Warts are actually benign
tumors of the epidermis caused by a virus. The virus
responsible is the human
papillomavirus (HPV), a double-
stranded DNA virus. The virus
resides in the bottom layer of
the epidermis and replicates into almost normal-looking
skin. Different sub-types of HPV
cause different types of warts.
Some human papillomavirus
subtypes also cause cervical
cancer and other more obscure types of wart-related cancers
The Wart Root Myth
Contrary to popular belief,
warts do not have "roots". They
only grow in the top layer of
skin, the epidermis. When they
grow down, they displace the
second layer of skin, the dermis. They do not grow into
the dermis. The underside of a
wart is actually smooth. The Appearance of Warts.
Warts normally grow out of the
skin in cylindrical columns.
These columns do not fuse
when the wart grows on thin
skin such as the face. On
thicker skin, the columns fuse and are packed tightly
together giving the surface the
typical mosaic pattern. Black
dots can sometimes be seen in
a wart. These are actually
blood vessels that have grown rapidly and irregularly into the
wart and have thombosed or
clotted off.
Who Gets Warts?
Warts can occur in people of all
ages, but occur most
commonly in children and
young adults. They spread by
direct contact, simply by
touching the wart. Warts normally resolve spontaneously
but the time it takes for this
resolution is variable. Most
warts resolve within weeks or
months, but some may take
years. It appears that a person's susceptibility to warts
and the time it takes for them
to go away is related to the
individual's immune system.
People who have immune-
related diseases such as AIDS and lymphoma, or who are
taking chemotherapy tend to
have more warts that last
longer.

Wart Treatments
Most warts can be treated with
simple over-the-counter
remedies. For those that are
resistant to these measures,
other types of treatments are
effective. Salicylic acid is a very common
and effective over-the-counter
treatment, but requires
consistent application every
day. They best way to use
salicylic acid is to first pare the wart with a blade, pumice
stone, emory board, or small
scrub brush. Soaking the wart
in warm water will aid in the
absorption of the medicine.
Salicylic acid is applied to the wart and allowed to dry.
Normal surrounding skin may
be protected with petroleum
jelly. Occluding the treated
wart with a band-aid or piece
of tape also improves the absorption of the medicine.
This procedure should be
repeated daily ideally around
shower or bath time. Salicylic
acid can be found in several
forms including a thick oil, or incorporated into an adhesive
plaster form. Cryotherapy is another
effective treatment of warts. A
provider applies liquid
nitrogen as a spray or on a
cotton swab to the wart. This
freezes and kills the effected cells. The connective tissue is
not destroyed; therefore, the
lesion usually heals without
significant scarring. The
human papillomavirus is not
killed by cryotherapy and is released into the surrounding
tissue allowing the immune
system to kill it. A blister
typically forms on the site
treated, crusts over, and falls
off. Since blisters are painful to walk on, cryotherapy is not a
first choice for warts on the
bottom of the foot. Other medicines may be
applied t o warts or injected
into them include lactic acid,
trichloroacetic acid (TCA),
formalin, glutaraldehyde,
cantharidin, podophyllin, Retin-A, and bleomycin. These treatments should be
supervised by a health care
provider.n

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