The Worrisome Wart
Two of the most common skin conditions seen in children are warts and skin tags. Despite the old wives' tale, children do not catch warts from touching toads; however, warts are contagious.
Warts are caused by the human papillomavirus, or HPV, which is spread among children through casual contact with others and with infected surfaces. HPV has many strains, and the strain determines the type or location of the wart. Children and tweens generally get what are known as "common warts," and the risk of these warts decreases with age as the immune system gets stronger. (Note: One strain of HPV can cause genital warts in teens and adults who are sexually active.)
Leave it Alone or Burn it Off?
Typical locations for warts include feet, hands and faces, but warts can appear almost anywhere on the body. Usually a wart is just an unsightly annoyance, but, if the wart is located where clothing or shoes chafe it, it may grow inflamed or become infected.
A healthy child's immune system often will make a wart go away within two years of its initial appearance without any additional treatment. HPV, however, remains life-long in the body, usually in its dormant state. Since there is no cure for HPV, most treatments for warts are intended to provoke the body's immune system. Such treatments irritate the skin within and around the wart, thus alerting the body's natural defenses to that part of the body. The immune system can then eliminate the wart while healing the normal skin around it. Sometimes multiple treatments are necessary to eradicate the wart, and sometimes warts reappear or develop in other places, since the virus remains in the body.
Common wart treatments include salicylic acid and cryotherapy. Salicylic acid wart treatments available over the counter contain less than 17 percent salicylic acid. These medications often are used first by families due to easy availability and low cost. If the wart remains intact after home treatment, your physician may prescribe a higher percentage formulation of salicylic acid or recommend a more intense treatment strategy.
Cryotherapy involves a physician freezing the wart with liquid nitrogen or a similar chemical. Multiple freezing sessions throughout several weeks produce the best results. Stubborn warts may require shaving of the superficial layers before cryotherapy is done.
Another approach to treatment involves placing a piece of duct tape on the wart at night, then lightly rubbing it with a pumice stone the next morning. This treatment may need to continue nightly for a month. If a wart still remains a problem, referral to a dermatologist for other treatments may be necessary.
The Harmless Skin Tag
Skin tags are benign growths of skin. They can appear anywhere, but they most commonly grow in skin creases, such as the neck, armpit and eyelid. Skin tags may be present at birth, but can develop as a child grows older. Most skin tags are little more than nuisances and can be left alone, but if they change in color or appearance, alert your family's health care provider. If a skin tag is bothersome or embarrassing to a child, it easily can be removed by the child's physician. Common removal strategies include surgical excision, cryotherapy or cautery.
Skin tags and warts, though sometimes a source of embarrassment, usually pose no serious risk to a child. If the wart or skin tag is bothersome, discuss treatment options with your physician. Otherwise, consider the wart or skin tag harmless, and use it as an example that beauty is more than skin deep.
Dr. Shipp is a pediatric resident at Levine Children's Hospital. Dr. Neuspiel is a general pediatrician at CMC: Myers Park Pediatrics and director of ambulatory pediatrics at Levine Children's Hospital