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Interviewer: Warts are common, but there can be a lot of confusion about what causes them, how to treat them, and when to worry about them. Dr. Luke Johnson is a dermatologist with 麻豆学生精品版. Are you ready to talk about warts?
Dr. Johnson: I was born ready, Scot.
Interviewer: This is going to be the highlight of your day, I bet, isn't it?
Dr. Johnson: One hundred percent.
Kids Get More Warts Than Adults
Interviewer: All right. Well, today we're going to talk about some of the ways that people try to remove warts, the real causes, and what actually works.
So my first question is, do you see a lot of patients for warts? Is this something you see a lot, or how would you gauge that? How would you quantify that?
Dr. Johnson: I would say yes. I assume it represents the number of people in the population who have warts. I'm a pediatric dermatologist by training. I see kids and adults, and I would say I see more kids with warts than adults with warts, but they both have them.
Interviewer: And why do you see more kids, do you think?
Dr. Johnson: I think warts are more common in the pediatric population. And it might just be that, in dermatology, the adults who come in usually come in because they're worried they might have skin cancer, and that's not an issue for kids. So there's just less other stuff they might come in for.
When to Take a Wart Seriously
Interviewer: You mentioned that they might come in because they're afraid that it's skin cancer. Is there a type of wart that people should come in for?
Dr. Johnson: Well, adults just come into the dermatologist because they are worried that they might have skin cancer and not know it, or they have something in particular that looks funny. Not that they necessarily think they have a wart, and they're worried it's skin cancer.
But to answer your question, most of the time, warts are not a big deal. But if you have other medical issues, especially if your immune system doesn't work right and the wart is allowed to go haywire, then it can turn into a skin cancer called squamous cell carcinoma.
So if you are someone like that, or you know people like that, and they have something that looks like a wart, and it's not acting like a wart, it should probably be evaluated.
Interviewer: All right. So, have you ever had a wart yourself before or after becoming a dermatologist?
Dr. Johnson: I will answer that question if you first tell me if you have ever had a wart, Scot.
Interviewer: Yes, I have. I've had, not a lot, but I've had two or three. I think I might have one right now on the bottom of my foot, but I'm not sure.
Dr. Johnson: I appreciate your candor. Maybe somebody should look at it.
Interviewer: All right. I'll talk to your people. How's that sound?
Dr. Johnson: Well, I have had a few. I remember having them as a kid, and I went to a doctor, and they "froze them off," and then nothing for most of my life. But when I was in dermatology school, or residency, as we call it, I did have a wart on my foot that I treated myself. So I understand how it is on the patient side.
The Truth About Wart Treatments
Interviewer: Now, how did you treat that? Did you freeze it off?
Dr. Johnson: There are a lot of different treatments for warts. This is what I tell my patients. None of them is considered the best. And whatever we do for warts, we usually have to do it over and over again for three to five months until the average wart goes away.
Interviewer: They're stubborn.
Dr. Johnson: They are. So freezing them, the medical term is cryotherapy, is fine. It works okay. You just have to, again, do it over and over again. So we usually have patients come back into our office every two to four weeks, and we tell them to expect three to five treatments before the average wart will respond.
Interviewer: All right. How did it feel? Did it hurt? Did it not hurt? Also, did it change kind of how you think about warts as a doctor treating your own?
Dr. Johnson: It hurt. I hated myself afterward.
Interviewer: Oh, so it is a little painful, the treatment?
Dr. Johnson: Everybody's experience is different, but it was certainly painful for me. It could be that I'm a wimp, or I just froze myself really hard. It was swollen and achy afterward, and I had to keep my foot elevated. It was kind of miserable.
And so the next treatment that I gave myself, I first injected my wart with lidocaine, which we have lying around all over the place in the dermatology clinic because we numb people before we biopsy their skin, for example. It numbed it up, so I didn't feel it. But I had injected so much lidocaine into my foot that, in addition to affecting the pain nerves, it affected the motor nerves, and then I couldn't move my toe afterward.
Interviewer: Oh, man. All right.
Dr. Johnson: Until the next morning.
Interviewer: And you've gotten better at this, right, since then?
Dr. Johnson: Well, no promises.
Interviewer: All right.
Dr. Johnson: But I've had more practice.
Interviewer: But these are all things that if a patient came in, they might experience. It sounds like maybe it's a little bit not an exact science?
Dr. Johnson: There certainly have been studies about the best treatments for warts, but again, none of them are considered the best. Freezing them is a reasonable thing to do. There are injections, so we can do shots into the warts if that's better for you for one reason or another.
The over-the-counter stuff that you can put on your warts probably works. You just have to be really diligent with it, and do it over and over again, every night, for three to five months before you can expect the average wart to go away.
What Causes Warts?
Interviewer: When I was younger, and I had my first wart on my foot, that's what I did. I used those little pads, I think they are, little medicine-treated pads. Does that sound like something I could've done?
Dr. Johnson: Yep.
Interviewer: Yeah, you had to put it on there a lot. And I remember towards the end of the treatment, I noticed these little black things in there. Was that the root of the wart? What was that?
Dr. Johnson: It was probably little thrombosed blood vessels. Some people call warts seed warts, but there's really no such thing. Or perhaps, they're all seed warts in a way, because they're contagious. But the little dark dots inside are little thrombosed capillaries.
Interviewer: And I seem to remember it went deep. Is that possible, or are warts not something that goes deep?
Dr. Johnson: They don't go that deep. They're a virus. Warts are caused by the human papillomavirus, HPV. If it sounds familiar and scary, there are some types of HPV that can cause genital warts and can even lead to things like cervical cancer. But the run-of-the-mill warts that we get on our hands and feet are caused by other HPV types. And because they're caused by a virus, they're contagious. The HPV virus infects the top layer of the skin.
Interviewer: And where do people generally get warts? We've talked about feet. Are there other places, and are there some places that are riskier than others to get them more likely?
Dr. Johnson: For the HPV virus to cause a wart, it has to get into the bottom layer of the top part of the skin. And so if your skin is fully intact and you come into contact with the virus, then you will not get a wart, because your barrier is intact. But if you have a little injury . . . Oftentimes, there are things we don't even know we have. We call them microabrasions, for example. If the virus can get there and to that level, then it can cause a wart.
And there's wart virus sort of all over the place. So the places where people will get them more commonly are the places of their body that touch stuff. So hands and feet are probably the most common.
How Are Warts Spread?
Interviewer: Okay. And they are contagious, right? Obviously.
Dr. Johnson: They are. They're not all that contagious because of the reasons that I mentioned, but they certainly are. So even though they're not dangerous for most people, the worst thing that can happen is they can spread, including to yourself, especially if you're picking at them or something. So don't pick at your warts.
Interviewer: Oh, okay. Is there a weird or unexpected place that you saw somebody get a wart in your profession?
Dr. Johnson: I don't think they're weird, but sometimes patients are surprised when I tell them that thing on their face is a wart.
Interviewer: Wow. Really? That probably doesn't happen that often, though, because . . . Well, I guess you touched it with your hand and then scratched your face and you had a little abrasion in your face. That's how that happened, right?
Dr. Johnson: Probably. We see this more commonly in kids. So if I have a patient on my schedule who's a kid and it says, "Skin tag on face," for example, it's likely that it's actually a wart.
Interviewer: All right. And if it did come in contact with your hands, if you're a hand washer, does that kill it, make it less likely that it would go to your face?
Dr. Johnson: Yes. When my kids go to the pool . . . So, pool decks are ideal ways to pick up warts. They're often spiky, so they cause these little microabrasions. People are walking around in bare feet, and they might have warts. You'll tread over their wart virus and then get it yourself. So I often will put hand sanitizer on my kids' feet after we're done with the pool for the day.
Interviewer: Oh, wow.
Dr. Johnson: I call it foot sanitizer.
Interviewer: I've heard that getting them in the shower is something that can . . . When I was in college, you were supposed to wear flip-flops to the shower. It sounds like you should be wearing flip-flops around the pool deck, too, probably.
Dr. Johnson: Yeah, probably. I wear flip-flops when I'm showering in public showers for this very reason.
Interviewer: All right. So I briefly mentioned it at the beginning, but are warts dangerous beyond the kind of one that might develop into skin cancer, or is it something that you don't really necessarily have to treat?
Dr. Johnson: So, for almost everybody, warts are not dangerous. If you do have a problem with your immune system, they can be. And then there are these subtypes of genital warts that can cause certain types of cancer.
Also, warts mostly go away on their own. In kids, anyway. In adults, it's less certain. But they can persist for years before they go away. But leaving them alone is very reasonable.
Interviewer: And is it possible that they might kind of just show up and then not grow bigger? I feel like the one I have on the bottom of my foot right now really isn't growing any bigger. It just kind of came out, and there it is.
Dr. Johnson: It's definitely possible. They're unpredictable. Sometimes they grow and spread. Sometimes they just sit there for years or decades.
Home Remedies That Work (and the Ones That Don鈥檛)
Interviewer: So, as far as home treatments are concerned, what about some of these hacks I've heard, like putting duct tape on my wart? Is that a way that I could treat it if I don't want to go to the store and buy the medicine?
Dr. Johnson: Short story is no. The longer story is that there was one medical study that looked like duct tape was effective, but nobody was able to repeat it. So it probably was a one-off sort of statistical outlier. It doesn't really work.
Interviewer: All right. So not something that's going to get you any benefit and probably just going to be a pain in the butt putting duct tape on the bottom of your foot all the time.
Dr. Johnson: Probably.
Interviewer: And what about . . . I mean, I kind of already know the answer. You alluded to this, but I'm going to ask it anyway. People who take a knife or nail clippers to it, trying to just cut it off, thinking that'll make it go away. Does that work?
Dr. Johnson: Well, cutting it out, probably not because you're not going to get deep enough. But a lot of warts can get this dead skin on top, which most of us probably have seen. In medical terms, we call it hyperkeratosis. And you have to get that stuff off for the medicine to work.
So if you're going to treat your wart with some of these at-home products, sort of paring it down, as we say, with something like that is a reasonable thing to do before you put the medicine on.
Interviewer: But be careful, right? So you don't start spreading it to the rest of your body when you're doing that process.
Dr. Johnson: Right. So, sometimes we recommend you use a nail file or an emery board that you don't use for any other purpose. You don't want to draw blood on yourself. You just want to make it thin so the medicine can work.
Interviewer: So, have you heard of any other remedies that people try, other than duct tape or just clipping them off or something like that?
Dr. Johnson: So the most out-of-the-box experience that people have told me they have tried was when I was a fellow in Oregon. So that could have colored the sort of people that I might run into. It was using what they called stump water. So to get stump water, first you have to have a tree stump, and then it has to rain overnight. And if there's a full moon, then the rainwater that collects on the stump is stump water, and it might have mystical properties. It doesn't seem that taking care of warts is one of them, though.
Interviewer: There's no research to back stump water?
Dr. Johnson: Not to my knowledge.
The HPV Vaccine Can Help Prevent More Than Just Genital Warts
Interviewer: All right. I think we covered it, man. Are you fulfilled? Do you feel as though that we . . . You said you were born ready to talk about warts. Do you feel complete?
Dr. Johnson: No. I want to talk about one more thing, the HPV vaccine. So this is a vaccine that is approved for people of all genders, ages 9 to 45. And it was developed to prevent genital warts of certain strains, which can cause cervical cancer. But there's some medical research that says it can help prevent or treat more run-of-the-mill warts as well.
So if you're looking to prevent them or even treat them, and you're aged 9 to 45 and you haven't had this vaccine, I think it is a great idea. The brand name is Gardasil. You don't need to get it from a doctor. You don't need a prescription. You can just roll up to a pharmacy and request it.