The primary manifestations of HPV infection include common warts, genital warts, flat warts, deep palmoplantar warts (Myrmecia), focal epithelial hyperplasia, Epidermodysplasia verruciformis, and Plantar cysts. Warts may be transmitted by direct or indirect contact. The human papillomavirus (HPV), with over 100 types of HPV identified, may occur at any site.
Around 10% of the world’s population suffers from warts, which are more prevalent in immunosuppressed patients and meat handlers. In school-aged children, the prevalence can reach 10% to 20%.
Warts can develop at any age; they are uncommon in infancy and the first few years of life, but they become more common as children enter school and reach their peak prevalence between the ages of 12 and 16 years. The male to female ratio is roughly equal.
Etiology
Warts are easily transmitted by direct or indirect contact, especially if there is the disruption of the normal epithelial barrier. Besides the skin, warts can also occur on mucous membranes. HPV tends to cause genital warts, flat warts, and palmoplantar warts. Warts are easily transmitted by direct or indirect contact, especially if there is the disruption of the normal epithelial barrier.
HPV types 1, 3, 27, 29, and 57 are also linked to common warts, but types 2 and 4 are more frequently found in people.
Types 3, 10, and 28 are responsible for flat warts.
The most prevalent type (type 1), followed by types 2, 3, 4, 27, and type 57 are the ones that cause deep palmoplantar warts.
Type 60 is the cause of cystic warts.
Types 13 and 32 are responsible for focal epithelial hyperplasia.
Type 7 diabetes is what causes butcher’s warts.
Pathogenesis
These subtypes of HPV include HPV strains 6, 11, 16, 18, 31, and 35, which have a tendency to transform into cancer in people with genital warts and people who are immunocompromised. HPV strains 5, 8, 20, and 47 also have cancerous potential in people with epidermodysplasia verruciformis. There are 100 subtypes of HPV, but only a few of them have the potential to cause cancer.
Verrucous carcinoma, a slow-growing tumor that is categorized as a well-differentiated squamous cell malignancy and is frequently mistaken for a common wart, has been reported to occasionally develop from warts, which are typically benign. Although it can occur on any part of the body, the plantar surface is where it most frequently occurs.
Clinical features
Warts can be painful, especially those on the soles of the feet, but for the most part, they don’t cause any bothersome symptoms. Some warts have tiny black or brownish dots that are caused by clotted blood that has leaked from capillaries (very fine blood vessels) in the skin.
Warts typically come in one or more of the following main categories, which can cover larger areas of skin:
Common warts (Verrucae vulgaris)
Most frequently found on the back of the hands and fingers, common warts are circumscribed, firm, elevated papules with a papillomatous (verrucous) hyperkeratotic surface. They may be single or multiple and typically spread randomly, but occasionally they may inoculate into linear groups of lesions (Koebner phenomenon). Over 50% of warts spontaneously disappear within two years.
Filiform warts (Digitate warts)
The face and neck are the two areas where filiform warts are most frequently found.
Flat warts (Verrucae plana)
The face and extremities are frequently affected by flat warts, which are shiny papules with a dome-like shape that typically appear in groups.
Plantar warts
Surgical pairing of a wart reveals multiple capillary bleeding points from the base of the lesion. They can be distinguished from corns by absence of skin lines. Plantar warts are flat or slightly raised corn-like plaques that commonly develop beneath the pressure points. They may be single or confluent multiple (mosaic warts). They are painful from lateral pressure, unlike other warts, which are typically asymptomatic.
Genital warts (Condylomata acuminata)
The anogenital region is frequently affected by genital warts, which are sexually transmitted.
Butcher’s wart
Clinically, butcher’s warts resemble common warts and tend to be widespread. They are specifically brought on by HPV 7 infection of the hands of butchers and other workers whose jobs require prolonged exposure to a cold, moist environment.
Epidermodysplasia verruciformis
A rare autosomal recessive condition called epidermodysplasia verruciformis is susceptible to squamous cell carcinoma and flat lesions resembling pityriasis versicolor from certain HPV types.
Diagnosis
Skin biopsies may be done if there is any doubt; otherwise, clinical diagnosis is typically used.
Differential diagnosis
A cutaneous viral wart may have one or more alternative diagnoses, such as:
- Seborrhoeic keratosis
- Squamous cell carcinoma
- Plantar corn and callus.
Management
General measures
To prevent the spread of the viruses, avoid picking or scratching at warts.
Any time you touch a wart, make sure to thoroughly wash your hands.
· Keep feet dry.
Every day, put on fresh socks.
If a tool has been used on a wart in the past, avoid using it, such as a pumice stone or nail file.
A waterproof plaster should be applied over the warts before swimming.
Never let anyone else use your socks, shoes, or towels.
Avoid wearing bare feet in public showers, locker rooms, or swimming pools.
The warts should not be touched.
Homeopathy medicines
Anagallis arvensis
Externally, Appy Q has the ability to destroy warts and soften flesh.
Antimonium crudum
Warts that are hard, horny, soft, or smooth and that appear in groups can be found on the palms, neck, and soles. Antimonium crudum is known for its thickly white-coated tongue.
Castor equi
Nipples that are nearly hanging, cracked, and sore, excessively tender, and covered in warts. Warts on the forehead and breasts. Violent itching in the breasts.
Causticum
Seedy, large, gagged warts on the face, especially on the nose, under the fingernails, or warts on the fingertips; hard, inflamed, and painful warts; numerous, very small warts; warts soft at base, horny on the surface; and warts that may be sensitive to touch.
Dulcamara
Large, smooth warts, usually in groups, on the palmar surfaces of the hands and face; worsens with cold washing.
Natrum carbonicum
Hand back warts that bleed easily and are tender to the touch.
Natrum muriaticum
Warts on the hands, palms, knuckles, and soles; deep, cutting pain; oily, rough, unhealthy, or yellow skin; tendency to develop warts after cautery with silver nitrate; craving for salt or salty foods in the patient.
Nitric acid
On the upper lip and abdomen, there are cauliflower-like warts that itch, prick, and stick in. The lips are inflamed, and the warts are large, jagged, pedunculated and easily bleed when touched or washed.
Sepia
Small, flat, hard, black or brown warts with a horny excrescence in the center, on the margins of the prepuce, upper lip, fingers, and face. Itchy warts. Blotchy, raw, rough, hard, or cracked skin. Purple-colored indurations from constant pressure.
Thuja occidentalis
Warts that are large, seedy, broad, conical, flat, pedunculated, indented in appearance, occasionally oozing moisture, reddish in color, easily bleed, and have a tendency to split from their edge or from the surface should be treated externally with Q. Warts on the back of the head, on the chin, side of the head, anus, genitals, thumb, sides of fingers, and left index finger
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