Definition. – A small, circumscribed, epidermal and papillary elevation of the skin.
Symptoms. – Various forms of warts are described according to their shape and the predominance of their character.
Verruca vulgaris or common wart is usually seen upon the hands especially of children. It is typically pea-sized, rounded, rough or smooth, broad at the base, slightly elevated, and pink, yellow, gray or brown in color. It may be single or multiple. A peculiar variety of verruca vulgaris is seen in young women and in laborers as a dense growth about the margin of the nail fold. Plantar warts (verruca plantaris) are not uncommon and may be painful and troublesome.
Verruca plana refers to flat, smooth warts. These are pin-head to finger-nail in size, slightly elevated, and of a brown or black color. They are often seen in large numbers upon the neck, arms and shoulders of the people (verruca senilis) in conjunction with other senile changes in the skin.
Fig. 103. – Verruca acuminata, situated above the anus between the lips of the buttocks. A reddish, projecting, vegetating mass with an offensive odor and foul secretion.
Usually multiple, they often attain a large size. When these flat warts occur upon the face, particularly in the young, they may multiply rapidly (Verruca plana juvenilis).
Verruca filiformis is a slender sessile growth, single or multiple, often seen upon the neck, shoulders, face and eyelids of adults. Their average size is an eighth of an inch. Rarely they may be congenital.
Verruca digitata is commonly observed upon the scalp and is characterized by clefts or digital divisions of the growth nearly or quite down to its base. The size varies from a pea to a dime.
Verruca acuminata (condyloma acuminata; venereal wart; fig wart) bears little resemblance to the other forms. It occurs about the muco-cutaneous surfaces, genitals, anus and mouth, and is a fleshy, elevated, sessile or pedunculated, pinkish or reddish growth. It is usually multiple and often bathed in an offensive secretion. These growths bleed easily and grow rapidly, frequently attaining the size of an egg. If upon the face they may appear hard and roughened like an ordinary wart.
Verruca necrogenica (anatomical tubercle; postmortem wart), is a contagious form usually occurring on the hands, probably due to a tuberculous infection (q.v.).
Etiology and Pathology – Children and young adults are most commonly affected. Most warts are due to microorganisms, and are feebly autoinoculable and contagious. However senile warts are due to nutritional changes in the skin incident to old age, while venereal warts are caused by contact with a local irritating secretion which may contain a causal germ. The initial factor in the formation of a wart is a local irritant, probably microbic. Anatomically there is a hypertrophy of the stratum corneum and of the papillae of the corium. A vascular loop is found in the center of each wart, which accounts for its ready bleeding. In the venereal type here is marked connective tissue and vascular hypertrophy as compared with the horny hyperplasia.
Prognosis and Treatment – While warts are innocent growths, it is often necessary to remove them for cosmetic reasons, and rather more imperative in the senile type because of possible epitheliomatous changes. Ancient and widespread superstitions concerning warts have given rise to internal and external treatments based largely on psychic suggestion. It is not my purpose to discuss these fictions.
Simple warts may be removed by caustics, excision, electrolysis, X-raying, refrigeration or fulguration. Ordinary caustics such as carbolic, nitric, sulphuric and trichloracetic acids, caustic potash, or chromium trioxide, may be repeatedly but carefully painted on warty lesions but the surrounding tissues should be protected by wax or vaseline to prevent the caustic from spreading. If the surface is hard and horny, horny, gentle paring with sand paper or file may be used previous to the application of one of the following: saturated solution of salicylic acid in alcohol, or 10 to 30 per cent. of the same in collodion; liquor carbonis detergens, full strength or diluted equally with alcohol; lactic acid; formalin; zinc chloride; or sodium ethylate. Pedunculated warts may be strangulated by tying a piece of fine silk or horse hair about the base. When the growth is separated caustics may be applied. Filiform, digitate and pedunculated growths may be cut off with curved scissors, after which the base should be touched with carbolic or nitric acid or powdered tannin. The galvanocautery may be used if the pedunculated warts are large because they are apt to bleed freely. Acuminate or venereal warts should be kept clean, dry and dusted with a powder of 2 per cent, salicylic acid in a boric acid base. It may be necessary to occasionally brush them with a solution of persulphate or iron or careful applications of acetic, nitric or chromic acid. Warts upon the soles of the feet may be treated with 25 per cent. salicylic acid plaster. Seborrheic or senile warts may be treated with a 5 to 20 per cent of plaster of resorcin, betanaphthol or salicylic acid, but I prefer Hebra’s prescription given in the treatment of corns, preceded or followed by high-frequency sparking.
In selected cases satisfactory results may be accomplished by the application of the carbon or glass-pointed electrode of the high-frequency currents. The X- rays in full doses, radium and concentrated solar rays have proven beneficial. Individual warts of fair size can be easily and cosmetically removed by solidified carbon dioxide, 20 to 100 seconds application with firm pressure. If operative measures are necessary, surgical excision or the Paquelin cautery may be used but scarring must be expected. There are many reasons for believing that an internal remedy prescribed on the totality of symptoms will benefit. One of the following may be tried: Antim crud., Baryta carb., B. iod., Calcarea carb., Carbo animal., Causticum, Kali mur., Lycop., Nat. mur., Nat. sulph., Phosphorus, P. acid., Psorinum, Sepia., Sul., Thuja.