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.

Skin Tags and Seborrheic Keratoses

Nuisances You don’t have to put up with. As time goes on, we all acquire tiny bits of extra skin called skin tags. These can range in size from 1-10 mm, and are flesh colored or brown.

Skin tags can be found on any part of the body, but are most common on the eyelids and neck, and in the armpits and groin, and under the breasts.  While skin tags are benign they can be annoying if they become irritating or rub on sporting equipment, and skin tags can interfere with shaving and can detract from one’s appearance and self-image.

Fortunately, we don’t have to put up with skin tags. These little annoyances can be easily removed in an office visit with little or no discomfort. Skin tags can almost always be removed without needing stitches, and the treated areas usually have healed completely in a week or two.

The cost of removing skin tags is quite reasonable - ranging from about $80 for a few tiny ones to about $200 for a larger number scattered over several areas.

Seborrheic keratoses are firm flat or raised, sometimes scaly or crusty flesh-colored, brown or black “barnacles” which accumulate (usually on the face and trunk) as time goes on. Some people start to develop seborrheic keratoses in their thirties, and most people have at least a few by the time they are sixty. To look at pictures of different types of moles, click on www.SkinCancerGuide.ca .

Seborrheic keratoses are usually just a nuisance, but - like skin tags — they can rub on clothing and equipment, and their appearance can sometimes be so distressing that they interfere with choice of clothing, sports like swimming, and intimacy.  Because seborrheic keratoses grow above the skin (but not down into the skin) they can be easily scraped off, and the treated areas heal up nicely within a few weeks. Sometimes the healed area remains pink for a few months after the seborrheic keratosis is removed.

The cost of removing seborrheic keratoses is similar to that for removal of skin tags: about $80 for one or two, with the cost gradually increasing depending on the number and size of seborrheic keratoses to be removed.

The cost of removing skin tags and seborrheic keratoses is a tax-deductible medical expense, just like things like dental bills.  So, if you are annoyed by skin tags or seborrheic keratoses you can be confident that it is simple and inexpensive to rid yourself of these nuisances.

By Kevin C. Smith MD FACP FRCPC

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 Skin Lesions - Warts, Moles and SebKs

By Van Le |  While freckles can add to a person’s beauty and uniqueness, other skin lesions such as large moles, skin tags, warts, and seborrheic keratoses can be unsightly and embarrassing. Most lesions are malignant (non-cancerous), however, it is important to be aware of and track any skin abnormalities on your body as a preventative measure.

Freckles

Freckles are irritating for some and embraced by others. They are pigment cells that retain within the skin to form light brown spots, and individuals with lighter complexions are more susceptible to freckles since their skin contains less melanin. Freckles, also known as ephelides, can appear on the face, arms and other sun-exposed areas. Excessive and continued exposure to harmful UV rays can cause more freckles and cause them to appear darker. While they are harmless, it is important to distinguish between freckles and symptoms of melanoma, a type of skin cancer that can grow from an existing freckle. Consult your doctor if you notice any change in freckle size, shape and color.

Skin tags

Skin tags are pieces of skin that hang from the surface of a surrounding area. Like freckles, they are benign, but can cause irritation if located on an area that is exposed to constant contact, such as the eyelids or areas where they can be snagged by jewelry or clothing. Skin tags can vary from a small pin-point size to a large grape size. While some can fall off on their own, there are several ways to medically remove skin tags, including freezing and burning. There are home remedies as well as creams available on the market to remove unwanted and embarrassing skin tags.

Seborrheic keratoses

Seborrheic keratoses, another benign skin lesion, can form anywhere on the body, but is commonly found on the chest and back. They can be distinguished from other types of lesions due to their waxy, stuck-on-the-skin appearance and often described as brown candle wax stuck on the skin. While the cause is still unknown, scientists have found that they can be hereditary and not affected by sun exposure.

Warts

Most warts are skin infections caused by viruses of the human papillomavirus (HPV) family. Basically, warts are benign tumors of the epidermis (outer layer of skin), and can occur in people of all ages, but are most commonly found on children and teenagers. There are different types, including flat and plantar warts. Flat warts are small in size but can be high in quantity, can spread to other areas of the body by shaving or scratching, and can be transferred person-to-person by physical contact. Plantar warts grow on the heel, ball or sole of the foot, and pressure from standing or walking pushes them into the deeper layers of skin.

Skin lesions like warts, seborrheic keratoses and skin tags are often harmless, but they can be embarrassing. While they can be surgically removed, there are creams and ointments available on the market to remove and reduce their appearance. If you have further questions about a particular skin lesion, consult your doctor or pharmacist for proper diagnosis and treatment.

Van Le is a staff writer for the CSU Daily Titan and writing intern for Vivoderm Laboratories in Los Angeles, California. She is currently pursuing a Journalism degree at California State University, Fullerton.

For the latest findings on skin lesions and treatments, you can also link to http://www.dermatosispapulosanigra.net

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.