verrucas are caused by viruses from the papillomavirus family. Their penetration through microcracks in the skin will cause cells to multiply in a given location. A small, characteristic growth then forms. These viruses are contagious through direct contact with an infected person or through dander, for example, in gyms or swimming pools. A few months pass between the moment of contagion and the verruca’s appearance. Verrucas are also spread by self-contagion from one part of the body to another.

Verrucas appear as small benign skin swellings occurring after contamination by a virus that infiltrates damaged skin. Verrucas of different appearances are located on the skin of the hands, face, toe, or soles of the feet. Eradication of the virus is rarely possible, and recurrence of verrucas is common.

Generally benign, verrucas can be of several stages and affect all categories of people. Very common among children, it is estimated that 20 to 30% of them will be affected by plantar verrucas. In London, one in four people will be affected. Revitalise London Dermatology Clinic, 22 Harley Road, Maryleb and Westfield Mall, Stratford, tells you more about verrucas, how to recognise them, the symptoms, and the treatments available to eliminate them.

About the disease

verrucas are a typical clinical manifestation of papillomavirus-associated infection. What do verrucas mean from a histological point of view? The tissue structure of these pathological formations is characterised by the proliferation of the epidermal (surface) layer with dysfunction of the keratinisation process, disruption of the cell structure, and proliferation of the papillary layer of the dermis. However, not all patients with human papillomavirus infection develop verrucas. The development of the disease is facilitated by skin trauma, dry skin, and dysfunction of the autonomic nervous system. There are several stages of verrucas: common or vulgar, flat or juvenile, plantar, anogenital, filiform, and genital.

Against the background of the long-term presence of the human papillomavirus in the body, an immunodeficiency state develops, associated with a deficiency of both the cellular and humoral components. Therefore, immunomodulators are often included in a comprehensive treatment program. Due to immunosuppression, verrucas can increase cancer risks. Removal of skin tumours and determining treatment tactics are the most critical stages of working with the patient, the implementation of which can affect the prognosis for life and the social adaptation of patients. To achieve the best therapeutic result, Revitalise London Dermatology Clinic uses a differentiated approach to selecting tactics and methods for removing tumours, depending on the nature, size, location, and nature of the cancer.

Verrucas: a common skin problem

Veccura appear as small swellings on the skin’s surface, corresponding to growths on the skin. They are due to skin infection by a virus of the mortal papillomavirus type or “  Human Papillomavirus  ” (HPV). That is why verrucas are called viral papillomas. The development of verrucas is benign. The “  Human Papillomavirus ” (HPV) viruses involved in the occurrence of verrucas are not responsible for skin cancer, unlike high-risk papillomaviruses. Affecting the mucous membranes and is involved in the occurrence of cervical cancer. Most verrucas disappear spontaneously within a few months, but some can persevere for years. It should also be noted that recurrences of verruca are common. In London, around one in four people have or will have verrucas. Children aged five to fifteen are most affected. Thus, fifty to seventy per cent present common verrucas at one time or another, and twenty to thirty per cent cent plantar verrucas. Certain types of verrucas form in the anal and genital areas and are called.

How are verrucas recognised?

There are different types of verrucas. They generally do not exceed the size of a pinhead, but some can reach the size of a pea.

• The most common are verrucas, yellowish-grey growths with an irregular surface forming, especially on the fingers and the back of the hand. They grow singly or in groups.
• Plantar verruca appear on the soles of the feet and penetrate deeply. They can be very hurting and make walking difficult.
• When I have a verruca, I can see a growth of varying sizes on different areas of my skin, up to several millimetres. Verrucas are caused by a papillomavirus-type virus, which has several strains. Most of these strains do not pose a problem. However, I need to pay attention to strains 16 and 18 of the papillomavirus, which can affect my mucous membranes and cause cervical cancer.
• Verrucas usually disappear within a few months, but some may remain present for several years. Depending on their location, verrucas sometimes go unnoticed. Plantar verrucas cause the most symptoms when they exist because walking promotes the appearance of pain or a feeling of discomfort. Recurrences are common, even after treatment with verrucas.

Diagnostics

A visual examination is sufficient to diagnose this pathology, but to identify HPV, the following is carried out.

• I am taking anamnesis.
• Physical examination.
• Laboratory research.

Eliminate verrucas by self-treatment.

Self-medication treatments are available to eliminate skin verrucas.  The latter generally use the principle of cryotherapy found in dermatology to burn the verruca and facilitate its elimination. Several applications may be recommended depending on the type of verruca and its size. Therefore, I seek the advice of a doctor to advise me on the products to choose and any contraindications, particularly in the event of pregnancy or in children. Dressings designed explicitly for the treatment of verrucas may also be considered. Verrucas are eliminated more quickly. This method takes longer than applying products directly to the affected area, but the two can be combined to improve their effectiveness. The dressings are also best suited for application to the feet or hands but not to the face or fingers.

How To Get Rid of a Verruca?

When you have a verruca, you must make sure you take some actions to limit transmission to other people and different areas of your body. You avoid touching or scratching it, and you ensure you wash your hands well if you do. You avoid going to risky places such as swimming pools or gyms until your verruca disappears or you wear a protective sock. You follow the following advice to prevent skin and plantar verrucas when you go to a risky place or if you are in contact with people who have them.

• You do not borrow the person’s towels or gloves.
• You don’t share my shoes or socks or use other people’s shoes if you don’t want to get a verruca.
• You avoid walking barefoot around swimming pools and collective changing rooms, showers, or gyms.
• You dry my feet and hands thoroughly when You wash them.

To limit contamination by genital verrucas, you must also respect specific hygiene measures and regularly take a smear with your gynaecologist. If you are a young woman between fourteen and twenty years old, condyloma can be avoided. Have you noticed a verruca on your skin or need advice on removing it? Please register at our Revitalise London Dermatology Clinic, 22 Harley Road, Maryleb and Westfield Mall, Stratford. You will be contacted by one of our partner doctors via teleconsultation.

One of the most common skin conditions

Even if they mainly affect children, they are not exceptional in adults. They are also frequently encountered in immunocompromised subjects, in particular, subjects who have undergone a kidney transplant due to the immunosuppressive treatments necessary for the transplant. An immune test, including white blood cell or leukocyte count and HIV serology, can be prescribed when multiple very profuse verrucas appear in an “a priori healthy” adult. The primary source of contagion is the skin lesion itself due to the dissemination into the environment of epidermal scales infected with the HPV virus. Therefore, the virus’s main reservoir is the individual carrying verrucas. Human-to-human transmission is often through skin contact, which is favoured by skin breaks and drying. Certain environmental factors, such as humid environments, close contact between individuals, family size, community life, and rural environments, play an important role in dissemination.

The different types of verrucas on the skin

There are several types of skin verrucas. Common (vulgar) verrucas grow up to several millimetres in size with a rough surface. The colour of such a verruca varies from yellowish-brown to dirty grey. At first, it may match the colour of the skin, but then the verruca darkens. Over time, the verruca increases in size, the surface becomes rough and uneven, and cracks may cover it. Common verrucas often appear on the fingers, the back of the hands, and, in children, on the knees. Quite often, around one verruca, the so-called maternal one appears – the one that appeared first and most significant, while other, smaller ones appear. Common verrucas are usually painless. Sometimes, they can disappear independently, but you shouldn’t rely on this.

Flat (juvenile) verrucas are formations that rise slightly above the skin’s surface and match in colour. They have a flat surface, usually smooth, sometimes somewhat rough. They occur in adolescents, mainly on the face, neck, and back of the hands. Multiple rashes characterise flat verrucas. Usually, they disappear on their own. Lifespan ranges from several months to several years. Redness and itching may occur if the skin is irritated in the area where flat verrucas appear. They appear as small elevations, 1 to 5  mm, of the skin with a flat top. Grouped into plates, they have a geometric shape with several angles.

Plantar verrucas arise on the soles of the feet where the skin is exposed to the most pressure or friction. They appear as small shiny bumps, like an ordinary yellow or brown verruca. They can reach large sizes – up to 2 centimetres in diameter. Under the influence of friction, the verruca may begin to crumble. Sometimes such a destroyed verruca looks like a pit with horny edges, at the bottom of which papillae are visible. Plantar verrucas are usually quite painful and cause significant discomfort.

Filiform verrucas usually appear with age. They are found in the armpits, groin, neck, under the mammary glands, and around the eyes. They can be on a narrow or wide base. They look like elongated elastic formations (up to 5-6 mm), usually flesh-coloured. Such verrucas can be easily injured.

A separate group consists of genital verrucas – formations also caused by a particular type of HPV. However, this type of virus is usually transmitted sexually. Genital verrucas are most often located on the genitals or in the anus, sometimes in the groin, armpits, under the mammary glands, and in the corners of the mouth. In appearance, they resemble a cockscomb or cauliflower. They are much less painful than a single verruca.

Causes of verrucas

The immediate cause of verrucas is the papillomavirus. Infection with this pathogen results in benign epithelial tumours that arise on the skin or mucous membranes. At the present stage of the development of medicine, more than 40 stages of papillomaviruses have been identified, each of which most often causes a species-specific kind of verruca. The primary method of transmission of papillomaviruses (HPV) is through human contact. The danger is posed by infected men and women and animals with human papillomavirus infection. Sometimes, asymptomatic virus carriage is possible when someone carries the disease without realising it. It can infect a relatively large circle of people.

Infection by autoinoculation is also possible. For example, verrucas in the periungual area are common in people who bite their nails. Self-infection can occur during shaving, hair removal, and depilation on the cheeks, chin, and legs. Sometimes, infection occurs in public places – when visiting a swimming pool, sauna, or gym. People who cut meat often get infections from animals, and the verrucas usually appear on the hands and forearms (“butcher’s verrucas”). The virus penetrates the dermis through tiny abrasions. Then, it multiplies in the superficial layer of the skin.

Why do we have verrucas?

Verrucas appear after skin contamination by a “ Human Papillomavirus ” virus, which has different types. Most often, viruses penetrate under the skin at the level of a lesion that breaks the protective skin barrier. Viruses that cause verrucas are contagious and are transmitted. The viruses in the verruca cells spread on the skin when the person scratches. This spread of viruses on the skin can create new verrucas through self-contamination. The virus can also be transmitted to another person through skin contact. The viruses present in verrucas are deposited on contact surfaces and then penetrate the damaged skin of another person coming into contact with these contaminated surfaces. They usually result from viral contamination in a gym, a collective shower, or a swimming pool. They occur faster after swimming in heated water, which relaxes the horny layer of the feet. Rough surfaces around pools and on swimming pool diving boards encourage skin damage and virus infection. Living in a community is also a factor in favouring viral transmission.

The Importance of Professional Verruca Removal to Prevent Infection

The virus accumulates in verrucas (papillomas and condylomas). When in contact with another person, there is a risk of infecting him, so you should not put up with the existence of verrucas. However, it would help if you did not try to eliminate the verruca yourself; firstly, this can lead to inflammation. Secondly, the “root” of the verruca may remain and grow again; thirdly, trauma to the verruca can contribute to its degeneration into a malignant formation. Removing a verruca if it is injured when wearing clothes, walking, or moving your hands is imperative. For this reason, eliminating plantar verrucas, filiform verrucas, groin verrucas, and axillary warts is recommended. Removing warts on exposed areas of the body is recommended for aesthetic reasons.

Treatment of verrucas

Treatment of verrucas can be represented by a variety of methods of influencing the area of ​​the pathological focus:

• Local use of cytotoxic drugs that disrupt the metabolism of altered cells.
• Physical destruction methods are implemented using electrocoagulation, laser cauterisation, and radiowave surgery.
• Chemical destruction methods that destroy infected skin cells.
• Systemic and local immunotherapy mobilises the body’s internal reserves to fight human papillomavirus infection.
• A combination approach is often required to increase therapeutic effectiveness. The doctor determines the optimal treatment program, considering the body’s characteristics.

Conservative treatment

Complex conservative therapy for verrucas can be carried out using immunostimulants and antiviral agents. However, achieving a significant therapeutic result with local effects on pathological foci is impossible. Conservative treatment is only a complement to destructive methods and can reduce the risk of relapse of chronic infection.

Treatment of flat verrucas may differ from generally accepted canons. Thus, the therapy uses local retinoids, which cause lysis of hyperkeratotic skin changes. In some cases, a combination of a retinoid and immunomodulators is required.

Treatment tactics for patients with skin manifestations of human papillomavirus infection are selected individually. The immune status, concomitant somatic pathology, localisation, nature of the pathological process, and effectiveness of previously administered antiviral therapy are considered.

Surgery

Therapy for verrucas and human papillomavirus infection is reduced to treatment to remove areas of altered epithelium and viruses. There is no traditional surgical treatment for verrucas. Patients are indicated for outpatient minimally invasive targeted interventions.

• Laser therapy.
• Electrocoagulation.
• Cauterisation with chemicals.
• Photodynamic therapy.
• Cryo-destructive destruction of local foci with liquid nitrogen.

Any of the presented methods of destruction is accompanied by moderately severe pain. Therefore, patients with a low pain threshold can undergo local anaesthesia. The analgesic effect usually occurs 10 minutes after the local anaesthetic is injected.

Prevention of verrucas

The primary method of preventing verrucas is protection against infection with papillomaviruses. Therefore, condoms should be used during casual intimate contact. It is necessary to have individual personal hygiene products.

Rehabilitation after verruca removal

Rehabilitation after verruca removal using destructive methods involves following simple rules.

• Do not tear off the crust.
• Regularly treat the surrounding skin with a product recommended by the doctor.
• Do not wet the area of ​​destruction until the tissue has completely healed.
• After skin regeneration, no visible changes remain; there are no negative consequences after properly performing destruction.

Radio wave removal of verrucas

In the Family Doctor, verrucas are removed using the Surgitron radio wave apparatus. This method provides effective and quick removal of verrucas. The intervention is carried out strictly in the required volume, in which healthy tissue does not suffer. The verruca is destroyed, and the risk of its re-formation is minimised. After removing a verruca with Surgitron, the skin heals quickly, leaving no traces at the healing site.

What is the difference between warts and papillomas?

From a medical point of view, the difference between verrucas and papillomas is insignificant. The human papillomavirus causes both neoplasms, has the same transmission routes, pathogenesis, and risk factors, and affects the epidermal layer of the skin. However, there is a difference between papillomas and verrucas. As a rule, papillomas are soft and often have a pedunculated base. Verrucas, on the other hand, are complex and have a broad base. Also, verrucas and papillomas are caused by different types of HPV; therefore, their location on the human body differs.

How do you get warts?

The human papillomavirus must enter a person’s skin or mucous membranes for a verruca to grow. It can happen in three ways.

• Sexual contact – during sex. It is the most common route of transmission of the human papillomavirus. Do not forget that even with simple genital contact without sex, there is a high probability of transmitting the virus.
• Transplacental transmission – from mother to fetus during pregnancy.
• The contact-household transmission route is through contact with infected people and household objects. Increase the risk of infection, microtrauma, and skin trauma.

A person is considered infected once the virus penetrates the skin or mucous membranes. Complete recovery with the disappearance of the human papillomavirus from the body. This process is called elimination. It is the most favourable outcome since, in this case, the person develops immunity to a specific type of HPV. Latent infection is when a person is a papillomavirus carrier with no disease manifestations. In this state, the person is not in danger but contagious to others. Clinically manifested infection in the form of a verruca. In this case, after infection, it may take 1 to 20 months before the papilloma manifests on the skin or mucous membranes. This period is called incubation.

Do warts need to be removed?

Unlike many other neoplasms, verrucas have a very high degree of infectiousness. Moreover, they can spread on the same person’s body. On the other hand, a healthy person with good immunity has a high chance that his body will cope independently with a specific verruca and the human papillomavirus in general. True, this takes about two years. Also, verrucas rarely transform into cancer. Therefore, during the ordinary course of the disease, when the verruca does not threaten health, there are no acute indications for its removal. In such cases, a person seeks medical help solely for aesthetic reasons.

Indications for removing skin verrucas are

• sudden colour change
• very rapid and uncontrolled increase in size
• soreness
• spread to other areas of the body
• recurrent nature
• verrucas exist for more than two years and do not disappear
• aesthetic dissatisfaction

Questions and answers

Which doctor treats verrucas?

Typically, a dermatologist is involved in the diagnosis and treatment of sexually transmitted diseases. However, with the anogenital localisation of these pathological skin growths, a gynaecologist or proctologist often performs the treatment.

What is a verruca treatment varnish?

It is one of the modern multi-component drugs, the active keratolytic ingredient. They destroy the connections between altered epithelial cells and contribute to their rejection.

What are senile verrucas?

These are foci of increased keratinisation, which lead to local skin thickening. The appearance of senile verrucas is most often associated with disruption of normal cell division, which develops with age.

Accurate Diagnosis and Personalized Treatment of verrucas

verrucas belong to benign skin diseases, falling into the category of so-called minor oncology. Various skin tumours often have the same clinical picture for an accurate diagnosis. It is important to contact qualified specialists. Dermatologists at the Revitalise London Dermatology Clinic, 22 Harley Road, Maryleb and Westfield Mall, Stratford Center, perform dermatoscopy and additional instrumental and laboratory diagnostics of verrucas. It allows you to establish an accurate analysis and develop a personalised assistance program. A polymerase chain reaction analysis is performed to identify the oncogenic potential of the papillomavirus, which makes it possible to determine the strain of the causative virus. According to clinical guidelines for verrucas, these data are used to develop an individual treatment and monitoring program for the patient.