almost without leaving a scar. Sometimes one burn may not be enough and repeated burns are required, this is especially true for warts on the feet and around the toes. The main disadvantage of the treatment is the pain involved.
Chemical treatment can be carried out using a variety of substances that poison the cells containing viruses or substances that dissolve the stratum corneum and the skin in a gradual process. One of the most common treatments from this category is based on salicylic acid that comes through plasters in which a piece of cloth is soaked in the acid, an ointment containing it or in the form of a nail polish or liquid that is brought into repeated contact with the wart until it dissolves. Sometimes during the treatment, local sensitivity appears and maybe even pain, which necessitates stopping the treatment until the reaction is forgotten and the sensitivity disappears. Substances belonging to the chemotherapy group such as bleomycin or 5FU which can be injected into the warts or applied to the back, poison and damage the cells containing the viruses and cause their death.
Physical therapy, a group that also includes liquid nitrogen, but also laser therapy, cauterization therapy (Hot needle) and electric needle therapy. In these treatments, high heat is caused in the wart cells, which causes their destruction and disintegration of the wart. A wound is formed instead and if the treatment has eliminated all the cells that contain the virus and make up the wart, the recovery can be complete with the disappearance of the wart. The treatments are often accompanied by intense pain and often precede the treatment with local anesthesia with an injection or ointment or with regional anesthesia.
Immunological therapy is a treatment based on exposing the virus that causes the wart to the patient's immune system - in a way that will cause the patient's immune system to react against the virus, attack, reject and eliminate the wart. The substances belonging to this group are "Aldara", and also other substances such as DMSO and interferon. At the same time, you can also use the newly developed vaccines that are supposed to cause the immune system to develop the tools to deal with the virus. Studies have proven that these vaccines are effective in preventing infections with viruses that cause genital warts. It is not clear if their effect is also effective against other types of warts. In all the treatments from this group - it is important that the immune system has the ability to deal with the virus from the start and in patients whose immune system is suppressed or damaged for some reason, these treatments are expected to have a particularly low effectiveness.
Special cases - plantar warts are a particularly resistant type to treatment since most warts are found deep in the skin and are actually protected from physical and chemical treatments. The therapeutic approach in these cases includes an advanced process of peeling and removing the layers of the wart, which causes the base of the wart to approach the surface in a way that will allow its removal. Another problematic type are warts around the cuticles, some of which are sometimes hidden under the nail plate and to deal with them you often have to remove part of the nail to access the protected wart. Genital warts are a type of warts treated, among other things, by gynecologists - when the warts are found on the lips of the vagina or on the inner walls or on the cervix and by proctologists, specialists in the anus when the warts are found around and inside the anus. In these sensitive locations, the physical treatments are more problematic, but due to the delicacy of the skin there, the local immunological treatments can be more effective. Another option is physical therapy under local anesthesia.
Dr. Gilead treats warts using liquid nitrogen, cauterization and chemical substances. Plantar warts are sometimes combined with surgical treatment.
The treatment of warts is not included in the consultation visits of the supplementary insurances of the health funds and is carried out as part of a private visit and for a separate payment. A decision on the appropriate treatment will be made in a counseling session within the framework of the supplementary insurances.
