Warts are a problem that bothers a great number of people and they are common throughout the world. Skin warts occur at any age. It has been estimated that 2–30% of school‐age children and young adults have warts. [1]
Oftentimes, we are told that the wart we have is a “seed wart”. In this article we will explore the main features of warts, and seed warts in particular, what they look like, and how to treat them.
What are warts?
As you probably already know, a wart is an abnormal but benign growth on the skin or mucous membranes[2] that is caused by a viral infection.[3]
Types of warts
There are two main types of warts caused by HPV: cutaneous warts, which appear on the skin all around the body; and genital warts, which appear on or around the genitals and anus of both males and females. There are many several subtypes of cutaneous warts which include common warts, also known as verruca vulgaris; palmar & plantar warts, a subset of common wart that appears on the undersurfaces of hands and feet; and plane warts, which are smooth and largely flat.[4]
what is seed warts?
A seed wart is a type of cutaneous wart in which a little black dot can be seen in the center of the wart, giving them the appearance of a having a “seed” inside. The black dots are actually blood vessels growing in the substance of the wart. [5]
Seed warts occur more often in certain types of warts. Plantar warts, for example, are more likely to show “seeds” that other warts. [6]
What causes Seed warts?
As outlined previously, the cause of warts is a virus called the Human Papillomavirus (HPV, for short). HPV attacks the outer layers of skin and mucous membranes, known as the epithelium.
HPV comes in many different types, which explains why warts have many different types and affect the body in different areas, as each type of virus favors a different part, or may cause a different type of wart. There are almost 200 different subtypes of HPV. [7]
Common warts are usually caused by HPV-2, but may also be caused by HPV types 1, 4, 27, and 57.[8]
How can I get warts?
Warts are contagious. They can spread from one person to another, or from one area of a person’s body to another area, either by direct contact with the wart or by the handling of the wart and spreading the virus through the fingers. [9]
HPV needs to penetrate into the deepest layers of the skin, however, in order to cause a wart, and that requires the upper layers to be injured or softened by moisture (a process called “maceration”).
This means that certain factors can increase the likelihood of HPV infection. These include: [10]
- Skin maceration caused by prolonged standing on wet floors, such as in swimming pools and shower rooms.
- Nail-biting and thumb-sucking, the former causing injury and the latter, maceration on the fingers, promoting HPV infection
- Shaving injuries might also give HPV the breach it needs in the skin to take root and cause warts.
- Constantly handling raw meat, poultry, or fish causes maceration and injuries increasing the risk of HPV infection.
Warts may not appear immediately after HPV invades the skin, however. Sometimes, it may take up to 20 months for the warts to appear.
People who are immunocompromised (those whose immunity is weakened due to chemotherapy or HIV infection) are especially susceptible to warts, where they are usually greater in number and are less likely to spontaneously resolve. [11]
What are the symptoms of warts? What do they look like?
There are usually no symptoms besides the warts themselves. Each of the different types of warts may look a little bit different.[12]
Common Warts
Common warts are small, firm bumps with a rough surface. There can be a single wart or many warts, sometimes fusing together forming a giant lump of warts. Each wart is usually no larger than 1 cm across. The warts may be painful to touch or pressure, especially on the palm and palmar aspect of the fingers or when fissures and crack form in them.
The warts may persist for months or years and may remain unchanged for a long time. Their appearance may start to change spontaneously after any interval of time.
It was previously mentioned that the warts that grow on the genitals are of a type different than cutaneous warts, but cutaneous warts – and common warts in particular – can be found on the genitals. This is quite rare in adults, constituting only about 1 or 2% of all cases of warts on the genitals. In children, however, the rate is much higher, constituting more than 60% of all cases.
Seed Warts
Remember that seed warts are just common warts that have blood vessels running through them, which are visible as black dots in the center of the wart. They have all other physical appearances of common warts
Seed warts are aggravated by sunlight, which increases their rate of growth of warts. They are usually more numerous compared to regular common warts. [13]
Plantar Warts
This type of wart is also a subtype of the common wart that grows on the lower (plantar) aspect of the foot. Its appearance is quite characteristic in that is sharply defined with a smooth collar surrounding it, and has a rough surface.
The warts may be multiple, and may fuse together giving the appearance of a mosaic, in which case they are called mosaic plantar warts.
Plantar warts usually appear on pressure points on the foot, with bony prominences underneath, which makes them painful to step on. Mosaic warts are usually painless.
As stated above, seed warts are more likely to appear in plantar warts.
Pigmented Warts
Another type of wart that may closely resemble a seed wart is the pigmented wart. These have been documented on the soles and palms of Japanese people in particular.
What is the prognosis of seed warts? How do they progress?
Warts have been known to go away on their own. This spontaneous resolution, however, may take any period of time, for a few months to a couple of years. The rate is usually faster in children, where half of the cases will clear away within a year, 65% within 2, and 95% within 4.[14]
The resolution of common warts is usually without any symptoms and progresses gradually over the period of resolution.
While plantar warts are regressing, they may undergo a process of inflammation, which could result in clotting of blood within the wart before it dries off, and could cause blackening or seeding.
How are warts treated?
There are several lines of treatment for warts.[15]
The first line consists of the following:
- Salicylic acid
- Glutaraldehyde
- Formalin
- Occlusion
- Topical 5-fluorouracil
- Caustics
- Retinoic acid
- Vitamin D analogues
The second line of treatment is:
- Cryotherapy
- Laser
- Hyperthermia
- Surgery
- Photodynamic therapy
The third line of treatment, which is reserved only for severe cases, includes:
- Podophyllin and podophyllotoxin
- Imiquimod
- Topical immunotherapy
- Intralesional immunotherapy
- Interferon
- H2 receptor antagonists
- Zinc
- Oral retinoids
- Intralesional bleomycin
- Cidofovir
- Psychological methods
Are there any natural ways to treat warts?
Having been around since antiquity, natural remedies to treat warts have been around for centuries.
Given the fact that many warts will spontaneously resolve and are only very slightly inconvenient, it might be prudent to wait for a little before resorting to medical treatments. [16]
The following methods may help alleviate the mild discomfort of warts:
- Filing or paring the rough bulging surface of the wart using a nail file or emery board is enough to aid healing and prevent discomfort. [17]
- The oil of the eastern white cedar (Thuja occidentalis, a tree native to North America) has been shown effective against warts. 3 or 4 drops are applied to the wart every night for about 21 days.[18]
- Applying a patch of natural banana peel to the wart and fixing it in place, especially if used in conjunction with Thuja oil might help.[19]
- Covering the wart with a layer of castor or olive oil and applying a patch of thinly sliced garlic is another natural remedy.[20]
- Immersing the wart in hot water (113° F / 45° C) for 30 minutes, twice a week may result in resolution. [21]
- Propolis is a resin that has been shown to be effective against common warts. [22]
- Tea tree oil has been reported as successful in resolving warts. [23]
Is there any way to prevent seed warts?
- Covering plantar warts with plaster strapping or wearing special rubber socks known as “verruca socks”, or sandals while at swimming pools or in shower rooms could help limit infection. [24]
- Simple domestic hygiene, like cleaning of bathtubs and showers, and avoiding sharing towels, is a very effective way to prevent the spread of warts. [25]
- Avoiding nail-biting and thumb-sucking could greatly reduce the spread of warts to the fingers or around the mouth. Painting the wart with any form of treatment and then covering it with adhesive plaster could help break the habit of biting or sucking. [26]
- There is actually a vaccine for warts currently being researched.[27] Vaccines against HPV types 6, 11, 16 and 18 are already in use in many countries, and vaccines against other types are currently in development. [28] The effect of these vaccines in protection against HPV infections is still undetermined, however. The vaccines are promising, though, as studies have shown that taking the vaccines produces a strong immune response, resulting in the secretion of antibodies that could target the virus. [29]
[thrive_text_block color=”light”]Common warts, seed warts, and plantar warts are all classified as cutaneous warts. They are benign swellings of the skin that could be painful, and may go away on their own. Several methods of treatment – including natural methods – are available and effective against warts. Warts are contagious and good hygiene and habits could help curb their spread to other locations or other people.[/thrive_text_block]
References:
[1] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.46.
[2] Ural A, Arslan S, Ersöz Ş, Değer B. Verruca vulgaris of the tongue: a case report with literature review. Bosnian Journal of Basic Medical Sciences. 2014;14(3):136-138. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333997/
[3] https://www.ncbi.nlm.nih.gov/pubmed/9563805/
[4] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.47-25.50.
[5] https://www.webmd.com/skin-problems-and-treatments/plantar-warts-palmer-warts#1
[6] http://moleremovalat.com/types-of-warts/seed.html
[7] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.44, 25.45.
[8] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.46.
[9] https://www.dermnetnz.org/topics/viral-warts/
[10] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.46.
[11] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.46.
[12] All information in this section is derived from this source unless otherwise specified:
Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.47-25.50.
[13] http://www.healthcentre.org.uk/cosmetic-treatments/wart-seed-warts-treatment.html
[14] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.50, 25.51.
[15] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.54.
[16] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.51.
[17] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.51.
[18] Kwok, C.S., Holland, R. and Gibbs, S. (2011), Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials. British Journal of Dermatology, 165: 233–246. doi:10.1111/j.1365-2133.2011.10218.x http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2011.10218.x/full
[19] Kwok, C.S., Holland, R. and Gibbs, S. (2011), Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials. British Journal of Dermatology, 165: 233–246. doi:10.1111/j.1365-2133.2011.10218.x http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2011.10218.x/full
[20] Kwok, C.S., Holland, R. and Gibbs, S. (2011), Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials. British Journal of Dermatology, 165: 233–246. doi:10.1111/j.1365-2133.2011.10218.x http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2011.10218.x/full
[21] https://emedicine.medscape.com/article/1133317-treatment?src=refgatesrc1
[22] https://emedicine.medscape.com/article/1133317-treatment?src=refgatesrc1
[23] https://emedicine.medscape.com/article/1133317-treatment?src=refgatesrc1
[24] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.51.
[25] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.51.
[26] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.51.
[27] http://www.clinicaladvisor.com/cmece-features/oral-lesions-caused-by-human-papillomavirus/article/193918/4/
[28] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.46.
[29] Harper DM, Franco EL, Wheeler CM, et al. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet. 2006;367:1247-1255.