Wart Treatment by Type of Drug and Procedure

The new advance in treatment of genital warts has been imiquimod (Aldara). This encourages the patient’s autoimmune system to attack the wart. This is particularly helpful in the moist areas of the skin or mucosal surfaces.

Salicylic acid
Salicylic acid can be applied either in the form of plasters or as liquid on to the warts. This will break down the thickened skin on the surface. It is more effective if the area is covered. These are useful for warts on the hands, knees and feet. They do turn the skin white. They can be used in combination with paring of the warts. Treatment with these at nighttime and covering with duct tape can be effective although slow.

Podophyllin

Podophyllin has a long history of use. It is useful mostly in genital warts. It should be applied very carefully on the warts, trying to prevent spread on to normal skin. It should be washed off after a few hours. There is irritation usually for a few days. Repeat treatments are usually required. A more purified form of podophyllin called podophyllotoxin is available for patient use. It can be used once or twice daily for a few days in succession. This produces some irritation. It has the advantage of not being as irritating as podophyllin and can be applied by the patients themselves.

Vitamin Acid

Vitamin acid (Tretinoin) is a vitamin A preparation. It is used in the treatment of acne and photo damage. Vitamin A products tend to regulate the surface of the skin, generally trying to keep the epidermis behaving normally. It may also cause some inflammation. In some individuals it can help reduce or even eliminate warts.

Cantharone

Cantharone (cantharidin) is derived from an insect. It can be very helpful in children but the application is painful. Inflammation and
blistering usually occurs later in the day, after application. Multiple treatments may be required. There are two concentrations. The
stronger version combines Cantharone with podophyllin and salicylic acid. Very occasionally the blistering reaction can be quite severe
and associated with swelling and pain. It is often very effective even in resistant warts.

Cryotherapy

Cryotherapy is the use of liquid nitrogen. This can be applied either with a Q-Tip or it can be sprayed on to the skin. It causes destruction by freezing water inside the cells. This damages the cell causing death. It is painful to apply and there is blistering associated with this. Multiple treatments may be required. Thawing and freezing again makes this therapy more effective. It can be a problem in dark skin in that it can either increase or decrease pigmentation, which can be permanent. This treatment can be used in combination with other therapies.

Electrodesiccation

Electrodesiccation is the use of an electric needle to burn warts. It usually requires a local anesthetic. It does have a potential risk of scarring. Very large warts can sometimes be scraped off before they are cauterized.

CO2 Laser

The CO2 laser has been used for many years. It essentially vaporizes water in the skin and causes destruction. It leaves a hole in the skin which will heal. There is often scarring with this technique. Other lasers such as the pulse dye laser are easier to use. The yellow light is absorbed by blood in the vessels that feed the warts. This is a similar laser used in the treatment of red birthmarks. The pulse dye laser at a high power setting can be effective particularly if multiple pulses are used in succession.

Aldara

Aldara is an immune response modulator. It boosts the patient’s immune response to viruses. It can also encourage the production of a
lasting immune memory. It has been available in Canada since 1999. It works best in the genital area as penetration into the skin is easier. When it is used elsewhere it often has to be covered to help with penetration into the skin. It has been shown to work well particularly in women. It is applied three times weekly. There will be some inflammation associated with this. The results may be enhanced by combining this with liquid nitrogen. This drug has added a very significant tool in treating genital warts.

Common Bacterial Infections of the Skin

Our skin is host to a number of bacteria, most of which are beneficial. Including the friendly flora in our gut, more than 200 species of bacteria reside within the tissues exposed to the external environment. Skin infections result from these bacteria when the integrity of the skin breaks down or when the immune defense system is weak.

Skin infections can occur on the skin surface or deeper within the skin tissue. The most common bacteria that infect the skin are Staphylococcus aureus and Streptococcus pyogenes. Read more about bacterial infections on www.skincareguide.ca/conditions/bacterial_infections

TYPES OF BACTERIAL INFECTIONS:

Impetigo and Ecthyma

Impetigo begins with a redness of the skin and progresses to blisters that fill with fluid and itch, and then produce honey-colored crusts. Lesions usually form around the nose and face. Ecthyma is a deeper version of impetigo that usually forms on the legs. It causes large boils, crusts, and deep sores that leave scars.

Folliculitis

Folliculitis is an infection of the hair follicles. It produces pimplelike skin bumps and small blisters with pus. Folliculitis occurs on the face, upper trunk, arms, and buttocks. When the infection goes deeper, feels tender, and produces more pus, it is furunculosis. Carbuncles are furuncles that have fused.

Abscess

An abscess is a deep infection that appears like a closed blister or an open hole with pus. It is usually tender and becomes sore and painful as the infection progresses.

Erysipelas and Cellulitis

Erysipelas is a superficial infection that tends to occur in young children and the elderly. It is also seen in those who have chronic swelling of the limbs, are addicted to alcohol, have diabetes mellitus, or have experienced trauma. Erysipelas mostly occurs on the face or legs. A fever occurs abruptly, the cheeks become red, and the skin feels hot, tense, and swollen. Cellulitis is a deeper form of this infection.

TREATMENTS:

Bacterial skin infections are treated according to their severity. Your physician may incise and drain deeper infections and abscesses, and recommend that you apply warm compresses. Creams such as Fucidin® or Bactroban® are prescribed for mild stages of:

* impetigo
* ecthyma
* folliculitis
* abscess

If the infection is more extensive, oral antibiotics such as Cloxacillin or Cephalexin are used as well as those in the erythromycin family. Penicillin is often used to treat for strep.

Antibiotic resistance is an increasing problem so it is best to have early adequate proper treatment to minimize risk of exposure to antibiotics and lower the risk of transmission to others.

During treatment, remember to wash your hands daily with an antibacterial solution such as Trisan®, Tersaseptic® or Hibitane®, or use a product like Safe4Hours® (www.invisicare.com) which kills bacteria for four hours. Hand washing is the most important thing you can do to minimize the spread of infection.

If you suspect a bacterial skin infection, see your doctor before it becomes severe. Due to the increase of bacterial resistance to drugs in general, it is important to take the full course of your prescribed medicines.

Treating Actinic Keratoses and Nonmelanoma Skin Cancers

Methyl Aminolevulinate-PDT for Actinic Keratoses and Superficial Nonmelanoma Skin Cancers

Methyl aminolevulinate-hydrochloride cream (Metvix® [in Canada] and Metvixia® [in the US], Galderma) in combination with photodynamic therapy (PDT) provides an effective treatment option for actinic keratoses (AKs), superficial basal cell carcinoma (sBCC), and Bowen’s disease (BD). Good clinical outcomes have been reported in the literature. Complete responses (CRs) in AK range from 69% to 93% at 3 months. In sBCC, reported CR rates were from 85% to 93% at 3 months and almost on par with cryosurgery at 60 months (75% vs. 74%). In BD, CR rates were 93% at 3 months and 68% at 2 years. Current evidence has shown that this noninvasive treatment is superior in terms of cosmetic outcome to other management strategies such as surgery. It also offers the advantages of relative simplicity, low risk of side-effects and decreased complications due to scar formation.

Topical Methyl Aminolevulinate (MAL)-PDT

Photodynamic therapy (PDT) treats superficial skin cancers and pre-cancerous lesions through photosensitized reactions requiring oxygen. Over the past several decades, PDT has been extensively investigated as an experimental therapy for human cancers. There is now growing interest in the use of PDT not only for nonmelanoma skin cancer (NMSC), but also for other skin tumors such as lymphoma, as well as for nononcological indications, such as psoriasis, localized scleroderma, acne, and skin rejuvenation.^1-4 In Europe, as well as in the US, porphyrin-inducing precursors, such as 5-aminolevulinic-acid (ALA) and MAL have been proven effective for the treatment of actinic keratoses (AKs) and basal cell carcinomas.^5-7 Both ALA and MAL induce protoporphyrin IX (PpIX) locally in the skin. Photodynamic therapy combines the simultaneous presence of a photosensitizer activated by an appropriate wavelength of light. For topical PDT, upon illumination, PpIX is transformed to the excited state and then returns to its ground state through a type-II photo-oxidative reaction.5 In this reaction, these molecules transfer energy to oxygen producing highly reactive oxygen species (ROS), singlet oxygen in particular. ROS accumulates locally within the affected tissue leading to direct cellular damage by apoptosis or necrosis, and indirect stimulation of inflammatory cell mediators.⁶

Previous studies have shown that MAL in combination with red light (570-670nm) has provided good clinical outcomes in the treatment of NMSC (both sBCC and Bowen’s disease) and AKs.⁷ MAL, the methylated ester of ALA, is a new topical photosensitizer that may offer advantages over ALA in terms of its deeper skin penetration (up to 2mm in depth) due to potentially enhanced lipophilicity and greater specificity for neoplastic cells.⁸ In a typical PDT session, the lesion surface is prepared by light curettage of any surface crusts and scales. The 3 hour application of 160mg/g MAL prior to irradiation with 37J/cm2 from a light-emitting diode system (emission peak of 632nm) corresponds to the time point of the highest ratio of fluorescence depth to tumor depth2 under occlusion. Two treatments 1 week apart for AKs, sBCC, and BD have been recommended; however, a single treatment session is possible and may be potentially sufficient for very thin AKs. For partially cleared responses, a second treatment course (consisting of two weekly PDT sessions) at 3 months may be considered.⁹ This article reviews key published trials of topical MAL-PDT for AK, sBCC, and BD.

AKs

A US randomized, multicenter, double-blind, placebo controlled study was performed in 80 patients with mild-to-moderate AKs on the face and scalp. Forty-two patients (260 lesions) were treated with MAL-PDT and 38 patients (242 lesions) received the placebo cream. MAL was applied for 3 hours followed by illumination with noncoherent red light (75J/cm2). Treatment was repeated after 1 week. A complete response rate of 89% with MAL-PDT and 38% with placebo was assessed after 3 months follow-up. An excellent or good cosmetic outcome was reported in more than 90% of patients treated with MAL.¹⁰

Tarstedt et al.11 reported response rates in an open label, prospective study that compared 2 regimens:

1. A single treatment session 2. 2 MAL-PDT sessions 1 week apart.

One hundred six patients received the single treatment and 105 patients received the second regimen. For thin lesions, clearance rates showed no significant difference (93% with single session vs. 89% with double sessions) For thicker lesions, clearance rates were higher for double sessions (84%) when compared with single treatment (70%). The authors concluded that single treatment is effective for thin AKs. Repeated treatments were needed for thicker or resistant lesions.

In another randomized, multicenter study, MAL-PDT (n=360 lesions) was compared with a single-thaw cycle of cryotherapy (n=421 lesions) or placebo (n=74 lesions). The PDT treatment arm consisted of 2 treatment sessions 1 week apart using 75J/cm2 with a noncoherent red light (570-670nm). After 3 months, clearance rates for MAL-PDT were significantly higher (91%) compared with cryosurgery (68%) and placebo (30%). Of the MAL-PDT treated patients, 83% were rated as having an excellent cosmetic outcome by an investigator vs. 51% of those treated with cryotherapy; the corresponding patient assessments were 76% and 56% respectively.¹²

A large randomized, intraindividual, right-left comparative study of 119 patients with face/scalp AKs was performed.14 The aim of the study was to compare 1 MAL PDT session to double freeze-thaw cryotherapy. After a 3-hour application of MAL using 37J/cm2 with double treatment 7 days apart, cure rates were seen when using MAL-PDT (87%) compared with cryotherapy (76%). Of patients treated with MAL-PDT, 10% required re-treatment after 3 months vs. 21% for cryotherapy. Cosmetic outcome significantly favored MAL-PDT (i.e., 77% vs. 50%).13 A recent study, however, showed lower efficacy with MAL-PDT (78% clearance) on the extremities compared with cryotherapy (88% clearance).¹⁴

In a recent multicenter, double-blind, randomized study by Pariser,15 the efficacy of MAL-PDT using a red light-emitting diode (n=363 lesions) was evaluated vs. placebo (n=360 lesions) for grade 1 (slightly palpable) and grade 2 (moderately thick) AKs on the face and scalp. Lesion complete response rates were significantly superior for MAL-PDT (86.2%) vs. placebo (52.5%). The patient complete response rate was 59.2% for MAL-PDT subjects, and lower for those who had vehicle PDT alone (14.9%). Scalp lesions responded better with MAL-PDT (93%) than did facial lesions (87%). Grade 1 lesions had slightly higher complete response rates than grade 2 lesions (89% vs. 80%). Furthermore, larger lesions with diameters of >20mm had poorer response rates compared with smaller lesions (74% vs. 86%).

When treating AKs, biopsies should be considered for thick, keratotic lesions to rule out squamous cell carcinoma. Calzavara-Pinton et al.¹⁶ have shown that even if squamous cell carcinoma is limited to microinvasive involvement, the treatment outcome is poor.

Superficial BCCs

The recent British Photodermatology Group guidelines for topical PDT concluded MAL-PDT to be effective for sBCC.⁹ In an attempt to compare clearance rates and cosmetic outcomes between MAL-PDT (n=60) and double freeze-thaw cryotherapy (n=58) in sBCC, a 5-year European randomized trial was performed in 118 patients. This protocol used MAL applied for 3 hours at 75J/cm2 with noncoherent red light (570-670nm) for 1 session. Partially treated patients at 3 months were given 2 further MAL-PDT sessions (n=20) or repeat cryotherapy (n=16). Complete clinical response rates after 3 months’ follow-up for MAL-PDT were 97% of 102 lesions, while that of cryotherapy was 95% of 98 lesions; the difference between these 2 treatments was not statistically significant. At 5 years’ follow-up, clearance rates were similar for the MAL-PDT group (75%) and cryotherapy (74%). Of the lesions initially cleared with MAL-PDT, 22% had recurred vs. 20% after cryotherapy. Cosmetic outcome was judged superior following PDT (87% vs. 49%).¹⁷ Double MAL-PDT treatment cycles for ‘difficult-to-treat’ sBCC (and nBCC) were reported by 2 prospective multicenter studies. This included recurrent, large-sized lesions and/or those occurring on the mid-face or ears. In the first study, 87% of patients (n=94) had ‘difficult-to-treat’ lesions occurring on the face or scalp. The protocol was a single cycle of MAL-PDT (MAL 3h, 75J/cm2, 570-670nm or 580-740nm, 50-200mW/cm2) involving 2 treatment sessions 1 week apart. For partially treated lesions after 3 months’ follow-up, a second cycle was repeated. Complete clearance at 3 months was 85% for sBCC after histological review (75% for nBCC). After 2 years, the recurrence rate was 22% for sBCC (14% for nBCC). Ninety-four percent of patients were assessed to have a good to excellent cosmetic outcome.¹⁸ In the second study, efficacy, safety, and cosmetic outcomes were examined in 95 patients with BCCs that were ‘difficult-to-treat’ and at high risk for surgical complications. A total of 148 BCCs (sBCC and nBCC) were treated with the same PDT protocol (MAL 3h, 75J/cm2, 570-670nm, 50-200mW/cm2) with re-treatment for non-complete response lesions at 3 months. Overall, histologically-confirmed lesion complete response rate was 89% (93% sBCC and 82% nBCC) after 3 months’ follow-up. Fifteen percent of lesions had histologically confirmed recurrence within 2 years increasing to 20% within 4 years. Ninety-seven percent of patients rated their cosmetic outcome as good to excellent at 3 months.¹⁹

Bowen’s Disease

A large randomized, controlled, multicenter study reported similar clearance response rates following MAL-PDT (86%), single freeze-thaw cryotherapy (82%), and 1 month application of 5-fluorouracil (83%) in 225 patients with histologically confirmed Bowen’s disease. MAL-PDT (MAL 3h, 75J/cm2, 570-670nm, 70-200mW/cm2) was given as a single cycle 1 week apart. Lesions with a partial response at 3 months were re-treated. Cosmetic outcome was superior for MAL-PDT in 94% of patients vs. 66% with cryotherapy, and 76% with fluorouracil.²⁰ Clearance rates after 2 years for MAL-PDT was 68% vs. 60% with cryotherapy and 59% with fluorouracil.⁷

Conclusion

MAL is an effective low molecular weight topical porphyrin-inducer that is typically used in combination with a red light-emitting diode for PDT. It offers therapeutic benefit for thin and moderate thickness AKs. It should be considered as a treatment option for superficial BCCs and Bowen’s disease, particularly in situations where surgery may be problematic or where patients have multiple lesions. However, long-term cure rates, as mentioned above for Bowen’s disease and sBCC, are only 68% and 75% respectively. Because of the appreciable nonresponse and recurrence rates, patients treated with PDT for either disease should be monitored closely during the first 2-3 years after PDT, which is when most lesion recurrences occur. According to studies, patients’ high preference for MAL-PDT may be mainly due to its good to excellent cosmetic outcome and general tolerability of side-effects. No direct comparative studies have yet been reported with MAL and ALA. Important parameters, such as the depth of penetration of MAL-PDT, tumor thickness, location, and careful patient selection are key elements for efficacy. In the US, MAL-PDT is currently FDA-approved for the treatment of AKs only, whereas in Canada, MAL-PDT is officially indicated for the treatment of both AKs and sBCCs.

B. Ortiz-Policarpio, MD and H. Lui, MD, FRCPC

Photomedicine Institute, Department of Dermatology and Skin Science, Vancouver Coastal Health Research Institute, BC Cancer Agency, and University of British Columbia, Vancouver, BC, Canada

Wart Treatment by Type of Wart

Treatment will depend in part on the location, the age of the patient, as well as the size and immune status of the individual. The treatment choice will depend in part on previous experience of the patient and the patient’s preference. Many of the treatments can be uncomfortable and therefore difficult to use in children.

Treatments can be either destructive as in the use of liquid nitrogen or most recently there is an immunological approach to boost the patient’s own immune system.

Common Warts

Liquid nitrogen cryotherapy is most commonly used in those who can tolerate the pain. Repeat treatments are frequently required. Excising or scraping off these warts is less desirable as it will scar. The use of pulse dye laser or very occasionally the Co2 laser can be used in resistant lesions. Cantharone can be used particularly in children as it is more easily tolerated. Other treatments involve the use of immune therapy. Substances such as DNCB involve painting the substance on the warts in order to develop an allergic reaction. This immune allergic reaction will be useful for destroying the wart.

Flat Warts

Flat warts frequently occur on the face and on the legs. Care needs to be taken not to use a treatment that will have a high risk of scarring. Very light liquid nitrogen cryotherapy can be used.

It is important that shaving is done very carefully or is stopped for a while as this is known to spread these warts. Treatments such as Aldara have been used. Topical treatments such as vitamin A acids (Tretinoin) can sometimes be of benefit. Efudex cream has also been used.

Plantar Warts

Plantar warts can be stubborn. Because of their location aggressive use of liquid nitrogen cryotherapy is difficult in that it can not only be painful but swelling and soreness can prevent walking for a number of days. Often paring the warts by thinning them down can be helpful. The use of salicylic acid preparations that are applied daily and cover the affected area will eat away at the surface of the wart allowing it to be pared down. This may make it more responsive to liquid nitrogen. The use of duct tape to soften the lesions in some individuals can be in itself curative. It appears that changing the water content and making the skin mushy enhances the patient’s ability to eradicate these warts. Treatments such as surgery and scraping of these warts is discouraged as scars can sometimes be painful on the weight-bearing parts of the foot. The pulse dye laser can be used once the wart has been thinned as it does not produce scarring. Occlusion combining these therapies with Aldara cream in some individuals is helpful.

Genital Warts

Genital warts are usually sexually transmitted. It is important that woman be checked to rule out any atypical changes on the cervix. Small warts can be treated with liquid nitrogen although this is uncomfortable. Podophyllin or podophyllotoxin can be applied every few days and this can be helpful.

Identifying Common Skin Conditions; Warts, Moles and More

A reader of our sites recently commented, “I know that the people often mistake warts, skin tags and moles but these are three different skin disorders. I am trying to find out information to convince people that skin tags and warts and moles are not and the same.”

The internet can be a valuable resource to finding answers to most our skin treatment issues. But if you just want a quick overview of the most common skin conditions; warts, moles (nevis), dark spots (dpn), skin tags, and Seb-Ks (seborrheic keratoses), then the information provided here can be a great place to start.

Identifying Common Skin Conditions; Warts, Moles, DPN, Skin Tags and Seb-Ks

There are several skin lesions that are very common and almost always benign (non-cancerous). These conditions include moles, freckles, skin tags, benign lentigines, and seborrheic keratoses.

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.

Moles, Dysplastic Nevus and Dermatofibroma

Moles are growths on the skin that are usually brown or black. Moles can appear anywhere on the skin, alone or in groups. Most moles appear in early childhood and during the first 20 years of a person’s life. Some moles may not appear until later in life. It is normal to have between 10-40 moles by adulthood.

As the years pass, moles usually change slowly, becoming raised and/or changing color. Often, hairs develop on the mole. Some moles may not change at all, while others may slowly disappear over time.

A dermatofibroma is a benign skin bump that occurs most commonly on the legs. A dermatofibroma is a firm, slightly elevated, dome-shaped, often darker-colored papule.

Sometimes a dermatofibroma is confused with a mole. The way to tell the difference between the two is to pinch the bump. If you pinch a dermatofibroma it creates a dimple because it is attached to the underlying subcutaneous tissue. On the other hand, if you pinch a mole, it projects up away from the skin.

Dysplastic Nevus

A dysplastic nevus, (or naevus; pl. nevi or naevi) is an atypical melanocytic nevus; a mole whose appearance is different from that of common moles. Dysplastic nevi are generally larger than ordinary moles and have irregular and indistinct borders. Their color frequently is not uniform and ranges from pink to dark brown; they usually are flat, but parts may be raised above the skin surface. Dysplastic nevi can be found anywhere, but are most common on the trunk in men, and on the calves in women.

Dermatosis Papulosa Nigra?

Dermatosis papulosa nigra (DPN) is a benign, cutaneous (relating to the skin) condition common among blacks. It is usually characterized by multiple, small, hyperpigmented, asymptomatic papules on the face of adult blacks. Histologically, dermatosis papulosa nigra resembles seborrheic keratoses. The condition may be cosmetically undesirable to some patients.

Dermatosis papulosa nigra affects up to 35% of the African American population. Blacks with a fair complexion have the lowest frequency of involvement. Dermatosis papulosa nigra also occurs among Asians, although the exact incidence is unknown.

What is a Wart?

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.

What is Seborrheic Keratosis?

Benign lesions that don’t ever turn into cancer, seborrheic keratoses, or Seb K’s for short, can look dangerous. In reality they are just annoying. Also irreverently called barnacles, they come in all different shapes and sizes from large black growths to barely noticeable raised areas.

Characteristics of Seborrheic Keratosis
The wicked witch with a wart on her nose probably had a Seb K not a wart. So how can you tell if that bump on your face or chest is actually a Seb K? They do have some defining characteristics. Warty surface - Seborrheic keratoses may look like warts but they don’t contain human papilloma viruses that cause warts. As they develop some can have a very rough surface with deep pits and fissures almost like cauliflower being pulled apart.

Hopefully, this helps clear up any misnomers or confusion you may have about a wart or mole or any skin condition you are worried about. If any skin condition persists, changes or grows painful, seek medical attention or the professional advice of a doctor immediately.

Treating Warts on Children

Many of us have had a wart somewhere on our bodies at some time. Other than being a nuisance, most warts are harmless and go away on their own.  More common in kids than in adults, warts are skin infections caused by viruses of the human papillomavirus (HPV) family. They can affect any area of the body, but tend to invade warm, moist places, like small cuts or scratches on the fingers, hands, and feet. Warts are usually painless unless they’re on the soles of the feet or another part of the body that gets bumped or touched all the time.

Kids can pick up HPV — and get warts — from touching anything someone with a wart has used, like towels and surfaces. Kids who bite their fingernails or pick at hangnails tend to get warts more often than kids who don’t because they can expose less-protected skin and create open areas for a virus to enter and cause the wart.

Types of warts include:

* common warts. Usually found on fingers, hands, knees, and elbows, a common wart is a small, hard bump that’s dome-shaped and usually
grayish-brown. It has a rough surface that may look like the head of a cauliflower, with black dots inside.
* flat warts. These are about the size of a pinhead, are smoother than other kinds of warts, and have flat tops. Flat warts may be pink, light brown, or yellow. Most kids who get flat warts have them on their faces, but they can also grow on arms, knees, or hands and can appear in clusters.
* plantar warts. Found on the bottom of the foot, plantar warts can be very uncomfortable — like walking on a small stone.
* filiform warts. These have a finger-like shape, are usually flesh-colored, and often grow on or around the mouth, eyes, or nose.

Sometimes warts are sexually transmitted and appear in the genital area, but most warts appear on the fingers, hands, and feet.

Are Warts Contagious?

Simply touching a wart on someone doesn’t guarantee that you’ll get one, too. But the viruses that cause warts are passed from person to person by close physical contact or from a surface that a person with a wart touches, like a bathmat or a shower floor. (You can’t, however, get a wart from holding a frog or toad, as your child might have wondered!)

A tiny cut or scratch can make any area of skin more vulnerable to warts. Also, picking at a wart can spread warts to other parts of the body.
The length of time between when someone is exposed to the virus that causes warts and when a wart appears varies. Warts can grow very slowly and may take weeks or longer, in some cases, to develop.

Preventing Warts

Although there’s no way to prevent warts, it’s always a good idea to encourage kids to wash their hands and skin regularly and well. If your child has a cut or scratch, use soap and water to clean the area because open wounds are more susceptible to warts and other infections.

It’s also wise to have kids wear waterproof sandals or flip-flops in public showers, locker rooms, and around public pools (this can help protect against plantar warts and other infections, like athlete’s foot).

Treating Warts

Warts don’t generally cause any problems, so it’s not always necessary to have them removed. Without treatment, it can take anywhere from 6 months to 2 years for a wart to go away. A doctor might decide to remove a wart if it’s painful or interferes with activities because of the discomfort.

Doctors have different ways of removing warts, including:

* using over-the-counter or prescription medications to put on the wart
* burning the wart off using a light electrical current)
* freezing the wart with liquid nitrogen (called cryosurgery)
* using laser treatment (with recalcitrant warts)

Within a few days after the doctor’s treatment, the wart may fall off, but several treatments might be necessary. Doctors don’t usually cut off a wart because it can cause scarring and the wart may return.

If an older child has a simple wart on the finger, ask the doctor about using an over-the-counter wart remedy that can help remove the wart. This treatment can take several weeks or months before you see results, but eventually the wart should crumble away from the healthy skin. Wart medicines contain strong chemicals and should be used with care because they can also damage the areas of healthy skin. Talk with your doctor before using any over-the-counter wart medicine on the face or genitals.

Also make sure that your child:

* soaks the wart in warm water and removes dead skin on the surface of the wart with an emery board (that’s never going to be used for nails) before applying the medicine. Be careful not to file into it.
* keeps the area of the wart covered while the medicine works
* knows not to rub, scratch, or pick at it to avoid spreading the virus to another part of the body or causing the wart to become infected

You might also have heard that you can use duct tape to remove a wart. Talk to your doctor about whether this type of home treatment is OK for your child.

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.

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.

Natural Acne Scar Treatments

Hormonal changes and overly active sebaceous (oil) glands that commonly occur in adolescence usually cause acne, however acne can still affect adults as well. Zits, pimples, acne, cystic skin eruptions, blackheads and white heads all fit into the acne skin malady category.

The temptation to squeeze the spots and remove the infected matter, albeit tempting, will not reform your skin to its natural radiance. In fact, secondary infection by bacteria being pushed back into the deeper layers of the skin can cause more pain, inflammation and most likely future scaring. Once the bacteria have been released, it can re-infect the surrounding skin. The facial scars are actually remnants of the bacterial infection caused by ‘procedure.’

The unfair fact is that adult acne will affect 25 percent of men and 50 percent of women in their adult lives. We know that identifying hormonal changes as the main cause of adult acne aren’t entirely proven. There isn’t just one cause. Acne in adult women can be linked to cosmetic use, some hair products and can frequently be brought on by the hormonal fluctuations associated with pregnancy. Certain types of prescription medications can also cause adult acne. Some strains of acne, such as Acne vulgaris, don’t typically show up in adults until midlife. Adult acne also forms differently, whereas adolescent acne begins on the forehead and cheek area, adult acne tends to show more on the chin, jaw line and neck.

With all this new adult acne erupting (pardon the pun) more than before, natural acne and scar treatments are gaining more acceptance as consumers want to make healthier more sustainable choices for their skincare.

Your skin has an amazing natural ability to regenerate itself and a new layer of skin growth will generally cover any scarring, but in the rare cases where this does not occur then a more advanced scar treatment is in order. Always consult with your doctor or dermatologist before beginning any facial treatments to be sure you are not causing further damage.

A healthy, well-balanced diet plays a large role in helping your body and skin to regenerate itself to its optimal condition. Many dermatologists recommend a diet high in natural minerals. These minerals are to maintain the health of the skin cells, which in turn should prevent a further outbreak of acne and repair damaged tissue. Diets, which include plenty of green vegetables, un-cooked vegetables such as carrots, spinach and cucumbers, have also helped many to maintain smooth, blemish-free skin. The idea is to try to create a new fresh layer of skin so that the scars reduced or eradicated.

Are you drinking enough water?

By consuming a regular amount of water daily, you can improve the look of your skin. The average human body is comprised of 60 percent water. Drinking more water, instead of sugar-laden sodas or energy drinks will keep the skin moist and smooth; it will also clear away the dead skin cells, flush toxins and aid in the regeneration of new skin cells. Mixing water with natural ingredients like citrus, fruit or vegetable juices, can also be helpful to exfoliate the skin.

With a proper nutritious diet, vitamins and plenty of water, most see results within a few months. It can take up to a year for acne scars to heal completely. Acne scars do not show up overnight and removing them can take the same amount of time if not more. It takes patience, but with the proper motivation for beautiful, glowing skin, it will be well worth the wait.

Of course, some scars may be so deep as to require dermalogical treatments such as lasers or painful acid peels. Try the natural methods first, as theses procedures can be quite costly. Any effort you make to regenerate your skin naturally will only help the dermatologist’s treatments even further.

Always remember to gently cleanse and moisturize your skin everyday as well. Applying harsh, drying chemicals to your acne will usually cause further inflammation and breakouts. One natural treatment that had shown good results is to mix pure sandalwood oil with rose water, apply it to your scar(s) and leave on the skin overnight. Cleanse face as usual in the morning.

Alternative Acne Treatments and Prevention

Several surgical or medical treatments may be used to reduce acne or the scars caused by the disease.
•    Chemical peel. A chemical known as glycolic acid is first applied to the skin. When it dries, it is peeled off, taking the top layer of skin with it. This treatment helps reduce scarring.

•    Collagen injection. Shallow scars are filled in by injecting collagen, a skin protein, beneath the scars.
•    Comedo extraction. A special tool is used to remove a comedo from a pore.
•    Dermabrasion. The affected skin is first frozen with a chemical spray. Then it is removed with a brush or sandpaper-like instrument.

•    Intralesional injection. Anti-inflammatory drugs are injected directly into inflamed pimples.
•    Punch grafting. Deep scars are removed and the area repaired with small skin grafts.

Alternative treatments for acne focus on proper hygiene and diet. Patients are advised to keep their skin clean and oil-free. They are also encouraged to eat a well-balanced diet high in fiber, zinc, and raw fruits and vegetables. They should also avoid alcohol, dairy products, caffeine, sugar, smoking, processed foods, and foods high in iodine, such as table salt.

Some doctors recommend the use of herbs to supplement the diet. Some herbs that have been used in the treatment of acne include burdock root, red clover, and milk thistle. Additional nutrients that may help to control acne include B-complex vitamins and chromium. Chinese herbal treatments that are recommended include cnidium seed and honeysuckle flower. Another herbal treatment is tea tree oil. The proper dose of these substances can be recommended by physicians or nutritionists.

Acne cannot be cured. However, it can be controlled in about 60 percent of patients with the drug isotretinoin. Improvement usually takes at least two months, and the problem may recur after treatment has been stopped. Inflammatory acne that results in the formation of scars may require one of the more aggressive treatments already described.

PREVENTION

There are no sure ways to prevent acne. However, the following steps tend to reduce flare-ups ofthe condition:
•    Gently wash—do not scrub—the affected areas once or twice every day.
•    Avoid rough cleansers.
•    Use makeup and skin moisturizers that do not produce comedos.
•    Shampoo often and wear hair away from the face.
•    Eat a well-balanced diet and avoid foods that trigger flare-ups.
•    Give dry pimples a limited amount of sun exposure unless otherwise directed by your doctor.
•    Do not pick or squeeze pimples.
•    Reduce stress.

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