wart

an epidermal tumor of viral origin; the term is also applied loosely to any of various benign epidermal proliferations of nonviral origin. Called also verruca. Warts are generally more common among children and young adults than among older persons. Most are less than 0.6 cm (a quarter of an inch) in diameter; they may be flat or raised and dry or moist. Usually they have a rough and pitted surface, either flesh-colored or darker than the surrounding skin. They usually develop on the fingers and hands, but may also occur on the elbows, face, scalp, or other areas. When on especially vulnerable parts of the body, such as the knee or elbow, they are subject to irritation and may become quite tender. Two specific types are plantar warts and venereal warts.



A wart develops between 1 and 8 months after the virus becomes lodged in the skin. The virus is often spread by scratching, rubbing, and slight razor cuts. In more than half the cases, warts disappear without treatment, but some remain for years.

A circumscribed cutaneous elevation resulting from hypertrophy of the papillae and epidermis. See: illustration

A wart of the genitalia, caused by strains of human papillomavirus (HPV) some of which are transmitted by sexual contact. In women they may be associated with cancer of the cervix and vulva. An estimated 1 million new cases of genital warts occur each year in the U.S., making genital warts the most common sexually transmitted illness. They commonly occur with other genital infections, and grow rapidly in the presence of heavy perspiration, poor hygiene, or the hormonal changes related to pregnancy. Synonym: venereal wart See: illustration

Treatment

A variety of therapies, including topically applied chemicals such as podophyllin (10% to 25% in compound tincture of benzoine), trichloroacetic acid, or dichloroacetic acid usually remove small warts; other treatments include CO₂ laser therapy, cryosurgery, electrocautery, 5-fluorouracil, imiquimod, and recombinant interferon alfa-2a. Nevertheless, there is no completely safe and effective therapy available for genital warts.

Patient care

A history is obtained for unprotected sexual contact with a partner with known infection, a new partner, or multiple partners. Standard precautions are used to examine the patient, to collect a specimen, or to perform associated procedures. The health care professional inspects the genitalia for warts growing on the moist genital surfaces, such as the subpreputial sac, the urethral meatus, and less commonly, the penile shaft or scrotum in male patients and the vulva and vaginal and cervical wall in female patients. Multiple warts have a cauliflower-like appearance. The patient usually reports no other symptoms, as the warts are generally painless, but a few complain of itching and pain. Diagnosis usually is made by visual inspection, but darkfield examination of wart cell scrapings may be used to differentiate HPV warts from those associated with second-stage syphilis. Biopsy is indicated if cancer is suspected. A nonthreatening, nonjudgmental atmosphere is provided to encourage the patient to verbalize feelings about perceived changes in sexual behavior and body image. Sexual abstinence or condom use during intercourse is recommended until healing is complete. The patient must inform sexual partners about the risk for genital warts and the need for evaluation. The patient should be tested for human immunodeficiency virus and for other sexually transmitted diseases. Genital warts can recur and the virus can mutate, causing warts of a different strain. The patient should report for weekly treatment until all warts are removed and then schedule a checkup for 3 months after all warts have disappeared. If podophyllin is applied, the patient is taught to remove it with soap and water 4 to 6 hrs after the application. Female patients should have a Papanicolaou test on a schedule recommended by their health care providers.

A wart on a pressure-bearing area, esp. the sole of the foot. Synonym: verruca plantaris