Infectious Disease Compendium

Warts

Diagnosis

A warty growth in the extremities or genitals (condyloma acuminatum).

Epidemiologic Risks

Touching other humans with warts. Handling frogs and toads are not a risk factor.

Microbiology

Human papillomavirus.

Empiric Therapy

- Warts on the hand and feet can be 'burned off' with liquid nitrogen (hold on the wart for 10 seconds, repeat 2 weeks later if needed) or various preparations containing salicylic acid (Compound W®).

Heat may work better than cold (PubMed).

- Condyloma acuminatum: Podofilox (podophyllotoxin) 0.5% podofilox solution or gel applied twice daily for three consecutive days every week for up to 4 weeks

OR

Imiquimod 5% cream three times a week (wash site with soap and water 6-10 hrs after applying.), on alternate days, for up to 8 weeks OR Trichloracetic acid 10% to 90% solution is used topically at weekly intervals in pregnancy. It isn’t fun OR Liquid nitrogen freeze every 1 or 2 weeks. I shall leave the treatment of cervical papillomavirus to ob/gyn.

Interferon injection into the wart is also effective (Meta-analysis).

There is a vaccine.

Pearls

In a meta-analysis "Imiquimod and podophyllotoxin possess similar curative effects on condylomata acuminata but podophyllotoxin has more serious adverse effects (PubMed)."

Duct tape? See the Medscape link.

The following treatments have not been evaluated in clinical trials but one has the benefit of requiring a dead cat.

"Say -- what is dead cats good for, Huck?"

"Good for? Cure warts with."

"No! Is that so? I know something that's better."

"I bet you don't. What is it?"

"Why, spunk-water."

"Spunk-water! I wouldn't give a dern for spunk-water."

"You wouldn't, wouldn't you? D'you ever try it?"

"No, I hain't. But Bob Tanner did."

"Who told you so!"

"Why, he told Jeff Thatcher, and Jeff told Johnny Baker, and Johnny told Jim Hollis, and Jim told Ben Rogers. There now!"

"Well, what of it? They'll all lie. Shucks! Now you tell me how Bob Tanner done it, Huck."

"Why, he took and dipped his hand in a rotten stump where the rain-water was."

"In the daytime?"

"Certainly."

"With his face to the stump?"

"Yes. Least I reckon so."

"Did he say anything?"

"I don't reckon he did. I don't know."

"Aha! Talk about trying to cure warts with spunk-water such a blame fool way as that! Why, that ain't a-going to do any good. You got to go all by yourself, to the middle of the woods, where you know there's a spunk-water stump, and just as it's midnight you back up against the stump and jam your hand in and say:

  'Barley-corn, barley-corn, injun-meal shorts,    Spunk-water, spunk-water, swaller these warts,' 
and then walk away quick, eleven steps, with your eyes shut, and then turn around three times and walk home without speaking to anybody. Because if you speak the charm's busted."

"Well, that sounds like a good way; but that ain't the way Bob Tanner done."

"No, sir, you can bet he didn't, becuz he's the wartiest boy in this town; and he wouldn't have a wart on him if he'd knowed how to work spunk-water. I've took off thousands of warts off of my hands that way, Huck. I play with frogs so much that I've always got considerable many warts. Sometimes I take 'em off with a bean."

"Yes, bean's good. I've done that."

"Have you? What's your way?"

"You take and split the bean, and cut the wart so as to get some blood, and then you put the blood on one piece of the bean and take and dig a hole and bury it 'bout midnight at the crossroads in the dark of the moon, and then you burn up the rest of the bean. You see that piece that's got the blood on it will keep drawing and drawing, trying to fetch the other piece to it, and so that helps the blood to draw the wart, and pretty soon off she comes."

"Yes, that's it, Huck -- that's it; though when you're burying it if you say 'Down bean; off wart; come no more to bother me!' it's better. That's the way Joe Harper does, and he's been nearly to Coonville and most everywheres. But say -- how do you cure 'em with dead cats?"

"Why, you take your cat and go and get in the graveyard 'long about midnight when somebody that was wicked has been buried; and when it's midnight a devil will come, or maybe two or three, but you can't see 'em, you can only hear something like the wind, or maybe hear 'em talk; and when they're taking that feller away, you heave your cat after 'em and say, 'Devil follow corpse, cat follow devil, warts follow cat, I'm done with ye!' That'll fetch any wart."

"Sounds right. D'you ever try it, Huck?"

"No, but old Mother Hopkins told me."

"Well, I reckon it's so, then. Becuz they say she's a witch."

"Say! Why, Tom, I know she is. She witched pap. Pap says so his own self. He come along one day, and he see she was a-witching him, so he took up a rock, and if she hadn't dodged, he'd a got her. Well, that very night he rolled off'n a shed wher' he was a layin drunk, and broke his arm."

"Why, that's awful. How did he know she was a-witching him?"

"Lord, pap can tell, easy. Pap says when they keep looking at you right stiddy, they're a-witching you. Specially if they mumble. Becuz when they mumble they're saying the Lord's Prayer backards."

"Say, Hucky, when you going to try the cat?"

"To-night. I reckon they'll come after old Hoss Williams to-night."

"But they buried him Saturday. Didn't they get him Saturday night?"

"Why, how you talk! How could their charms work till midnight? -- and then it's Sunday. Devils don't slosh around much of a Sunday, I don't reckon."

"I never thought of that. That's so. Lemme go with you?"

"Of course -- if you ain't afeard."

Rants

Curious Cases

Relevant links to my Medscape blog

Warts

Last Update: 03/23/19.