Witches, Toads and Warty Woes By Mark B. Levin, M.D. and Louis J. Tesoro, M.D.

"Ewww!" That is the reaction most often encountered when we tell a child they have a wart. Parents are usually more politic about it! Everyone who experiences warts or molluscum, though, want to know what they are, how they are spread and, most importantly, how to get rid of them.

Warts and the lesions of molluscum contagiousum are caused by viruses, pesky little germs that seem to be everywhere. These particular viruses specifically cause skin infection and are not associated with malignancy. They are believed to spread by contact with others who have the lesions, either directly or indirectly, for example, through shared damp towels. Once these viruses enter the skin, they induce lesions that have a characteristic appearance, making them easily identifiable.

Molluscum contagiosum lesions initially look like a small insect bite that grows into a raised pimple-like structure having a clear dome with a central dent, called an umbilication. Multiple lesions are the rule rather than the exception. They can occur anywhere on the body, but are most commonly found on the abdomen, thighs, chest, and inner arm. They sometimes itch and seem to spread more easily if scratched. Although they frequently resolve on their own within a 6 month period, some last longer. Because multiple lesions are unsightly, many parents seek ways to make them disappear more rapidly. Topically applied chemicals, such as podophyllin or other preparations are used by dermatologists to hasten the resolution of these lesions. The older practice of squeezing a molluscum lesion to extrude the creamy white virus-containing core is not recommended because of the pain, the possibility of inducing infection and the probability of causing spread.

Common warts, also called verrucae (ver-oo'-keye), start out as a small firm bump under the surface of the skin. Some people mistakenly think the lesion is due to a small splinter or piece of glass. The lesion is usually not painful, unless it is traumatized (warts on the sole, or "plant" of the foot, called plantar warts, are often painful since walking bruises them). Over time, the wart enlarges and takes on a coarse appearance with what looks like small black dots in it. Just when it seems to be the most unpleasant looking, it falls off! The process from start to finish takes from 6 months to three years, depending on the person's immune response and the location of the wart. It is common for new warts, called satellites, to appear anywhere on the body during the evolution of the primary wart. Although this concerns parents, when the primary wart disappears, the satellites generally follow suit in days.

For those who have warts in uncomfortable (e.g., the sole) or unsightly places (e.g., the face or hands), parents often want resolution more quickly than the time it takes nature to heal them. The most rapid method is electrocautery. This entails injecting a topical anesthetic under the wart, burning it with an electrical device and physically pulling the wart off of the skin, being as sure as possible to remove the core. Any bit remaining in the skin can cause the wart to re-grow. The procedure leaves a hole in the skin, which takes about 10-14 days to heal. A bump of scar tissue may remain after it is healed.

The second most aggressive method is to freeze the wart(s). This process usually takes about 30 seconds to a minute. Although it is a cold burn, the technique is nonetheless a burn and it stings for about 20 seconds. If the wart is shed with the injured skin, then no further treatment is needed. If not, the treatment is repeated every 2 weeks until the wart is gone. Too frequent applications of the freezing material can damage too much normal skin. Too infrequent applications can allow the wart to re-grow.

In the past, dermatologists would often apply acids or other caustic agents to the wart to destroy it. The wart would then be covered with a dressing. A recent study that compared the freezing technique, the caustic applications and a simple unmedicated dressing (duct tape), found that the duct tape worked the best! The technique used in the study was to cover the wart with a piece of duct tape continuously for six days and six nights. On the seventh day, the tape is removed and the wart is soaked in water to soften it, followed by gentle abrasion with an emery board or a pumice stone. On the eighth day, the cycle is repeated. If the duct tape comes off during the 6-day coverage cycle, a fresh piece of tape is re-applied. The process should be continued until the warts have gone or until two months have elapsed. This study showed the duct tape method to be inexpensive, easy and successful in about 80% of the patients. The mechanism that causes the duct tape to be effective is unknown.

If your child has warts or molluscum and refuses to tolerate them, speak to your doctor about these various methods for removal. By the way, warty witches and warty toads have nothing to do with human warts!

Dr. Mark B. Levin 

Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.

Dr. Louis J. Tesoro 

Dr. Tesoro has been a member of the staff at The Pediatric Group since 1988. Dr. Tesoro is Chairman, Department of Pediatrics, Medical Center at Princeton, 1996 to present and Attending Pediatrician, Medical Center at Princeton, 1988 to present. He has served on several Departmental and hospital committees, lectured at the Universiy of Pennsylvania and has published original articles both while at The Children's Hospital of Philadelphia and at The Pediatric Group

© The Pediatric Group, P.A. 2004. All rights reserved.