Flat warts: causes, symptoms and treatment

1. The main causes of flat warts
2. Symptoms characteristic of flat warts
3. Diagnostics
4. Treatment
5. How to treat a flat wart using traditional methods
6. Drug treatment of flat warts

Flat warts are benign formations on the surface of the skin that occur in only 4% of patients seeking help from dermatologists. This is actually very little, considering that about 90% of the world's inhabitants are carriers of HPV - the human papillomavirus. It enters the body through injured areas of the skin (scratches, cuts, etc.), and then integrates into skin cells, changing and deforming them. The affected cells begin to rise above the skin, as the superficial layer of the dermis grows greatly. This occurs due to the growth of tissues that lie underneath and consist of the papillae.

Unlike other papillomas, flat warts do not have a tendency to degenerate into a malignant tumor. They rise above the surface of the skin by only 5 mm and have a flat outline. As a rule, the number of such skin formations is multiple, and the place of localization is the face, the back of the hands or lower legs. The formation of such papillomas is provoked by HPV types - 3, 10 or 28, 49. Children, adolescents and young people usually suffer from flat warts, which is why they are often called youthful or juvenile warts.

Today, medicine offers several methods for getting rid of flat warts, but it is important to correctly diagnose and prescribe appropriate therapy.

The main causes of flat warts

As mentioned above, this disease manifests itself due to infection of the body with HPV. This usually occurs as a result of direct contact with a carrier of the virus or the use of things of a person suffering from such skin problems. Direct contact includes shaking hands, hugging or kissing, but you can also become infected by touching handrails or railings, door handles, library books or elevator buttons and other common objects. In this case, the playing factor is damage to the skin (scratches, cuts, hangnails, etc.) or the mucosal surface.

Often, infection occurs in childhood and is characterized by slow development (persistence), without manifesting itself in any way. Despite this, the infection is almost impossible to remove. Only when “favorable” conditions are created does the virus begin to damage skin cells, resulting in the formation of flat warts.

Factors that activate HPV are:

1. a general decrease in the immune background, which is typical for adolescence;
2. fear or severe shock;
3. chronic stressful condition.

Often, even after successful treatment of flat warts, relapses occur. All this happens due to the fact that HPV is constantly in the human body and when papillomas are removed, the very source of their appearance is not eliminated. If the skin nodule is constantly exposed to injury or the chosen treatment method was incorrect, there is a possibility of self-infection with the papilloma virus. In this case, flat warts affect areas of healthy skin.

Symptoms characteristic of flat warts

The photo shows multiple flat warts

This formation only rises slightly above the skin; it has the shape of a rounded nodule or wart, but may have irregular outlines. The surface of flat warts is smooth, and the skin pattern is completely absent. Their distinctive feature is that in such skin nodules there are no processes of keratinization of the skin next to the papillomas. Flat warts have a healthy skin color ranging from pink to light brownish. Since their sizes are small (no more than 5 mm), they are slightly visible above the epithelium.

The places where flat papillomas spread are considered to be: skin of the face (forehead, cheeks or chin), lower legs or arms (forearms or back of the skin on the hands). Even if you press on such a papilloma, it will not cause pain, itching or burning. If a flat wart is detected, then several more such papules can be seen nearby; they are usually located at a distance from each other and do not tend to merge into one large tumor, like other varieties. There are practically no symptoms by which patients can recognize that they have flat warts. However, often their formation is a clearly visible cosmetic defect, so young people experience psychological problems along the way, especially if the location is on the face. Occasionally, flat warts are found due to the fact that the patient notices mild itching of the skin.

Due to the visible defect, patients often take measures to remove papillomas on their own. However, such self-medication methods do not always end successfully and lead to a worsening of the clinical picture of the disease. For example, they provoke heavy bleeding at the site of wart formation. Infection can penetrate into such wounds, resulting in the spread of warts to healthy adjacent parts of the skin.

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Diagnosis of flat warts

Photo of a girl’s cheek being heavily affected by flat warts

Usually, with such a problem, it is recommended to consult a dermatologist, who, after a visual examination, can make the correct diagnosis or additionally prescribe dermatoscopy - examination of papillomas without surgical intervention. If necessary, a study of the cells of the affected skin (biopsy, that is, a tissue sample) is carried out, which is recommended to be performed after removal of a flat wart, which can provide 100% confirmation of the previously made diagnosis.

Often, a polymerase chain reaction (PCR) test is performed to determine whether a patient is actually infected with HPV. This method allows you to diagnose a large number of different infections based on the study of human DNA and RNA. To identify the possibility of degeneration of flat warts into cancerous tumors, it is recommended to be examined to detect those types of HPV that are responsible for a high carcinogenic risk.

Basically, differential diagnosis of flat warts is carried out, making it possible to exclude them based on certain factors or symptoms. For example, juvenile warts differ from ordinary or vulgar warts in that their surface is denser and their size is smaller. Thread-like papules are characterized by the possibility of growth, which is not the case with flat warts, and plantar skin nodules are never found in areas where juvenile warts are usually localized. Such papillomas will never appear in the groin area or on the genitals.

Depending on how many flat warts were detected on the patient’s body, the following degrees of damage are divided:

1. easy - there are no more than two flat papules;
2. average - 10-100 flat warts over the entire surface of the body, but no additional symptoms are observed;
3. heavy - more than 100 papillomas, and the skin nodules become painful.

As for the location, there is no clear classification visible here.

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Treatment of flat warts

Today, medicine offers several methods with which you can get rid of flat warts. However, since they can form on the face, some of the methods are not used to avoid leaving scars. Also, after consultation, a dermatologist may prescribe a course of antiviral or immunomodulatory drugs.

Among the surgical methods for removing flat warts are:

1. surgical excision of papilloma;
2. electrocoagulation;
3. cryodestruction;
4. laser coagulation;
5. "radio wave knife"

The first two methods are practically not used to remove flat warts in the facial area (cheeks, chin), since they are the most traumatic for the surface of the epithelium and leave behind clearly visible scars even when cosmetic sutures are applied to the wounds. The use of liquid nitrogen during cryodestruction is also not suitable, since the process freezes fairly deep layers of the skin and the marks from warts resemble small burns, after which residual marks are possible.

But in other places where flat warts form, these methods can be used for treatment and therefore more about them:

1. Surgical method allows you to use a scalpel to cut out a flat wart, while a small capture of healthy tissue occurs. It is prescribed only when it is necessary to take parts of the papilloma for examination for the presence of cancer cells. After the procedure, a cosmetic suture is applied to the wound. Rehabilitation after surgery is longer, the effectiveness is also low and is only 50–60%. There is a high risk of relapse - up to 50%. The price for removing one papule starts from 350 rubles.
2. Electrocoagulation is almost the same excision of a flat papule, but instead of a simple scalpel, a coagulator loop is used, to which a high-frequency current is applied. Using such a loop, the surgeon simply cuts off the wart, leaving a wound in its place. The method has a higher efficiency compared to surgical excision - 80-95%. The cost of removing one flat wart starts from 500 rubles.
3. Cryodestruction has proven itself to be excellent due to its high efficiency (70-100%). However, relapses occur in only 15% of patients. Cauterization of the papilloma occurs by applying liquid nitrogen to its surface. A dermatologist uses a cotton swab attached to the end of a wooden stick, or a special cryoapplicator. The effect on the wart is carried out for 10-30 seconds. Due to the fact that tissue freezes at a deep level of the skin, the papule becomes dense and turns white. In its place a bubble appears, resembling a microburn. After a week, the crust covering this area gradually begins to dry out, and after 14 days it comes off, revealing a spot of healthy light pink epithelium. Even after the wart site has healed, a small indentation may remain. Removal of one papilloma will cost from 300 rubles.

Now about the methods that are clearly applicable for removing flat warts on the face:

1. Laser coagulation - a procedure in which you can set the depth of skin tissue for exposure to a laser beam. Under the action of the laser, the layers of the flat wart are burned out and they begin to evaporate. The crust that remains after the procedure at the site of the papule is separated after 14-30 days. It takes a doctor a few minutes to remove one wart. The effectiveness of this method is 93%. The price for removing one papilloma starts from 140 rubles.
2. Radio wave method also makes it possible to regulate the penetration to the optimal depth of radio waves, which are obtained by converting electric current with the Surgitron apparatus. The frequency of the radio wave method is 3.8-4.0 MHz. Usually, no blood is released during the manipulation, which is why it is called a “radio wave knife.” With a fairly high efficiency of removal of flat warts, the possibility of relapse is reduced to 2-5%. The price of the operation starts from 600 rubles.

If we talk about complications that are inherent in even the best methods of removing flat warts, then these are:

1. resulting burns on the skin;
2. remaining scars after removal;
3. The wart tissue is not completely removed and this provokes its subsequent growth.

It is important that the doctor who deals with diagnosis and subsequent treatment is highly qualified. This will minimize the risk of complications. However, none of the methods provides a 100% guarantee that flat warts will not reoccur. This is due to the fact that HPV is permanently embedded in the genes of skin cells and, in the presence of stimulating factors, can appear again. If antiviral therapy is administered after wart removal, the infection goes into a “dormant” (latent) state, and therefore the risk of relapse is reduced.

How to treat a flat wart using traditional methods?

Since flat papillomas mainly occur in children or young people under 20 years of age, they often disappear on their own over a certain period (sometimes several years). However, due to their location on the face, such warts can cause psychological problems. In addition, if skin nodules are subject to constant trauma, they can begin to spread to healthy areas of the epithelium.

In folk medicine, there are many methods for treating flat warts, among which the most popular are:

1. Treatment of flat warts with ice. Boiled water is frozen. A piece of ice is wrapped in gauze and pressed against the papilloma for 7–10 minutes. Instead of water, you can use a decoction of thyme leaves, chaga mushroom, and celandine stems. Repeat the procedure until the skin formations completely disappear.
2. Using garlic paste. You can use peels from fresh bananas here. A banana peel is cut into small pieces and, after putting garlic pulp on a white layer, it is applied to the flat wart. Such applications are carried out overnight until the papules disappear.
3. Juice from sour varieties of apples (you can take an unripe fruit). For 1-2 weeks, it is recommended to lubricate the skin lesions with liquid, especially if they are on the face. You can also replace apples with apple cider vinegar.

Drug treatment of flat warts

You can use drugs only after consultation with a dermatologist, since many of them have a keratolytic effect and contain caustic acids:

1. Solcoderm (price from 401 to 1,489 rubles) contains a caustic substance that has a necrotizing effect on the flat wart, as a result of which it is rejected on its own. However, during use, burning, tingling and pain at the cauterization site may occur. Instructions for use are described here.
2. Cryopharma for warts (price from 914 rub.) is used for cryodestruction at home. The method is the same as when using ice yourself, but in this case, removal (freezing) of a flat wart can be achieved faster.
3. Ointmentscontaining salicylic acid (the price of salicylic ointment starts at 21 rubles). The substance ensures necrotization of flat wart tissue. The tissue of the growth begins to gradually die, while the skin is minimally injured. Ask your pharmacy for the following ointments to remove flat warts: salicylic ointment, oxolinic ointment, Panavir gel, Vartox paste (a safe means of removing warts on the face, hands, feet, plantar formations on the feet).
4. Collomak (price from 311 rubles) has a keratolytic effect, and also has an anti-inflammatory and antiseptic effect. The product disinfects the wound and prevents the spread of HPV to healthy tissues, and has a preventive effect. Read carefully the contraindications for Collomac.

Video about the treatment of flat warts:

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