The Home School Court Report
Vol. XXV
No. 4
Cover
July/August
2009

In This Issue

SPECIALFEATURES
REGULARCOLUMNS
ANDTHEREST

Doc’s Digest Previous Page Next Page
by Dr. Rodger Sayre
- disclaimer -
Have You Had a Toad in Your Shoe?

I was 13. Although I was being raised in a solid Christian home, every weekday I waded into the pressure-cooker-like atmosphere of public school, where individuality vanished amidst the crushing heat of peer influence. I desperately wanted leather Adidas sneakers like my best friend Beaver (yes, that was his real name!) wore, white with the three black stripes across the mid portion of the shoe. I wanted my hair to come to my earlobes, sweeping across my forehead just above my eyebrows. Instead I walked to school in my cheap vinyl Adidas look-alikes that made my feet sweat, head topped with a classic 50s haircut, shaved up the back and over the ears, combed to the side with the help of a little dab of Wildroot Cream Oil, Charlie. Girls were becoming less gross with each passing day, and I was really, really self-conscious. I didn’t care much for my sneakers or my haircut, but I HATED the wart I had on my right ring finger! I remember walking down the hall with my thumb covering the dorsal aspect of my forth distal phalanx. When girls giggled, I thought for sure it was in response to that hideous growth. Verruca vulgaris is the medical term for a hand wart—how aptly named!

www.istockphoto.com
...
WARTS ARE NO
RESPECTER OF
PERSONS. I HAD
NO REASON TO BE
EMBARRASSED.
...

Warts are no respecters of persons. I had no reason to be embarrassed. Even pretty girls get warts! And they’re very common. The incidence of warts is reported to be about 10% in young people, most occurring between ages 12 and 16, with girls afflicted more often than boys. My kids took issue with the prevalence of 10%. I polled them and their average estimate was 70%. That’s probably because most of my kids have had warts!

When my daughter Hannah was 6 (she’s now 19), we had a youngster over to play for the day. He was being unkind to her twin brother, Luke. My kids have a tendency to watch out for one another, so Hannah took it upon herself to teach this visitor a lesson. While he played barefoot in the sandbox, she found a toad under a plank in our side yard and put it in his shoe, so he would get warts. I’m not sure where she got that idea. Surely not from her daddy!

Warts are actually a viral infection in the surface of the skin, contracted from other people who are carrying the wart virus. It would be convenient to blame a toad, but this virus spreads from person to person. The human papilloma virus (HPV) sets up camp in the epidermal tissues, causing the skin to grow in an abnormal, but characteristic and usually easily identifiable manner.

The treatment options for warts have changed a little over the years. We treated that wart on my finger with something that came in a little glass bottle with a solid glass applicator. We’d put a drop on the wart, and cover it with a Band-Aid. It smelled like the office of Dr. Davenport, our old family doc. If they had taken me to see Doc Davenport for this problem, he would likely have treated it the same way most MDs of that time era approached wart treatment. After numbing the area, the doctor would place a couple of sharp probes on either side of the lesion and pass an electrical current through the wart, frying the tissue between. People would refer to this as having their warts “burned off.” It was very effective in ridding a person of his or her wart, but the resultant scar was often as unsightly as the wart itself.

Nowadays, physicians often use a treatment at the other end of the thermal spectrum. Liquid nitrogen is applied to the wart, freezing the wart tissue. Because wart tissue is limited to the epidermis and because it freezes faster than the surrounding normal tissue, wart tissue can be selectively destroyed, resulting in little to no scarring. I have treated literally hundreds of warts in this manner over the past 25 years. Other than the not-infrequent problem of recurrence, there have been no complications.

Another equally effective (albeit painfully slow) method of treating warts is the use of chemical solutions similar to that which I used as a child. This treatment option has the advantage of being very inexpensive and very safe. Most over-the-counter preparations are salicylic acid in a fairly weak concentration. The same solution is available by prescription in a much more concentrated form that will work a little more quickly.

Even less expensive than topical solutions is the use of duct tape. Yes, you read it right. I said duct tape! (Or is it duck tape?) Anyhow, a bit of duct tape is applied right over the wart and left in place for a week, followed by abrasion of the area by sand paper or a pumice stone, followed by more duct tape. This is a particularly viable option when treating plantar warts, the warts that grow on the soles of the feet. You may now add another item to the long list of things you can do with duct tape! When the simple treatment options fail, there are lasers, injections with chemotheraputic agents, injections with immune stimulators, etc. These high tech and expensive options are usually reserved for unusual cases, with treatment rendered by those who have been specially trained.

Finally, although most warts spontaneously resolve even with no treatment, sometimes warts will multiply and become more difficult to treat with time. Given the physical irritation, the social stigma, and the potential for propagation, I recommend treating warts sooner rather than later. If the duct tape or over-the-counter topical treatments aren’t doing the trick, give your family doc a call.


About the author

Rodger Sayre, MD, FAAFP, has been an HSLDA board member since 1997. He and his wife, Mary, have graduated 5 of their 11 children and continue to teach the rest at home in Pennsylvania. Dr. Sayre is certified as a Diplomat of the American Board of Family Medicine and is a Geisinger Medical Group associate with a busy practice in Tunkhannock.