Dr. Conway McLean

When reviewing the characters in numerous fairy tales, let us consider the plight of the poor witch, who always seems afflicted with that most hideous of conditions: the facial wart. How did such an appendage come to be? And why was it on her nose, of all places? Upon further review, we may not want to answer this last question, but perhaps we might delve into some other pertinent concerns about this very common entity.

Naturally, one of the first questions I am asked is, “What is a wart?” A reasonable question, certainly, but this is not much of a mystery. A wart is caused by a particular type of virus, although not the type that causes the flu. The technical term for a wart is verruca, although these have a particular appearance, many other skin lesions are mistaken for a wart. A physician specializing in this body part is going to be most familiar with this pathology and best trained to identify.

Viral organisms are fascinating since they stretch the limits of the term “living.” There are aspects of viruses that don’t really fit into our definition of what is life. Still, to this day, biologists consider them to lie in a grey zone between living organisms and a collection of chemicals.

The behavior of the common wart can be something of a mystery, as well, and highlights how much we don’t know about viral infections, particularly of the skin. Virology is not a well-developed science, as evidenced by the fact that we have no antibiotic for a viral infection. Certainly, we can treat the symptoms, but because viral particles replicate inside our own cells, we have no medication that can find the “organism.” The common cold is a viral infection of the respiratory system, and the modern pharmacy is overrun with products for treating this nefarious sickness, but none of them stop the infection. It’s simply your body’s natural defenses that eventually do that. And depending on the vitality of your immune system, this can take quite some time.

Because of changes that occur to our immune system as we age, viral infections of the skin, also known as warts, are much more of a problem in the young. When an adult gets a wart on the bottom of the foot, it can be stable and unchanging for years, whereas a wart in a young person is wildly unpredictable. They can have a single lesion one day, and a few days later, there can be 20 or more. Alternatively, a child can be cursed with many warts, present for months, causing pain on a daily basis, and they can disappear, practically overnight.

Warts that infect skin on most parts of the body have a particular appearance, tending to develop into a well-defined, localized prominent bump. The exception would be when the infection is spread by walking on a surface where some appropriate viral particles are present, thus causing the infection to develop on the bottom of the foot. The pressures of weight bearing prevent the growth from protruding from the skin, instead forcing it to grow into the foot. But these never invade deeper tissues, only residing in the skin. Regardless, developing this mass can be understandably painful.

Where this topic gets interesting is in the number of different treatment approaches and methods that have been utilized over the years. Many home treatments are available, although the success rate of these is poor. The most common options include destruction with a topical acid or application of intense cold. Also popular is the use of a blistering medication, as well as various surgical procedures. Options get a little more unusual from there. There is the application of a skin cancer medicine, injection of another one and even a “home remedy” where the wart is covered repeatedly by tape.

A rather bizarre technique is where one of the warts is cut out, and then buried beneath the skin elsewhere, in an attempt to help the body recognize the wart as a foreign invader. Perhaps the newest method is the use of microwave radiation (yes, just like your microwave oven). This technology does not “cook” the lesion, but instead, the microwaves trigger the body to attack the infected tissue, utilizing the body’s natural defense mechanisms. There are real positives with this method: it’s easy for the patient, it’s relatively painless, and has an extremely high success rate (usually the wart resolves in just one or two treatments). Most of the common methods require regular and repeated treatment, requiring a certain amount of patience.

Many physicians find these a particularly frustrating condition. They are very resistant, prone to recurrence, and many of the therapies have significant complications. But warts are an infection and can come to cover large areas of skin. Additionally, when left alone, they can turn into a type of skin cancer. Obviously, these should be evaluated by a physician, especially since, after all, it might not be a wart.

Dr. Conway McLean, DABFAS, FAPWHc, is a physician who specializes in treating foot, ankle and lower leg problems.