Viral Warts: Treatment, Prevention, and Recurrence Concerns

Hello, I would like to ask a question about viral warts?

Hello, doctor.
I have been living abroad for many years and returned to Taiwan last year.
While I was overseas, I noticed a raised lesion on the sole of my foot, but since it was not painful and did not affect my walking or daily life, I didn't pay much attention to it, thinking it would disappear over time.
Later, I also noticed a white bump on the pad of my right index finger, which I assumed might be a splinter, and similarly, it didn't bother me, so I ignored it as well.
After two to three years, I recently saw news about warts and realized that the lesion on my foot resembled them.
After researching online, I suspected it might be a viral wart.
Upon closer observation, I noticed that due to my work in Australia, the sole of my foot began to peel and produce flakes.
I also observed small blisters forming around the wart, which were very tiny and required careful inspection to see.
Additionally, I found a small white bump (about the size of a sesame seed) next to the pad of my finger, and I discovered two more on my palm that were even smaller, which I initially thought were just regular blisters.
I promptly visited a dermatologist, who confirmed that they were viral warts.
The doctor used cryotherapy for treatment.
After the initial treatment of the wart on my foot, I noticed several small blisters around its edges.
The doctor mentioned that my wart was quite large and that there were many surrounding it, so I underwent multiple cryotherapy sessions.
The treatment for my hand was not as prolonged; the doctor advised me not to touch them and to avoid sharing shoes with others.
However, while I was abroad, I had carpets at home, and the doctor indicated that it was highly likely I contracted the virus from the carpets.
After the cryotherapy, the doctor instructed me to return once a week, and I plan to go back next week.
Upon returning home, I observed that I still had several very small bumps on both hands, but I am unsure if they are warts like the two on my palm that received cryotherapy.
The area on my foot that underwent cryotherapy is still showing some small blisters that were not treated.
My question is, after completing the treatment, will I risk spreading the virus if I have other unnoticed warts? I cannot visually identify all the viral warts on my body, so will this prevent me from fully healing? Is there any special treatment that can eliminate all the viruses (including those that may not have manifested yet) at once? This situation is quite troubling; it feels like a cycle.
Although I have treated the larger warts, if the smaller ones remain unnoticed, will they keep recurring? (What if the small viruses grow larger again...?)

Lin Xue, 20~29 year old female. Ask Date: 2020/08/03

Dr. Wu Yuxin reply Dermatology

I can only say that to eradicate it, we must actively treat until none are left; otherwise, it will continue to spread.

Reply Date: 2020/08/03

More Info

Viral warts, also known as verrucae, are benign epithelial tumors caused by the human papillomavirus (HPV). They can appear on various parts of the body, including the hands and feet, and are often characterized by their rough, raised surfaces. Understanding the treatment, prevention, and recurrence concerns associated with viral warts is essential for effective management.

Treatment Options
The treatment for viral warts can vary based on their location, size, and the patient's overall health. Common treatment modalities include:
1. Cryotherapy: This is one of the most common treatments, which involves freezing the wart with liquid nitrogen. This method can cause the wart to blister and eventually fall off. Multiple sessions may be required, especially for larger warts.

2. Topical Treatments: Over-the-counter treatments containing salicylic acid can help dissolve the wart gradually. These treatments require consistent application and may take several weeks to show results.

3. Laser Therapy: For warts that are resistant to other treatments, laser therapy can be an effective option. This method uses focused light to destroy the wart tissue.

4. Electrosurgery: This technique involves burning the wart with an electric current. It is often used for larger or more stubborn warts.

5. Immunotherapy: This approach stimulates the immune system to fight the virus. It can involve topical applications of immune response modifiers or injections of antigens.

Prevention Strategies
Preventing the spread of HPV and the recurrence of warts involves several strategies:
1. Avoid Direct Contact: Since warts are contagious, avoid touching warts on yourself or others. Do not share personal items like towels, razors, or shoes.

2. Maintain Good Hygiene: Keep your skin clean and dry. Moist environments can promote the growth of warts, especially in areas like the feet.

3. Protective Footwear: Wear sandals or flip-flops in communal areas such as swimming pools, locker rooms, and showers to reduce the risk of HPV exposure.

4. Regular Skin Checks: Regularly inspect your skin for any new growths or changes. Early detection can lead to prompt treatment.

Recurrence Concerns
One of the most frustrating aspects of viral warts is their tendency to recur. Even after successful treatment, new warts can develop due to the persistence of the virus in the skin. Here are some points to consider regarding recurrence:
1. Subclinical Warts: It is possible to have small, subclinical warts that are not visible to the naked eye. These can still harbor the virus and lead to new outbreaks.

2. Immune Response: The body’s immune response plays a significant role in controlling HPV. Some individuals may have a stronger immune response, leading to fewer recurrences, while others may be more susceptible.

3. Treatment Limitations: No single treatment guarantees complete eradication of the virus. While treatments can remove visible warts, they may not eliminate the virus entirely from the skin.

4. Follow-Up Care: Regular follow-up with a dermatologist is crucial, especially if you notice new growths. Early intervention can prevent the spread and recurrence of warts.

Conclusion
In conclusion, managing viral warts involves a combination of effective treatment options, preventive measures, and awareness of recurrence risks. While treatments like cryotherapy and topical agents can be effective, it is essential to understand that the HPV virus may remain in the skin, leading to potential future outbreaks. Regular monitoring and maintaining good hygiene practices are vital in managing this condition. If you have concerns about new growths or the effectiveness of your treatment, consult with a dermatologist for personalized advice and management strategies.

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