Hello, I am Dr. Neal Schultz, and welcome to DermTV. Warts are very common growths caused by a virus. As a matter of fact, they are so common that the technical word for wart in medical terminology is verruca vulgaris, translated from Latin that means common warts. Warts are caused by the HPV virus which is also called the human papillomavirus. And because it is caused by a virus:
1. Of course, it is an infection.
2. It is contagious.
The most common locations that we get warts are on the fingers, on the feet and the genitals. Warts are very easy to catch and unfortunately very difficult to treat with medicines. Because of that, we try to treat them surgically with local anesthesia to cut them out. But regardless of how you treat them, with medicines or with surgery, they tend to come back. As a matter of fact, I would like to say that warts have done more to ruin the reputation of a dermatologist than anything else we treat because they tend to come back. Let us talk about why they come back. When your body has an infection, there is a fight between the body and the infection. Normally, the body wins and makes the infection go away, but in order for that to happen, the body has to see the infection and be aware of it. When you have a wart growth, which is a viral infection, this virus lives in what we call an “immunologic window.” That means that body’s immune system just cannot see it. If it cannot see it, it cannot fight it. And when the body is not helping you fight the infection, then it is very difficult for topical medicines to fight the infection and win. And for that reason, many topical medicines either work very slowly and sometimes not at all. So, the alternative is to cut the virus out. Cut out your wart. Well, we do that with local anesthesia. But let me give you an example of why that tends to fail. This is a tracing of the back of my left hand and the red dot is obviously a wart on the back of my thumb. But look at the little black lines coming off of the wart. Those are tentacles. You cannot see them, I cannot see them. They are under the skin. And those tentacles from one end to the other are much larger than the actual wart. If I just remove the wart and there are tentacles and do not remove the tentacles, those tentacles tend to become a focus from which the wart grows right back. So, if I want to be sure I am going to get rid of the wart and have it not come back, I have to guess and take a much larger area than the actual wart takes. Well, if I do that, I am going to cause an unnecessarily disfiguring scar. So we do not like to take those large areas out. Instead, we just remove the wart, and that is why in about one in four times the wart tends to come back. There is one other situation and that is the bottom of the foot. Again, if you cut a wart out, you may go sufficiently deep if you are successful, so that you actually get a scar. Well, a scar will be of cosmetic importance only elsewhere, but on the bottom of the foot, a scar can be very painful because scars on weightbearing surfaces, when you step on them, cause pain. If that happens, you have pain whenever you walk, and obviously that is a very bad situation. So, if you happen to have one of these annoying, infectious growths, I am going to explain in another episode what the best treatments are to get rid of them. Please join me again at DermTv.com. If you have a question, please send it to me by visiting: DermTv.com/question. I am Dr. Neal Schultz, and thank you for watching today.