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The Canadian Skin Patient Alliance

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Skin Patient Charter

We are very proud to release the first ever charter specifically for patients living with conditions, diseases or traumas that affect the skin.

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June 21st, marks National Indigenous Peoples Day, a day to recognize and celebrate Indigenous peoples across Canada. We honour their vibrant culture and traditions by sharing this article on Indigenous Skin Healing.

Indigenous Skin Healing

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We are proud to recognize Dr. Jerry Tan as the 2018 Dermatologist of the Year. Thank you for all you do for skin patients in Canada.

2018 Derm of the Year

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The staff and Board of the CSPA would like to thank Barbara-Anne Hodge for her many years of service with us. Barb has been part of the CSPA since almost the beginning, and has served in many positions including as our Past Chair. Her term on our Board has come to an end and wish her the very best in her future projects!

Thank you!!

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If you are living with warts or know someone who is, you may want to stay up-to-date on the condition as well as current treatments and news.  

Other Resources

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Only a physician can confirm whether or not you have warts, so if you experience any wart-related signs or symptoms, visit your doctor. Some skin growths that may resemble warts are actually moles, corns, calluses, skin tags, or even skin cancer. It is particularly important to seek help if you suspect that you have genital warts because they are sometimes linked to cancer.

Your physician will perform a physical examination that consists of a visual inspection, sometimes with a special magnifying instrument called a dermatoscope. Occasionally, a biopsy of the lesion will be performed if the physician is uncertain of the diagnosis. Women with genital warts may also undergo a Pap test to make sure they have no signs of cervical cancer.

Although warts can sometimes disappear without treatment, many people choose to treat their warts if they are unsightly, start to spread, or make them feel uncomfortable. Talk to your doctor about whether treatment is appropriate and, if so, which treatment is right for you.

Lifestyle Changes and Skin-care Strategies

Non-genital Warts

If you develop warts, you can make several lifestyle changes to help them heal properly and prevent them from spreading:

AVOID

INSTEAD

  • Brushing, shaving or clipping areas with warts
  • Biting fingernails if warts are near them
  • Picking at warts
  • Touching warts
  • Use different nail clippers or files for nails with warts and healthy nails
  • Keep hands as dry as possible
  • Wash hands after touching warts
  • Cover a child's warts with a bandage to discourage picking


Genital Warts

You can change your lifestyle to prevent the spread of genital warts once they occur:

AVOID

INSTEAD

  • Having multiple sexual partners
  • Having unprotected sex
  • Use a condom during sex, but be aware that condoms may not cover the entire affected area
  • Disclose to your partner that you have genital warts
  • Recommend that your sexual partner be checked for warts by a physician


Medical Treatments

Most wart treatments are topical. Some treatments can be carried out at home, and some must be applied by a doctor. They each use a different chemical to achieve the same thing; to kill the wart cells, causing them to peel and fall off. Treatments are also available to help your body’s immune system attack the wart cells. The type of wart treatment you will use depends on what type of warts you have.

Topical Treatments

Cantharidin and cantharidin combination products cause skin to blister and peel off. They are used by doctors to remove external genital warts (i.e., warts on the penis or the vulva). They are available alone and in combination with other wart-removing agents (salicylic acid and podophyllin). These products can damage healthy tissue if not applied properly. These and most other topical treatments for warts cause some local pain or blistering where they are applied.

Imiquimod is a prescription immune-response modifier that causes your body’s normal immune defences to attack the wart. It is provided as a prescription cream and can be used to treat external genital warts (i.e., warts on the penis or the vulva) and warts near the anus. It is also used for other kinds of skin conditions (cancerous and pre-cancerous skin growths). For genital and perianal warts, imiquimod is usually applied at bedtime and used three times per week for up to 16 weeks, while other formulations of it are applied every night until clear. You should not apply a bandage over the cream, but you may apply a cotton gauze pad to the area. Some people experience long-term changes in skin colour (lightening or darkening) in the treated area. If you experience serious irritation following treatment, you can discontinue imiquimod for a few days and then resume treatment when the reaction subsides. Most people experience some inflammation, reddening and irritation in the treated area. Uncommonly, some women have difficulty urinating as a result of the inflammation.

Liquid nitrogen (cryotherapy) is one of the most common treatments for warts. Extremely cold liquid nitrogen is used to “freeze off” or “freeze burn” the wart, causing the cells in the wart to die and the wart to peel off. Liquid nitrogen is extremely dangerous to handle, and it must be applied only by a doctor. You may require regular repeated treatments to remove the wart completely, and occasionally treatment may cause some scarring after the wart is removed.

Podophyllin and podofilox (podophyllotoxin) cause skin cells, including those in the wart, to die and peel off. These preparations are used by doctors to remove external genital warts (i.e., warts on the penis or the vulva). Podophyllin is available alone and in combination with other wart-removing agents (salicylic acid and cantharidin).Your doctor will apply the first dose of podophyllin and will instruct you on how to apply the later doses, usually once or twice a day for up to three days, followed by at least four days of no treatment. If necessary, you may repeat this course of treatment (three days of treatment followed by four days of no treatment) for up to four weeks, on the advice of your doctor. When using podophyllin, apply it directly to the genital warts, using a layer of petroleum jelly to protect the surrounding skin. It will dry to form a film surrounding the wart.You should not use podophyllin if you are pregnant. This and other topical products for warts can damage healthy tissue if not applied properly.

Salicylic acid is one of several strong acids used to “burn off” warts. To use, first soak the affected area in warm water for five minutes and remove softened wart tissue with a washcloth or emery board. Apply the gel directly to the wart and allow it to dry and form a barrier around the wart. Treat once a day until the wart is cleared; if you develop any discomfort, take a break, and then restart as needed. This product and other strong acids must not be used near the eyes or mucous membranes. Salicylic acid can damage healthy tissue if not applied properly. If you have diabetes or any other condition that impairs your circulation, check with a doctor before using. In addition, salicylic acid is flammable and should be kept tightly capped and away from open flames.

Other strong acids (bichloroacetic acid/trichloroacetic acid) can be used to spot-treat warts. Bichloroacetic acid and trichloroacetic acid are used for several kinds of warts, including genital and plantar warts. To avoid risk of damaging your healthy skin, these treatments must be applied by your doctor. You may require repeated treatments to remove the wart completely.

Systemic Treatments

Human papilloma virus vaccine prevents infection from certain strains of human papilloma virus (HPV) that cause genital warts. HPV infection can eventually lead to cancers of the cervix, the vagina and the vulva. The vaccine is given to girls and women, ages 9 to 26 and more recently has also been approved in males. Vaccination requires three injections into the muscle of the upper arm or thigh: an initial dose and boosters after two months and six months. The vaccine can only be used to prevent HPV infection, not to cure it. Because it is not 100 per cent effective and only works on certain strains of the HPV virus, it is still important to avoid unsafe sexual contact. Women should continue to have regular gynecological exams and Pap tests, whether or not they have been vaccinated.

Other Treatments

Some medications are officially approved for treating other conditions/diseases, not warts, but they have been tried in the treatment of warts with variable success. Some alternative treatments and home remedies have also been studied in the treatment of warts, but evidence is limited or mixed. These treatments are included here for information only.

  • Prescription: Cimetidine, intralesional immunotherapy (e.g., interferon, bleomycin), 5-fluorouracil, epinephrine
  • Other: Laser therapy, aminolevulinic acid with photodynamic therapy infrared coagulation, duct tape coverage, surgical therapies (e.g., surgical excision)

Footnotes:

*All information on medical treatments on this site is provided as an overview only. For a complete and up-to-date list of side effects, warnings and precautions, read the product’s package insert and consult your doctor or pharmacist.
**If you are considering an alternative or complementary therapy, discuss it with your doctor first, and always be sure to keep your doctor up to date about any vitamins, supplements, or other forms of alternative treatment you are taking. Like any medication, alternative therapies can interact with other medications/treatments and, in some cases, have side effects of their own. Remember that “natural” does not necessarily mean “safe.”

The information in this section has been gathered from existing peer-reviewed and other literature and has been reviewed by expert dermatologists on the CSPA Medical Advisory Board.

Warts are small growths on the skin caused by the human papillomavirus (HPV). This virus invades skin cells and enters a resting period, called latency, that may last for months or years. During latency, the virus multiplies and invades additional cells, which then take on the appearance of warts. Although over 100 strains of HPV can infect any part of the body, certain strains tend to infect specific areas of the skin. There are six primary types of warts:

  • Common
  • Plantar
  • Flat
  • Filiform
  • Periungal
  • Genital

Warts are contagious and can spread through direct and indirect contact. Common warts are spread through activities such as nail biting, whereas plantar warts are often picked up from wet surfaces, such as shower stall floors and swimming pool decks. Flat warts are usually spread by shaving, and genital warts, which are highly contagious, are spread through sexual activity.

HPV infections can sometimes occur along with other uncommon disorders, such as epithelial hyperplasia (Heck’s disease), epidermodysplasia verruciformis or plantar cysts. Some strains of genital warts have the potential to cause cancer of the cervix, vulva, penis and anus.

Although warts frequently recur after treatment, many will disappear spontaneously within two to three years.

{jkefel title=[Fast Facts]}

Non-genital warts:

  • Approximately 65 per cent of non-genital warts disappear without treatment within two to three years.
  • Approximately 7 to 12 per cent of the general population is affected by warts.
  • Warts are more common in children. Approximately 10 to 20 per cent of school-aged children are affected.
  • In children, the incidence of warts peaks at 12 to 16 years of age.
  • Warts are twice as frequent in Caucasians as in those of African or Asian descent.
  • Both men and women are equally affected by warts. Up to 50 per cent of all men and women have been infected by HPV at some point in their lives.

Genital warts:

  • Genital warts are considered the most common sexually transmitted disease, affecting approximately 1 per cent of the population.
  • Both men and women are equally susceptible to infection.
  • Genital warts are most common in individuals aged 17 to 33 years of age.
  • It is estimated that 75 per cent of sexually active men and women will experience at least one genital HPV infection in their life.

{/jkefelend}

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Non-genital warts don’t usually have a major impact on quality of life. Aside from the pain caused by plantar warts, non-genital warts pose no physical threat or discomfort to otherwise healthy individuals. In addition, people with common, flat, plantar, periungal and filiform warts generally cope well psychologically with their condition even though large or multiple warts may be unsightly and cause embarrassment.

People with genital warts may feel shame at the social stigma of being diagnosed with a sexually transmitted disease, particularly if their family and friends react negatively to their condition or withdraw support. Fortunately, these attitudes and emotions usually fade over time. Some genital wart patients may also find it challenging to adjust their sexual habits to prevent spreading their disease. Professional counselling can help people work through feelings of shame or depression, and can help people develop strategies for altering their sexual practices.

 

The symptoms of warts vary depending on their location on the body.

Common Warts (hands/knees)

  • Skin-coloured lumps of 1 mm to over 10 mm in diameter with a rough, irregular surface

Plantar Warts (sole of foot)

  • Thick, scaly lesions or rough, spongy lesions with tiny dark spots inside
  • Smooth, brown or yellow-grey surface that is often flattened
  • On areas of pressure, such as the heel or ball
  • Can fuse together to form larger mosaic warts
  • Occasionally accompanied by foot pain

Flat Warts (face/hands/shins/knees)

  • Fairly smooth individual bumps of 1 mm to 5 mm in diameter
  • Can form groups of hundreds of bumps
  • Can spread rapidly as a result of everyday activities, such as shaving

Filiform Warts (nose/mouth/beard area)

  • Skin-coloured bumps with growths that look like threads sticking out of them

Periungal Warts (nails)

  • Rough bumps with an uneven surface and border
  • Under and around toenails and fingernails
  • Can affect nail growth

Genital Warts

  • Soft, moist, flesh-coloured bumps
  • On the vagina (inside and outside), cervix or anus in women; on the tip or shaft of the penis, on the scrotum or around the anus in men
  • Symptoms are often absent, but the condition is still contagious and can lead to complications

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