24 Jun You and Your Wart
Treatment: “Rub bacon fat on your warts then hang them in the sun to dry. As the fat melts away, so do your warts” Sir Francis Bacon
In this age of lasers and high-powered wizardry that has become modern medicine, perhaps nothing humbles a dermatologist more than the simple wart. We tinker at will with the immune system, graft skin and stem cells, shoot lasers into the skin with micron precision—all impressive. But when it comes to warts, we sometimes feel like cavemen. Warts can occur anywhere on the body, even in the mouth, on the tongue and on genitals. They are the result of a localized infection by the Human Papilloma Virus, or HPV. You pick up the virus somewhere in your environment or from another human. There is no evidence toads carry HPV despite what your older brother told you. The virus sets up camp in your skin and hijacks your skin’s machinery. It makes a thickened shield of skin over itself resulting in the typical shaggy calloused appearance we can all recognize.
There it sits. It may grow larger. It may not. Our immune system has trouble recognizing the virus and so no inflammatory attack is mounted against it. Most warts do resolve by themselves within 6 months to 2 years through mechanisms not fully understood. Those little “seeds” you see in there are actually tiny broken blood vessels. I grew up using the term “seed wart” but have since found out it is meaningless. Warts are consummate survivors. They resist freezing, chemical burns, fire, and even fifteenth-century bacon strips. I am convinced that if we looked, viable wart viruses would be found on the skin of mummies fresh out of the earth after 2000 years. The HPV is a diverse family of viruses and comes in many flavors. Medical students are made to memorize the different strains that account for warts on various body parts, which strain the butcher gets, which ones cause cancers; and so on.
The Latin word for wart is verruca, meaning small hill; or so I’m told by all my Latin speaking friends. Doctors will often diagnose a “verruca vulgaris”. While the wart may look vulgar to you, it is just another Latin term denoting something common. The Romans wrote about warts and were especially fascinated by genital warts. It wasn’t until the end of the nineteenth century that doctors realized they were infectious. Even then it took until the 1950’s before the medical community accepted it.
Our treatments these days are as varied as the warts themselves but usually involve some form of physical destruction (freezing, burning, chemicals—the things I just mentioned to which they were resistant!). Evaluating the effectiveness of different treatments is challenging because warts so often resolve on their own despite what is done, or not done. I’ve had good success waking up the immune system by injecting a small amount of a yeast protein into the wart. This usually takes 2-3 treatments but the warts often just melt away.
I’ve also used lasers and even injected chemotherapeutic agents into them. In 25 AD, Celsus suggested using ash to burn them away. He also felt it necessary to recommend against individuals biting or sucking off warts from the feet of others. Perhaps the strangest look I get from parents is when I suggest using the daily application of duct tape to cure warts. It works pretty well…sometimes. The adhesive causes a low grade irritation to the skin. When the immune system moves in to clean up this irritation, sometimes it kills the wart by collateral damage. At least that is my theory. My patients all like to believe the tape “pulls the wart out.”
A phrase we often hear is: “We just want them gone in one treatment.” It is usually the mother saying this, as she has probably taken off work or rounded up the other kids to make it to the appointment. Well, we share that goal. Explaining that it may take several treatments sometimes gets me an incredulous look from mom. Although no one has ever said it, I can imagine them thinking that I am withholding some potent, single-shot therapy from their child. Believe me: I could live the rest of my life quite happy if I never treated another wart. I think most doctors secretly share this opinion. Often by the time a wart gets to our office, other treatments have failed miserably and the parents are ready to “just cut it out!” Sometimes I do. Most of the time it is not the most feasible option since one never really knows where the wart ends and normal skin begins. Take too much skin and you are a butcher. Take too little and you are incompetent. That’s why I now just recommend bacon rubs.
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