Warts on the face and hands
Most people develop warts on their hands at some time in their life. They are harmless, and only matter because of their appearance – in fact, some children seem quite pleased with their warts. In the UK, family doctors treat 2 million patients for warts each year (Prescriber 2008 19(22):46-50 They seem to be most common between the ages of 12 and 16 years.
There are two main types of warts on the hands or face.
The type that many people (especially children) have on their hands starts as a small, flesh-coloured pimple that grows slowly over weeks or months to become a rough, raised lump. They are often called ‘common warts’. If you look closely, you will see that the normal tiny lines of the skin (the lines that are used in fingerprints) do not cross the surface of the wart. You may also be able to see tiny black dots in the wart; these are blood capillaries.
Some warts remain as very small, flat bumps; this type often occurs in clusters on the face, neck and hands. There may be 20 –100 at any one time. In men, they are usually in the beard area, and in women they may occur on the legs.
The cause of warts
All warts are caused by a virus, human papillomavirus or HPV. It can take several months between catching the virus and a wart showing up. The virus causes overgrowth of cells at the base of the outer layer of the skin. Warts are entirely on the surface of the skin. They do not have deep roots that penetrate into the deep layers of the skin. Papillomavirus takes hold of damaged skin more easily, which is why warts are particularly common in children who bite their nails or pick at the skin round the nail. It also explains why warts tend to occur in the shaved beard area in men.
Folk remedies for warts
There is no scientific evidence that any of these remedies is effective. The reason people believe in them is because warts disappear by themselves
Tape the inner side of a broad bean pod over the wart.
Every day, rub the wart with a raw potato.
Squeeze radish juice onto the wart.
Squeeze dandelion sap onto the wart.
Mix castor oil into a paste with baking soda. Apply the paste twice a day.
Rub the wart with a piece of raw meat. Bury the meat in the garden. Wait for the wart to drop off as the meat rots.
What you can do about warts
It is important to be sure that what you are dealing with really is a wart. If you have even the slightest doubt, ask your doctor to have a look.
Something that looks like a wart, but which grows rapidly or does not go away with a remedy from the pharmacist, should definitely be checked by a doctor. There have been rare cases in which people have mistaken a skin cancer, such as a melanoma, for a wart and tried to treat it themselves.
Do not treat warts at the side of your fingernail by yourself, because you may damage the nail.
If you have warts on the genitals or round the anus, do not try the following remedies. Look at the section on genital warts for advice.
Doing nothing is one option, and is the sensible choice for young children, because wart treatment can be painful. Although some warts may last for years, this is unusual. Normally the body’s immune system will eventually recognize the wart and get rid of it. A wart has a 50% chance of disappearing within a month or two without treatment, and two-thirds will have gone within 2 years. This is the reason so many people are convinced that folk remedies work – the wart would probably have disappeared anyway. An advantage of doing nothing is that there will be no scarring after the wart has gone.
Duct tape is a simple method of treating warts on the hands. You can buy duct tape at a hardware store, or you can use any strong, sticky, waterproof tape. According to one study (Archives of Pediatric and Adolescent Medicine 2002;156:971–4), duct tape is as effective as other treatments, such as freezing.
Cut a piece of tape the same size as the wart and stick it on.
Leave it for 6 days, then remove it in the evening.
After removing the tape, soak your hand in warm water and then gently rub the wart with an emery board. Leave the tape off overnight and then apply a new piece for another 6 days.
If the skin under the tape becomes red and soggy, stop using the tape for a few days.
Continue this routine for 2 months.
In the study, 85% of the warts disappeared with this treatment and most did so within 4 weeks.
However, a more recent study in the same journal (Archives of Pediatric and Adolescent Medicine 2006;160:1121–5) gave a much lower success rate of only 16% after treatment with duct tape for 6 weeks. And another study has suggested that after duct tape treatment, a wart is more likely to reappear (Archives of Dermatology 2007;143:309–13).
Wart paint for hand warts. For hand warts, buy some wart paint from a pharmacy. Wart paints are not suitable for using on the face (or genital area), or if you are pregnant. Most contain salicylic acid; some also contain lactic acid. The acid does not attack the virus, but simply removes some of the warty tissue, so that the body’s natural recovery process has less to do. Therefore the result is very unpredictable. In one person, the wart may disappear in days, while an identical-looking wart in a different person may take weeks and weeks, so this treatment does need patience. Overall, salicylic acid wart paint cures about 75% of warts (British Medical Journal 2002;235:461–4).
The instructions will tell you to rub the wart with a pumice stone or an emery board before applying the paint. Do not overdo it – if you rub too hard, you may encourage spread of the virus onto nearby skin. In fact, this rubbing down needs to be done only twice a week, not every time you apply the paint.
Before applying the paint, soak the wart in warm water for 2 minutes; this will encourage the paint to penetrate the wart. Then dry it thoroughly using your own towel.
Then apply a tiny drop of the paint to the centre of the wart using a cocktail stick, matchstick or the applicator from the bottle. Take care to avoid getting the paint onto the skin nearby; you could protect the normal skin with Vaseline.
Allow the paint to dry and then cover it with a sticking plaster.
If the skin becomes sore, you have probably been rubbing it down too enthusiastically. Stop the treatment for a few days until the skin recovers.
Other types of wart paint or gel are worth trying if you have been using the salicylic acid wart paint for 3 months and the wart has not gone. Ask your pharmacist for glutaraldehyde (which may stain your skin brown) or formaldehyde paint or gel. However, some people are over-sensitive to these substances, so it might be better to ask your doctor for advice. Redness or itching around the wart may indicate an allergy to the treatment.
Silver nitrate (caustic) pencil is another possibility. In the UK, you can buy these pencils from pharmacies without a prescription. The silver nitrate gently burns the wart and therefore should be used carefully according to the directions on the packet. A study showed that three applications of silver nitrate, 3 days apart, had cleared 43% of warts 1 month later. Do not use silver nitrate on the face and do not use it more than six times on the hands. It can cause staining of the skin and clothes.
Freezing aerosol. An aerosol is available from pharmacies that works in a similar way to the liquid nitrogen used by doctors, but does not reach the very low temperatures that their equipment achieves. Only one application is used and you should follow the manufacturer’s instructions. Do not use it on your face. If you have dark skin, freezing may not be a good idea, because it can sometimes remove pigment from the skin, leaving a white patch.
Zinc sulphate supplements may help to clear warts in people who are deficient in zinc (British Journal of Dermatology 2002;146:423–31). However, zinc deficiency is rare in healthy people who eat meat, cereals and dairy products. Therefore zinc supplements are unlikely to help most people with warts.
What your doctor can do about warts
Freezing the wart with liquid nitrogen (also known as cryotherapy) can deal with warts on the face as well as on the hands. Some doctors are specially trained, and have the equipment to do this; otherwise, you can be referred to a hospital dermatology clinic. Freezing for a few seconds gives the wart frostbite. A blister may form under the wart, and then the roof of the blister, including the wart, falls off. It is painful and sometimes feels sore for several days after each treatment, so it is not suitable for children under the age of 10. You will probably need several treatments and, like all wart treatments, it is not always successful. In one study (published in the British Journal of Dermatology), several treatments over 12 weeks got rid of 45% of warts, and treatment every 3 weeks was just as effective as weekly treatments. Some research suggests that freezing is no more effective than wart paints.
Laser treatment with a ‘pulsed dye laser’ burns the tiny blood vessels within the wart. The wart dies and eventually falls off. It is not clear how effective this treatment is, because scientific studies have given contradictory results. The main side effect is loss of skin colour (loss of pigment). Scarring is minimal.
Other treatments, such as injecting the drug bleomycin into the wart, are sometimes used in hospital clinics. Laser treatment is another possibility, but it is not better than other treatments; there may be scarring and it is painful. Cutting the wart out might be appropriate for troublesome single warts, but is not a realistic option if you have several.
Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Sunday, September 4th 2011
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