Wart

WART (verruca), a term, with the addition of various additional names, designating a whole range of small protrusions above the skin having the most diverse etiology, characterized, despite apparent local benignity, by isolated location, localization in the superficial layers of the skin, approximately mound-like shape, with a surface covered with small papillary elevations. Such a purely morphological classification is now obsolete; from a modern viewpoint, the name wart can only be applied to small acquired benign neoplasms, histologically representing acanthoma (see), i.e., the result of simultaneous hypertrophy of both a group of skin papillae, especially with their elongation in height, and all layers of the overlying epidermis, in the absence of inflammatory phenomena in their tissue. Inoculated both on a carrier and on a previously healthy person, they are apparently caused by a special filterable virus. The action of alkalis or acids on erosions (Cronquist, Winternitz), possibly, does not cause W., but simple vegetations. Therefore, from the group of W., i.e., infectious acanthomas, the following types must be excluded: 1) Peruvian W. (see Verruga peruana); 2) Cadaveric W. (see Tuberculous diseases of the skin); 3) Horny W. (see Naevus); 4) Senile (seborrheic) W. (see Euratoma); 5) Soft W. as an indefinite term, referred by some to pointed condylomas, by others to soft verrucous nevus; 6) Filiform W., i.e., the smallest, occurring almost exclusively in women on the neck, face and chest disseminated, brownish soft pillar-like elevations up to 2-3 mm in height, often disappearing spontaneously, especially after childbirth. Not studied histologically, they are classified by some authors as acanthomas (which is more likely), by others as soft fibromas of the naevus type. The group of W. should include: a) common W., b) flat, juvenile W., and c) W. (or condyloma) pointed.- Common W. (verruca vulgaris s. simplex), ranging in size from a pinhead to a pea, color of normal skin or grayish-yellow or grayish-peppery; in form it represents elevations, mound-like or flattened on the surface (finely granular or coarsely thread-like), hard to the touch, at the base round or somewhat angular. More often isolated, they can merge into an angular disc, the flat and thick horny covering of which often cracks, whereby the W. can become inflamed; this is especially characteristic of W. located under or around the nail. The usual localization is the back of the hand and fingers (see illustration), less often their palmar side; even less often - the face, eyelids, hairy scalp, etc. Usually one W. appears first - the "mother", which remains the largest; subsequent W. are smaller and sometimes very numerous. W. are more common in children and adolescents. Sometimes disappearing spontaneously, W. usually exist for months and years. Sometimes they are arranged linearly, arising on the site of a scratch. Often after the destruction of the "mother W." all others disappear spontaneously. The disappearance of W. from X-rays on one side causes their spontaneous disappearance on the opposite side. Clinical variety: Plantar W. (v. plantaris) - common W. on the sole, large and covered with an especially thick horny layer, wherefore patients mistake it for a corn. Always few in number, they are located isolated under the heads of bones, which makes them very painful when walking. Removal of the horny covering reveals a series of characteristic thread-like pillars.--Flat (juvenile) W. (v. plana juvenilis) - a variety of verruc. vulg.; differs by a special tendency to dissemination, spontaneous disappearance after several months or years, and small size; characterized by a flattened shiny surface, often polygonal outlines and yellowish-brown coloration. Often exists alongside common W. and later can transform into them.-Pointed W. (or condylomas) - well-known, resembling rooster combs or cauliflower heads, verrucous small growths, juicy and moist, pink or flesh-red in color, with a tendency to multiply, grow and coalesce. Located, mainly in men in the preputial groove, on the frenulum, inner leaflet of the prepuce, less often on the urethral lips and in the navicular fossa; in women they are especially large and numerous, occupying mainly the area of the external genital parts and adjacent parts, less often the cervix; sometimes observed at the anus, in the armpits, on the oral and laryngeal mucosa. Sometimes reaching enormous sizes, they can perforate the preputial leaflet in women and serve as an obstacle to sexual and sexual intercourse. Moisture, friction, uncleanliness - essential conditions for their growth and multiplication; therefore in sweaty, seborrheic, suffering from prolonged discharges from the genital parts, anus, these W. are especially numerous and large. Due to local conditions (friction and maceration), histologically they differ from common W. by the thinness of the horny layer, the interrupted granular layer, colossal acanthosis and papillomatosis, with tree-branching papillae and large vessels. In initial forms they are completely identical with simple or flat W. The X-cells (Unna) characteristic of pointed W. are present only in intensely proliferating condylomas. The gangrenous transformation described by some authors is rare. Usually observed during sexual maturity, they are equally rare in children and the elderly. Treatment. For few simple W., external means are indicated: excision, galvanocautery, electrolysis, solid carbon dioxide or chemical cauterizing and reducing medications. Juice of fresh celandine, trichloroacetic or chromic acid. For periungual W., the best treatment is radium. For numerous simple or flat W., internal means - large doses of magnesium salts, lime water or arsenic, mercuric iodide (2-3 times a day 0.01) or X-rays. For plantar W. - solid carbon dioxide or moxibustion, excision of the superficial layer and application of chromic acid. For pointed W., internal means are powerless. Locally - cleanliness, drying, galvanocautery, ferric chloride or trichloroacetic acid.