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[music] Hello, I’m Dr. Neal Schultz
[pause]
and welcome to DermTV.
Warts are very common growths caused by a virus. As a matter of fact, they
are so common that the technical word for wart in medical terminology is
verruca vulgaris, translated from Latin that means common warts. Warts are
caused by the HPV virus which is also called the human papillomavirus. And
because it is caused by a virus:
1. Of course, it is an infection.
2. It is contagious.
The most common locations that we get warts are on the fingers, on the feet
and the genitals. Warts are very easy to catch and unfortunately very
difficult to treat with medicines. Because of that, we try to treat them
surgically with local anesthesia to cut them out. But regardless of how you
treat them, with medicines or with surgery, they tend to come back. As a
matter of fact, I would like to say that warts have done more to ruin the
reputation of a dermatologist than anything else we treat because they tend
to come back. Let us talk about why they come back. When your body has an
infection, there is a fight between the body and the infection. Normally,
the body wins and makes the infection go away, but in order for that to
happen, the body has to see the infection and be aware of it. When you have
a wart growth, which is a viral infection, this virus lives in what we call
an “immunologic window.” That means that body’s immune system just cannot
see it. If it cannot see it, it cannot fight it. And when the body is not
helping you fight the infection, then it is very difficult for topical
medicines to fight the infection and win. And for that reason, many topical
medicines either work very slowly and sometimes not at all. So, the
alternative is to cut the virus out. Cut out your wart. Well, we do that
with local anesthesia. But let me give you an example of why that tends to
fail. This is a tracing of the back of my left hand and the red dot is
obviously a wart on the back of my thumb. But look at the little black
lines coming off of the wart. Those are tentacles. You cannot see them, I
cannot see them. They are under the skin. And those tentacles from one end
to the other are much larger than the actual wart. If I just remove the
wart and there are tentacles and do not remove the tentacles, those
tentacles tend to become a focus from which the wart grows right back. So,
if I want to be sure I am going to get rid of the wart and have it not come
back, I have to guess and take a much larger area than the actual wart
takes. Well, if I do that, I am going to cause an unnecessarily disfiguring
scar. So we do not like to take those large areas out. Instead, we just
remove the wart, and that is why in about one in four times the wart tends
to come back. There is one other situation and that is the bottom of the
foot. Again, if you cut a wart out, you may go sufficiently deep if you are
successful, so that you actually get a scar. Well, a scar will be of
cosmetic importance only elsewhere, but on the bottom of the foot, a scar
can be very painful because scars on weightbearing surfaces, when you step
on them, cause pain. If that happens, you have pain whenever you walk, and
obviously that is a very bad situation. So, if you happen to have one of
these annoying, infectious growths, I am going to explain in another
episode what the best treatments are to get rid of them. Please join me
again at DermTv.com. If you have a question, please send it to me by
visiting: DermTv.com/question. I am Dr. Neal Schultz, and thank you for
watching today