Warts | Water warts (go to molluscum contagiosum) | Whiteheads (go to comedones) | Whitespots (go to pityriasis versicolor) | Wrinkles

Warts are skin growths caused by the human papilloma virus (HPV). They are more common in children and young adults but no age is spared.

Causes

• Human papilloma virus (HPV). Many different subtypes of HPVs have been discovered, some of which have a potential to cause cancers (see below).
• Infection is spread by skin-to-skin contact including sexual intercourse in the case of genital warts or indirectly through contaminated wet surfaces for example, the floors of public baths and gymnasiums.

  Symptoms
  There are several varieties of warts:
  
  

• Common warts (verucca vulgaris)

   

  • Firm grey, brown or skin-coloured growths with a irregular rough surface.
  • Occurs anywhere on the body, especially on the hands, fingers and knees. Periungual warts are common warts that occur around the nails.

   

• Plane warts

   

  • Skin-coloured or light brown, slightly elevated, flat-topped growths.
  • Multiple and may occur in the hundreds.
  • Commonly occurs on the face, back of the hands and the shins.

   

• Filliform warts

   

  • Taglike or fingerlike growths.
  • Commonly affects the eyelids, face and neck.

   

• Plantar warts

   

  • Callus-like thickenings in the soles.
  • Pain on walking.
  • Mosaic warts are multiple closely-set plantar warts.

   

• Genital or venereal warts (condylomata acuminata)

   

  • Soft fleshy growths with a tendency to cluster, forming cauliflower-like masses.
  • Occurs in the genital area or around the anus in homosexual men.

   

• Rare varieties

   

  • Laryngeal papillomas - wart infection of the larynx (voice box) of newborns.
  • Epidermodysplasia verruciformis.

  Plantar warts. Click on image for larger view

  Complications

• Female patients with genital warts may transmit infection to their babies during delivery, causing laryngeal papillomas.
• Some subtypes of the wart virus have been observed to cause cancers, especially some of the ones causing genital warts, laryngeal warts and epidermodysplasia verruciformis.

  What you can do

• You should consult a doctor if you have diabetes or warts on the face or genital area.
• Over the counter wart preparations may be used for warts on areas other than the face and genitals but follow the instructions carefully.
• See a doctor if there is no improvement or if warts recur.

  What the doctor may do

• Confirm the diagnosis.
• Treat with liquid nitrogen, trichloroacetic acid or cantharidin, electrosurgery, curettage (scraping), carbon dioxide laser or excision (removal by cutting).
• Treat genital warts with podophyllin or any of the above methods (caution: podophyllin cannot be used in pregnant women because it may harm the baby).
• Treat resistant warts with intralesional or intramuscular interferon, intralesional bleomycin (caution as scleroderma of the fingers has been reported) and isotretinoin.
• Examine sexual partners of patients with genital warts for infection.
• Perform yearly Pap smears (cervical cancer smears) in women with genital warts.

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Wrinkles, often equated with ageing are of enormous concern in modern societies, especially among women. They need to be differentiated from the fine lines due to dryness of the skin which respond most readily to many moisturisers. Sun-damage accelerates wrinkling which is why fair-skins develop wrinkles earlier than the dark-skins.

Cause

• Wrinkles develop when the collagen fibres in the dermis degenerate as a consequence of intrinsic ageing and photoageing (see ageing).
  
  Symptoms
  Wrinkles may be divided into two types:
  
  
• Dynamic wrinkles which are caused by the action of the muscles of facial expression on skin that has loss its elasticity due to ageing.
• Static wrinkles.

  Coarse wrinkling due to photoageing. Click on image for larger view

  What you can do

• Minimise sun-damage (see sun protection). Remember that sun-damage begins as soon as you are exposed to the sun so precautions should be taken from a very early age.
• Avoid smoking as nicotine reduces blood circulation to the skin and may predispose to the development of wrinkles.

  What the doctor may do

• Prescribe topical tretinoin.
• Perform chemical peels, dermabrasion (surgical skin planing), laser resurfacing, face lifts or use implants (eg., collagen) to puff up wrinkles.
• Inject botulinum toxin to weaken the muscles of facial expression that cause dynamic wrinkles.

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