bubble_chart Overview

Warts are skin surface growths caused by a virus, with the disease name first mentioned in the Neijing. They are commonly seen in children and young adults, with an incubation period of 1 to 3 months, and can spread autonomously. The virus resides in the spinous layer cells, promoting cell proliferation and forming wart-like lesions. Common types include common warts, flat warts, molluscum contagiosum, and condyloma acuminatum. In traditional Chinese medicine, they are referred to as wart eye (verruca vulgaris), mouse nipple (molluscum contagiosum), wart eye (verruca vulgaris), thousand-day sore, scab sore, or regret sore, colloquially known as "hóuzi" or "jiāntóuròu."

bubble_chart Etiology

Traditional Chinese medicine believes that this disease is caused by insufficient yin blood, liver cervical malignancy with cachexia nourishment, disharmony of qi and blood, blood dryness generating dryness, tendon qi manifesting externally on the skin, or the invasion of wind-toxicity pathogens, obstructing the meridians, and accumulating in the skin.

Modern medicine considers warts to be viral skin diseases. Common warts, flat warts, and condyloma acuminatum are all caused by papilloma tumor diseases viruses. All three exhibit pathological changes such as hyperkeratosis of the epidermis, thickening of the spinous layer, and elongation of the rete ridges. Pestilence molluscum contagiosum is caused by the pestilence molluscum contagiosum virus (a member of the poxvirus family), with the characteristic features being the presence of molluscum bodies and degenerative changes within the epidermal cells.

bubble_chart Clinical Manifestations

Due to the different types of warts, the clinical manifestations vary:

1. Flat warts: Present as flat, raised lesions the size of rice grains or sesame seeds, with a smooth surface and light brown or normal skin color.
2. Molluscum contagiosum: Initially appears as rice-sized, hemispherical papules with a small white dot in the center, gradually increasing to the size of a mung bean, with distinct borders, hard texture, and a central depression resembling a navel. The color may be grayish-white, milky-white, slightly red, or normal skin tone, with a smooth surface. The number of lesions varies, ranging from a few scattered ones to several clustered together, not merging, and a white, cheese-like substance can be squeezed out.
3. Common warts: Initially appear as rice-sized, slightly yellow keratotic papules with a pinpoint red dot visible in the center, gradually increasing to the size of a mung bean, forming round or polygonal, papillomatous elevations with distinct borders, hard texture, and a rough, spiny surface in grayish-white, dirty, or dirty brown. The first lesion is usually solitary, remaining unchanged for a long time or increasing in number, with adjacent lesions merging together, and sometimes self-inoculation may occur.
4. For details on condyloma acuminatum, refer to sexually transmitted diseases.

bubble_chart Diagnosis

Based on clinical manifestations and pathological examination, the diagnosis can be confirmed.

bubble_chart Treatment Measures

(1) Internal Treatment:

1. Chinese medicinals for oral use: The treatment should focus on clearing heat and removing toxin, nourishing blood and activating blood circulation, softening hardness and dissipating masses. The prescription used is Zhi You Tang. For cases with severe wind-heat dampness toxin, Glabrous Greenbrier, Coix Seed, Purslane, and Hedyotis can be added. For liver deficiency with blood dryness and unflourishing sinew qi, Nacre, Peony Root, raw oyster shell, and Rice Bean can be added. For kidney yin deficiency and insufficient liver blood, Gui Shao Rehmannia Tang can be used instead, with the addition of Sichuan Lovage Rhizome and Achyranthes Root.
2. Western medical internal treatment: One of the following methods can be chosen: ① Virusil 0.1g, taken orally three times daily; ② Urotropine 0.3g–0.6g, taken orally three times daily; ③ 10% bismuth subsalicylate oil 2ml, intramuscular injection; ④ 1% antimony potassium tartrate 3–5ml, intravenous injection, twice weekly; ⑤ Interferon 2–5ml, intramuscular injection, once weekly.

(2) External Treatment: The following methods can be selected as appropriate, but care must be taken to protect healthy skin.

1. Wan Ling Dan corrosive agent: A paste made from 1.5g of camphor powder, 25g of salicylic acid, 1g of procaine, 1.5g of sugar, and 95% alcohol, applied to the wart.
2. Crushed Brucea javanica seeds applied to the affected area, changed daily, usually cured in 2–3 applications. Alternatively, Brucea javanica oil (Brucea javanica mixed with peanut oil and soaked for half a month) can be dabbed on the affected area.
3. Equal parts of soda ash and quicklime mixed with 2% procaine solution to form a paste, applied externally to the wart. Discontinue application when a burning sensation occurs.
4. Compound salicylic acid collodion (30g each of salicylic acid and lactic acid, 100g of flexible collodion): Soak the affected area in warm water for 5 minutes, dry, then apply directly to the wart once daily. This is a good keratolytic agent but is flammable, so caution is needed.
5. Waike Qixuan records: "Rubbing with chicken gizzard skin can cure it. Another method involves moxibustion on the first wart with mugwort, after which the rest will fall off and heal."

(3) Injection Therapy:

1. Use 2.5% iodine tincture 0.1–0.2ml, or 18% saline solution with 2% procaine added as appropriate, 0.5–1ml per injection into the base of the wart. The wart will dry and fall off in about a week.
2. Interferon 0.5–1ml, injected into the wart once weekly. Alternatively, interferon solution can be sprayed locally.

(4) Surgical Therapy: Methods such as cryotherapy, electrocautery, laser therapy, or surgical excision can be selected as appropriate, but care must be taken to preserve healthy skin or skin islands to prevent scar contracture and avoid stricture of the anus.

bubble_chart Differentiation

It should be differentiated from proliferative anal subcutaneous nodules, genital cancer, and genital Bowen-like papulosis.