FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[COMMON WARTS USUALLY SUCCUMB TO COMMON DRUG STORE REMEDIES]

Question: My 15-year-old son has been having trouble with warts. He has them on his hand, particularly around the nail of his index finger, and he also has one on the bottom of his foot. We've tried several non-prescription products without getting rid of the warts. Should we see a dermatologist?

Answer: Seeing a dermatologist for a skin problem seems sensible. Your family doctor may also be able to help, too. In fact, despite the previous failures, you may still be able to take care of the wart infection yourself with non-prescription remedies.

First, I'll explain a little bit about warts and then give you a basic primer on wart treatment. All warts result from infection with the human papilloma virus. Scientists have identified over 100 different sub-types of this virus. They all share the characteristic of invading normal skin or mucous membranes and causing abnormal growth what you and I call a wart at the site of the incursion. Warts are often classified by their location rather than by the specific type of virus that causes the lesion. Warts around the fingernails, like your son has, are called periungual. Those on the bottom of the feet are plantar warts.

Warts are quite common. About 50 percent of the population reports having warts at some time in their lives, but I suspect that the rate may actually be higher. In most situations the body's defense system recognizes the wart virus as an invader and eliminates it. This occurs in two thirds of those infected, but it often takes up to two years.

Individuals with suppressed immune systems, particularly those with organ transplants or with HIV, may have an especially difficult time with warts. They may aquire new infections and fail to show improvement after a reasonable period of time, or they may have a recurrence of warts that appeared to have previously cleared up.

I recommend that warts be treated when:

- They are cosmetically objectionable or painful,

- The risk of spreading the infection to other parts of the body or to other individuals is high, or

- In very rare instances, the wart interferes with breathing or speech.

All wart treatment is designed to destroy the infected skin, since there is currently no treatment that can kill only the offending virus.

The non-prescription wart remedies work quite slowly, but they have a very low risk of producing a scar. The most frequent reason for unsatisfactory results with these products is failing to follow the label instructions. The products must be used daily, along with daily soaking of the skin followed by peeling or scraping off the dead layers of wart before reapplication of the product. I'd suggest that you help your son try this approach for two months before you make a doctor's appointment.

Doctors use a variety of methods to destroy the wart-infected skin. Cutting, burning, freezing, scraping and the use of strong acids are quite common. Each method has about equal results. Occasionally with large warts, or those resistant to previous treatments, the anti-cancer drugs bleomycin or 5-FU are used. Unfortunately, even with these more powerful agents, several treatments are often required, and the warts may still come back.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.