Types and Causes of Warts

A wart (also known as verruca) is generally a small, rough tumor, typically on hands and feet but often other locations, that can resemble a cauliflower or a solid blister. Warts are common, and are caused by a viral infection, specifically by the human papillomavirus (HPV) and are contagious when in contact with the skin of an infected person. It is also possible to get warts from using towels or other objects used by an infected person. They typically disappear after a few months but can last for years and can recur.

Warts are caused by a virus called human papilloma virus or HPV. There are approximately 100 strains of human papilloma viruses. Type 1, 2, and 3 causes most of the common warts. Type 1 is associated with deep plantar (sole of the feet) and palmar warts (palm of the hand). Type 2 causes common warts, filiform warts, plantar warts, mosaic plantar warts. Type 3 causes plane warts, or commonly known as flat warts. Anogenital warts are caused by types 6, 11, 16, 18, 30, 31, 33, 34, 35, 39, 40 and others. HPV types 6 and 11 cause about 90% of genital warts cases. HPV types 16 and 18 currently cause about 70% of cervical cancer cases, and also cause some vulvar, vaginal, penile and anal cancers. Gardasil, a vaccine for HPV is designed to prevent infection with HPV types 16, 18, 6, and 11; it is claimed to prevent infections to other strains of anogenital warts through cross protection against other types of HPVs. HPV is associated with oral cancer, laryngeal cancers, tracheal and lung cancers.

Types of wart

A range of different types of wart has been identified, varying in shape and site affected, as well as the type of human papillomavirus involved. These include

• Common wart (Verruca vulgaris), a raised wart with roughened surface, most common on hands and knees;
• Flat wart (Verruca plana), a small, smooth flattened wart, flesh coloured, which can occur in large numbers; most common on the face, neck, hands, wrists and knees;
• Filiform or digitate wart, a thread- or finger-like wart, most common on the face, especially near the eyelids and lips;
• Plantar wart (verruca, Verruca pedis), a hard sometimes painful lump, often with multiple black specks in the center; usually only found on pressure points on the soles of the feet;
• Mosaic wart, a group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet;
• Genital wart (venereal wart, Condyloma acuminatum, Verruca acuminata), a wart that occurs on the genitalia.

How are skin tags treated?

There are several effective medical ways to remove a skin tag, including removing with scissors, freezing (using liquid nitrogen), and burning (using medical electric cautery at the physician’s office).

Usually small tags may be removed easily without anesthesia while larger growths may require some local anesthesia (injected lidocaine) prior to removal. Application of a topical anesthesia cream prior to the procedure may be desirable in areas where there are a large number of tags.

Dermatologists (skin doctors), family physicians, and internal medicine physicians are the doctors who treat tags most often. Occasionally, an eye specialist (ophthalmologist) is needed to remove tags very close to the eyelid margin.

There are also home remedies and self-treatments, including tying off the small tag stalk with a piece of thread or dental floss and allowing the tag to fall off over several days.

The advantage of scissor removal is that the growth is immediately removed and there are instant results. The potential disadvantage of any kind of scissor or minor surgical procedure to remove tags is minor bleeding.

Possible risks with freezing or burning include temporary skin discoloration, need for repeat treatment(s), and failure for the tag to fall off.

There is no evidence that removing tags causes more tags to grow. Rather, there are some people that may be more prone to developing skin tags and may have new growths periodically. Some patients even require periodic removal of tags at annual or quarterly intervals.

Do skin tags need to be sent for pathology?

Most typical small skin tags may be removed without sending tissue for microscopic examination. However, there are some larger or atypical growths that may be removed and sent to a pathologist for examination under a microscope to make sure that the tissue is really a tag and nothing more. Additionally, skin bumps that have bled or rapidly changed may also need pathologic examination. While extremely rare, there are a few reports of skin cancers found in skin tags.

What else could it be?

While classic skin tags are typically very characteristic in appearance and occur in specific locations such as the underarms, necks, under breasts, eyelids and groin folds, there are tags that may occur in less obvious locations.

Other skin growths that may look similar to a skin tag but are not tags include moles (dermal nevus), nerve and fiber-type moles (neurofibromas), warts, and “barnacles” or “Rice Krispies” (seborrheic keratosis).

Warts tend to be rougher, with a “warty” irregular surface whereas skin tags are usually smooth. Warts tend to be flat whereas tags are more like bumps hanging from thin stalk. While warts are almost entirely caused by human papilloma virus (HPV), tags are only sometimes associated with HPV.

Groin and genital lesions resembling skin tags may actually be genital warts or condyloma. A biopsy would help diagnose which of these growths are not skin tags. Very rarely, a basal cell skin or squamous cancer or melanoma may mimic a skin tag, but this is very uncommon.

Is there another medical name for a skin tag?

Medical terms your physician or dermatologist may use to describe a skin tag include fibroepithelial polyp, acrochordon, cutaneous papilloma, and soft fibroma. All of these terms describe skin tags and are benign (noncancerous), painless skin growths. Some people refer to these as “skin tabs” or warts. However, a skin tag is best known as a skin tag.

Skin Tag At A Glance

• A skin tag is a common but harmless skin growth.
• Skin tags are frequently found on the eyelids, neck, chest, armpits, and groin.
• Treatments include freezing, tying off with a thread or suture, or cutting off.

What is a skin tag?

A skin tag is a common, acquired benign skin growth that looks like a small piece of hanging skin. Skin tags are often described as bits of skin- or flesh-colored tissue that projects from the surrounding skin from a small, narrow stalk. They typically occur in characteristic locations including the neck, underarms, eyelids, and under the breasts (especially where underwire bras rub directly beneath the breasts). Although skin tags may vary somewhat in appearance, they are usually smooth or slightly wrinkled and irregular, flesh-colored or slightly more brown, and hang from the skin by a small stalk. Early or beginning skin tags may be as small as a flattened pinpoint-sized bump around the neck. Some skin tags may be as large as a big grape.

Where do skin tags occur?

Skin tags can occur almost anywhere there is skin. However, favorite areas for tags are the eyelids, neck, armpits, upper chest (particularly under the female breasts), and groin folds. Tags are typically thought to occur in characteristic locations where skin rubs against skin or clothing.

Who tends to get skin tags?

Nearly half of the population is reported to have skin tags at some time. Although tags are generally acquired (not present at birth) and may occur in anyone, more often they arise in adulthood. They are much more common in middle age and they tend to increase in prevalence up to age 60. Children and toddlers may also develop skin tags in the underarm and neck areas. Since they are thought to arise more readily in areas of skin friction or rubbing, tags are also more common in overweight people.

Picture of skin tags

Hormone elevations, such as those seen during pregnancy, may cause an increase in the formation of skin tags, as skin tags are more frequent in pregnant women. Tags may be easily removed during or after pregnancy.

Skin tags are a benign condition and not directly associated with any other major medical conditions, since tags are commonly found on healthy people.

Is a skin tag a tumor?

Skin tags are a type of growth or tumor, albeit a completely benign and harmless one. Tags are not cancerous (malignant) and not found to have potential to become cancerous if left untreated.

What does a skin tag look like under a microscope?

The outer layer of the skin (the epidermis) shows overgrowth (hyperplasia), and it encloses an underlying layer of skin (the dermis) in which the normally-present collagen fibers appear abnormally loose and swollen. Usually there are no hairs, moles, or other skin structures present in skin tags.

What problems do skin tags cause?

These tiny skin growths generally cause no symptoms unless they are repeatedly irritated as, for example, by the collar or in the groin. Cosmetic removal for unsightly appearance is perhaps the most common reason they are removed. Occasionally, a tag may require removal because it has become irritated and red from bleeding (hemorrhage) or black from twisting and dying of the skin tissue (necrosis). Sometimes they may become snagged by clothing, jewelry, pets, or seatbelts, causing pain or discomfort. Overall these are very benign growths that have no cancer (malignant) potential.

Occasionally a tag may spontaneously fall off without any pain or discomfort. This may occur after the tag has twisted on itself at the stalk base, interrupting the blood flow to the tag.

Dermabrasion 101

Dermabrasion is one of three commonly used office-based surgical skin resurfacing and rejuvenation procedures. The technique takes its origin from ancient Egypt in 1500 B.C. where healers used a form of sandpaper to even out scars. Today the technique has seen over 3500 years of evolution.

Dermabrasion mechanically removes the most superficial layers of the skin and allows your skins normal healing properties to rejuvenate the skin itself. It is designed to reduce or remove moderate wrinkles, fine lines, skin blemishes, and uneven skin surfaces. In addition to wrinkle treatment, the technique has been used to treat acne scars, hide or camouflage surgical or traumatic scars and in select cases to remove precancerous lesions.

Microdermabrasion is not the same treatment as dermabrasion and will not be discussed further than this paragraph. Microdermabrasion is a much more superficial and thus a less dramatic rejuvenation procedure with little to no recovery period. Being a more mild procedure than dermabrasion, multiple treatments of micordermabrasion are often required and may never achieve the same degree of rejuvenation as traditional dermabrasion. Microdermabrasion uses a device that sprays a fine beam of aluminum oxide microcrystals to superficially peel the skin surface while simultaneously removing the tissue debris. As microdermabrasion is not as invasive a procedure, non-medical personnel offer this treatment through many spas and clinics.

Skin rejuvenation can also be performed with lasers or chemical peels. These modalities will not be discussed in this article.

CAUTIONS
Patients with darker skin complexions (Fitzpatrick skin types III to VI) may experience permanent skin discoloration or blotchiness with dermabrasion procedures. Patients of African, Asian and Hispanic descent should specifically be cautioned about skin discoloration.

PRE-TREATMENT CARE

Patients with a history of oral herpes infections should be placed on oral acyclovir prior to this treatment to avoid a herpes flare or extension of the condition following dermabrasion.
THE PROCEDURE
Dermabrasion is performed in an out-patient (often office) setting under local anesthesia. Full-face dermabrasion is performed under conscious sedation or general anesthesia, often with the assistance of an anesthetist. A small motorized hand piece rotates a wire brush or diamond fraise at speeds of 15,000 to 30,000 rpm. Skilled manipulation of the rotating brush or fraise removes the upper layers of skin in the areas requiring treatment. This results in a raw, open, partial thickness (through skin) wound that heals by epithelialization of the surface of the skin in a relatively short period of time. Initially the small pinpoint bleeding of the raw wound may be alarming but will subside rapidly with appropriate wound care.

THE RECOVERY
The recovery following dermabrasion skin resurfacing is approximately 2-3 weeks. Early post-operative pain is controlled with prescription medications for the first few days. Most patients require only over-the-counter medications or are comfortable without pain medication within days of the procedure. The skin may weep for the first 10-12 days but eventually stops as the surface layers of the skin are restored. Redness of the treated area is a normal part of recovery and disappears within 3-4 weeks of the procedure. Complete sun avoidance on the treated area must be observed until the redness in the skin has disappeared. Remember good sun protection should still be observed well after the healing period, as it was likely the sun damage to your skin that has driven you to seek this form of treatment in the first place.

Make-up can be used to cover the early skin discoloration once the skin has healed. Please ask your physician or surgeon for directions on when make-up can be used safely.
COMPLICATIONS

A discussion of potential complications is essential with every discussion about a surgical procedure. It is important to know that although complications from surgery are possible they are not common. Some possible complications associated with a dermabrasion are listed into both early and late complications:

EARLY
* Excessive surface bleeding
* Redness (fades with time)
* Infection (viral)
* Skin sensitivity

LATE
* Hyperpigmentation
* Hypopigmentation
* Milia
* Asymmetry (between sides)
* Residual wrinkles
* Scarring

For a more detailed discussion on expected results, recovery, and specific complications, please see your individual surgeon.

COST
Dermabrasion procedures are not covered under most insurance plans and the final cost for such procedures will be at the discretion of the plastic surgeon performing the procedure. Most surgeons quote costs based on the number of aesthetic areas being treated. The average cost of this procedure, is $1000 and higher.

DISCLAIMER
This website does not cover all of the medical knowledge related to dermabrasion nor does it deal with all possible risks and complications of skin resurfacing procedures. Although it is designed to provide the patient with greater depth of information in some areas, it is not intended to substitute for the in depth discussion between patient and surgeon that must occur prior to any surgical or treatment procedure. For a more detailed discussion on expected results, recovery, and specific complications, please see your plastic surgeon or dermatologist.

Author: Dr. Bryce J Cowan BSc MSc MD PhD FRCS(C)
Plastic, Reconstructive, Mohs & Aesthetic Surgeon

Maintaining Healthy Skin

The skin serves numerous functions - detoxifying, protecting, regulating - but the primary protective or barrier function is the most obvious. The top layer of skin cells has the most important function in maintaining the effectiveness of the barrier. Here the individual cells overlie each other and are tightly packed, preventing bacteria from entering and maintaining the water-holding properties of the skin.
Fatty substances (lipids) are secreted by the cells during the course of their journey from the base layer of the skin to the top. These lipid molecules join up and form a tough connecting network, in effect acting as the mortar between the bricks of a wall.

The cell wall barriers are simply layers of fats that surround the watery contents. Therefore, the communication mechanisms must operate through these fatty cell walls. In fact, many of the substances that are involved in this communication process are various fats since it is easiest for fats to move within the fatty layers that comprise the cell walls. Despite its bad reputation, proper fats and cellular fats are of major importance in our body’s biochemistry and physiology.

Damage to the skin barrier can result from a combination of genetic predisposion and exposure to sensitizing chemicals and other substances. That is why avoiding irritants is as important as using products that help. In skin care, the most common irritants are usually perfumes and preservatives.

Fatty substances control the majority of our body’s physiology through receptors that activate many important genes. Likewise, our skin barrier is comprised of a supporting structure of collagen, a protein that contains fats that serve a critical function. These fats prevent the excess loss of water through our skin and prevent the cells of our body from becoming dehydrated and dying.

A major sign of a defective skin is the dryness that results from excessive water loss. This water can not be applied topically but must be ingested. To prevent the excessive water loss and the resulting dry skin, we must repair the skin barrier. We find that the skin composition in individuals with dry skin is due to an improper mixture of the skin fats. This is commonly due to a deficiency in our diet of the correct fats, those contained in natural olive oils, avocados, and healthy nuts, etc. On a nutritional basis, we can provide these necessary fats through the skin sometimes through topical treatments containing natural butters or oils, like Shea, olive and cocoa butter. The epidermis is not a usual means to acquire nutrition but it can absorb enough fatty substances to correct the fat imbalances that are the cause of the defect in the skin’s barrier function and thus correct the dry, itchy skin or sensitive skin problem. Try to be aware of chemical preservatives in any topical products you do use.

Although many products today are labeled “fragrance free,” that is really a misnomer. Nearly all products contain some fragrance to mask their chemical odor; so-called fragrance-free products may just contain fewer chemicals than others. What’s more, the fragrances used in many products (even pricey perfumes) are commonly synthetic. For sensitive individuals, this chemical brew can be a problem To make matters worse, many natural fragrances are now extracted using harsh solvents rather than old-fashioned distillation methods, in which fewer chemicals come into contact with the essential oil of the flower. Unless you can determine the extraction method used, be cautious. This is one reason many individuals react negatively to the essential oils used in aromatherapy massages and related products – many are of a synthetic, chemical composition.

According to several studies, various preservatives including formaldehyde, parabens, and others commonly used in skin, hair, and beauty products can also provoke allergic reactions. Although the preservatives are needed to maintain product shelf life and only minute amounts are present in any given product, many products contain these same chemicals, including skin care products, makeup, medications, antiperspirants, toothpaste, and foods. Many of these products are used on a daily basis, causing a higher reaction rate. As a result, the overall exposure to these harmful ingredients is higher than would occur if only a single product were used. Studies show that massage therapists have more contact dermatitis – or skin inflammation - due to exposure to these extracts.

Until recently, few studies investigated the cumulative impact of repeated exposures to preservatives in a variety of products and ingredients. For the majority of people, these product preservatives are an additional benefit, not a problem. But, as the chemical compositions increase, so do the allergic reactions.
If you suffer from sensitive, allergic skin or severe dry skin, you may be among those who will have a problem or reaction to these chemical-laden products. In this case, it is your role as an informed consumer to carefully read labels for all products that come into contact with your skin - internally or externally- to assure that they don’t contain the listed ingredients that you must avoid. Your skin barrier does a lot to protect you naturally, help it out when you can and feed it nourishing chemical-free products whenever you can.

Best Acne Skin Care Treatments

If like many others you are desperate to get your acne treated in order to regain the skin you once had then using an acne skin care treatment is essential to the process. By reading through the tips provided below you should soon be back on the road to have that beautiful skin you had before you suffered from acne.

However it is important that first of all you know what acne is and then you will be able to treat it much better. A person suffers from acne because their sebaceous glands begin to produce too much oil and when combined with dead skin cells a person’s pores will then become blocked. As the pores are blocked they are unable to breathe correctly and then bacteria sets in and so blackheads and whiteheads will begin to erupt on the person’s skin.

In order to clean your face effectively whilst treating acne of any form you should not scrub it but rather gently wash it using a mild anti-bacterial soap or lotion.

Next you need to look at what you are eating and drinking. Many people do not realize this but what they eat and drink seriously affects their acne further. Therefore you should drink lots of fresh water each day. Not only will it help to remove all those unwanted toxins (which make a person’s acne worse) from the body but it is probably the most inexpensive form of acne skin care treatment.

You should also eat vegetables which contain high amounts of Vitamin A and will normally be bright orange or yellow or green in color. By eating plenty of these vegetables such as carrots, sweet corn and broccoli, cabbage etc, it will help you achieve a much better complexion on your skin.

Besides keeping the above points in mind, you should also consult your doctor. They will be able to prescribe acne skin care treatment medications that you will not be able to find or purchase elsewhere. But as well as using the medication provided by your doctor you should look more closely at your dietary habits and make the necessary changes and do not forget to drink plenty of fresh water also.

By taking these steps in your acne skin care treatment program you should be on the road to seeing the results of your work in the mirror in a very short period of time.