WARTS: AN INTRODUCTION

Did you know that there are only 2 kinds of warts? This is a good thing, because it makes self-diagnosis and treatment of warts quite simple. You can treat your own warts at home, but you should not be shy about going to your doctor to have warts treated. You see, doctors like warts. Warts give a doctor an opportunity to cut, shave, and freeze- satisfying procedures that make us feel like we're "doing something." I always get excited when a patient is coming in to have some warts treated, because I know it's going to be fun.
THE TWO KINDS OF WARTS:

1. Genital warts: these are caused by a strain of the human papilloma virus, or HPV. They generally occur in the genital area, but can occur on the anus as well. While they don't always cause cancer, they do have the ability to transform skin cells into cancer cells in some cases. For that reason, it's not a great idea to leave genital warts around, hoping that they will go away. It's also pretty hard to treat these at home; over-the-counter wart medications don't usually work on genital warts, and most of them will require a prescription cream or some freezing.

2. Common warts: these are the raised, rough warts that occur on the hands, elbows, and the feet, usually on the bottoms of the feet. These warts are also caused by a virus, in this case a strain of virus called human herpes virus 8, or HHV. The terminology is confusing because HHV is not a true herpes virus, and it does not cause herpes. It just causes these benign, painless, but annoying warts on hands and feet. Unlike genital warts, common warts do not ever cause cancer and they can be treated at home.

HOW DO WARTS SPREAD?
1. Genital warts: unfortunately, genital warts are very contagious. Brief skin contact with a genital wart can transmit the HPV virus from person to person. What's worse is that skin and mucus membrane contact with someone who has HPV can transmit genital warts EVEN IF the infected person does not have any warts, and EVEN IF they have never had any manifestations of HPV. For this reason, genital warts are scary, and they are common. Only condoms can prevent you from getting genital warts.
2. Common warts: the amazing truth is that we don't really know how common warts on the hands and feet are spread from person to person. You can touch someone's hand wart every day for years, and you probably won't get a wart. There are theories, none of them remotely proven, that the HHV virus that causes common warts lives in soil, bathroom floors, etc- but the truth is that we don't know. If you have a common wart, and chances are that you will sometime in your life, we just don't know where it came from.
HOW WARTS ARE TREATED: GENITAL WARTS
Most commonly, genital warts are given a freezing treatment with liquid nitrogen in your doctor's office. There is a cream called Aldara that has revolutionized genital wart treatment- this is applied at home and can completely eliminate warts, though it does cause skin irrititation. You need a prescription for this from your doctor. In my office, I usually freeze genital warts first, then have my patients use Aldara at home; in combination, the 2 treatments can eliminate the vast majority of genital warts. There are other topical medications that your doctor can prescribe as well. If all else fails, dermatologists can remove the most stubborn genital warts surgically or with laser treatment.
HOW WARTS ARE TREATED: COMMON WARTS
Freezing works great for common warts, but there are effective treatments you can use at home. You may have heard of patients treating warts by covering them with duct tape- this may work, but only about 30% of the time. Duct tape is actually a pretty crappy wart treatment when used alone. But salicylic acid is a great treatment, and it's available in drug stores without a prescription. As a liquid it is sold as "Compound W" which is dropped on the wart; it also comes in little patches, most notably Mediplast (by Dr. Scholl's). For home treatment I recommed that patients apply a Mediplast patch over warts, then cover the patch with duct tape. Any time the patch and tape falls off, it needs to be replaced with a fresh patch. This is important because it takes about 2 weeks of continuous coverage with salicylic acid to remove a wart. I'm not sure the duct tape does much, but it does help keep the salicylic acid patch in place. Using this method, all but the largest warts will usually completely fall off in 2 weeks.
You can also speed up the removal of a wart by filing down the dead skin. Periodically take a nail file or pumice stone, and rub off the top part of the wart. Don't do this if the wart starts bleeding.
Finally, some new products available in drug stores allow you to freeze your own warts. These products are not as cold as the liquid nitrogen doctors use, but they still can work. If you use one of these sprays or applicators, make sure to freeze the wart until it's completely white, then allow it to thaw out, and freeze it again 2-3 times. If it does not hurt at least a bit, you are probably not freezing the wart enough. The skin under the wart may blister after freezing- if so, leave it alone. Eventually it should dry out and the wart should fall off.
If home treatment does not work, you should see your doctor. Your doctor may cut some of the dead tissue off the top of the wart (this is painless), then freeze the wart underneath. For large warts, it can take 3-4 treatments (usually once a month) to finally get rid of a wart. But all warts can be conquered eventually!