Warts

Warts (medical name acrochordons) are painful benign skin lesions in the form of bumps, known for thousands of years. The term warts is a clinical term that refers to spots that generally develop on the skin or mucous membranes and are caused by the human papillomavirus (HPV). In the popular language, ants are called µαντραβίτσες or γαρδαβίτσες.

Because the infections caused by the HPV virus are many, in the Greek and international literature, they are distinguished into:

• Infections of the skin of the hands and feet, called warts or verrucae
• Infections of the mucous membranes of the penis, anus, and vulva, which constitute a venereal disease and are called condylomas

It is best not to confuse these two dermatological diseases because different types of HPV cause them.

Rationale
Ant virus, known as Human Papilloma Virus (HPV), belongs to the papovavirus family. Its core consists of double-stranded DNA enclosed in an icosahedron capsid of 72 capsomeres. Modern research methods, particularly DNA hybridization, have so far isolated 55 types of HPV viruses, which cause a wide range of diseases.

Epidemiology
The disease is contagious. The transmission of the disease occurs mainly by direct contact or indirectly with shared objects or after using shared spaces, e.g., public baths and swimming pools. Small cuts of the skin may be necessary to inoculate the virus. This explains the frequent location of ants in areas that usually suffer injuries (extremities of hands, legs of legs, knees) and the Koebner phenomenon (appearance of skin lesions along linear wounds). It was experimentally shown that the incubation time of ants ranges from 1 to 20 months, with an average of 4 months.
Warts are distinguished into common, smooth, and plantar, depending on the clinical picture and location.

Common warts (verruca vulgaris)
They are mainly due to the HPV2 virus and less often to HPV 1, 4, 26-29. They are surrounded by hard appendages with an irregular hyperkeratotic surface, varying in size. They are selectively located on the dorsal surface of the extremities of the hands and feet but also on the knees, shins, etc. They are usually asymptomatic unless located on the paronychia or onyx bed, which is painful and may cause onychodystrophy. Common warts are painless and benign skin bumps made up of a hard core of skin. The common ant is in the form of a hard lump with an uneven surface that resembles a cauliflower. Ants can be round or irregularly shaped, flat or bulging, and can reach the size of a pea. They can be white, gray, or brown. Common warts usually develop around the nails, fingers, and back of the palm but may also appear on the knees and face, especially where the skin has been torn.

Flat warts (verruca plana)
They are caused by the HPV3, HPV10, HPV26-29, and HPV41 viruses. They are flat or slightly raised papules with a smooth surface, usually 1–5 mm in diameter, of normal skin color, fawn-yellow or fawn-black. They are located on the face, back of the hands, shins, and forearms and are few or numerous. Koebner phenomenon is more common than in common ants.Early-stage smooth ants have a smooth, flat surface and are only a few millimeters in size. They look like a skin-colored or light brown bump. They grow in large numbers, from 20 to 100 at a time. They can appear anywhere, but they usually appear on the face of children. In adults, they typically appear on the chin and cheeks in men, while in women, they appear on the calves. Irritation caused by shaving may be responsible for this.

Plantar warts
HPV1 and HPV4 cause them. They are located on the soles of the feet at the points of support and are usually very painful with walking and simple pressure. They typically appear on the plantar surface of the heel but also on its sides. They have an irregular hyperkeratotic surface dotted with black dots, which correspond to clotted capillaries (and not, as many believe, to the "roots" of the anthill). When multiple warts congregate in a large plaque, they are called a "mosaic wart" and are resistant to treatment. When many ants are gathered together, the area swells (becomes edematous), and the patient does not even tolerate palpation. Using X6 to X10 magnification on clinical examination to document the diagnosis is best. Calluses occur only on the soles of the feet, are very sensitive, and are recognized by how they interfere with normal tissue of the skin. Their surface is uneven, swollen, spongy, thick, and scaly. Foot ants can be brown or gray (with a dark center), unsightly, and often very painful if left untreated. They are usually larger than common warts and flatter due to the pressure exerted on the sole when walking. They often develop under the most pressure points, such as the heels or the football.

Treatment of ants
There are several methods for treating warts. Recurrences usually occur after incomplete treatment. An indication of a complete treatment is the reappearance of normal skin folds in the area. In most cases, a treatment of at least 2-3 months is required.
The therapeutic method that a dermatologist will choose must not involve risks for the patient, leave no scars and cause the least possible pain and the fewest side effects

Treatment methods for ants include:

• Topical keratolytic: salicylic acid remains the simplest, most effective, and safest treatment when properly used. A combination of salicylic acid and lactic acid is often used to treat ants and is contraindicated in the case of localization on the face and the anus. Chlorogenic acid is also keratolytic but causes large, hard-to-heal wounds (craters) and inflammation.
• Cryopexia: Cryotherapy with liquid nitrogen is an excellent therapeutic method, especially for common and normal ants, especially on the face. The result is best when combined with keratolytic to remove hyperkeratosis, which acts as an insulator. Usually, 2-3 sessions are required, spaced three weeks apart.
• Electrocautery (electrocoagulation): It is a good method for small ants but not for large ones because it leaves a crater that takes time to heal.
• Laser cauterization: useful for large warts.
• Surgical removal: It is useful for large ants, especially on the sole.