Warts

wart is generally a small, rough growth, mainly on a human’s hands and feet. However they often also appear in other parts of the body. They resemble a cauliflower or a solid blister. They are caused by one of the many types of Human Papilloma Virus (HPV). There are many varieties of warts and they are mostly harmless. Warts are contagious and usually enter the body through broken skin.

If left untreated they can spread for some time over the body, however the most common ones will eventually disappear by themselves. This is because the immune system will eventually learn how to suppress the virus.  Some others types of HPVs will r cause discomfort for years.

Type of Warts

Many kinds of warts have been identified over the years, They significantly vary in shape depending on the type of HPV involved.

These include:

  • Common wart (Verruca vulgaris), a raised wart with roughened surface, most common on hands, but can grow anywhere else on the body;

common warts 1common warts

Common wart on the left and the same type of wart on the big toe on the right

This type of HPV can affect any other parts of the body. These warts are harmless and mainly cause discomfort. This HPV tends to spread, however when the immune system manages to come to terms with the virus the symptoms will disappear. These warts can last for years if left untreated.

  • Flat Wart (Verruca plana), a small, smooth flattened wart, flesh-coloured, which can occur in large numbers; most common on the face, neck, hands, wrists and knees;

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Two very typical cases of flat warts.

They are easily recognisable by their flesh colour. On dark skinned individuals they usually look like white spots. These warts do not present any danger. They will eventually disappear but they can last for years causing insecurity to the patient.

  • Filiform or digitate wart, a thread- or finger-like wart, most common on the face, especially near the eyelids and lips

Digitate WartDigitate wart1

Two cases of filiform warts.

When the wart is close to the eye or an important artery only specialised equipment should be used to safely remove it.

  • Genital warts (venereal wart, Condyloma acuminatumVerruca acuminata), a wart that occurs on the genitalia.

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Two cases of Venereal warts.

  • Mosaic Warts, a group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet;

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Two cases of mosaic warts, the picture on the left is a mocaic Wart on the sole of the foot and on the right a mosaic wart on the big toe.

  • Periungual Warts, a cauliflower-like cluster of warts that occurs around the nails.

Periungual wartsperieungal2

Two classical examples of Periungual Warts

  • Plantar Warts (verruca, Verruca plantaris), a hard sometimes painful lump, often with multiple black specks in the centre; usually only found on pressure points on the soles of the feet;

plantar-wartsplantar-warts1

Two examples of Plantar Warts

Traditional removal procedures

  • Keratolysis (ie separation) of dead surface skin cells performed by using salicylic acid, blistering agents, immune system modifiers (“immunomodulators”), or formaldehyde. These procedures are often pared with mechanical abrasion using pumice stone, blade etc. A minimum of 4 four sessions are required. On average it takes 8 sessions to completely remove the warts.
  • Electrodesiccation. This procedure involves traditional excision using a scalpel, after the excision has been performed the wound is treated with an electrode in order to kill off the virus. This procedure is very effective however it likely to scar the patient due to the traditional excision.
  • Cryosurgery. This involves freezing the wart (using liquid nitrogen), creating a blister between the wart and epidermal layer. After that the wart and surrounding dead skin falls off by itself. An average of 3 to 4 treatments are required for warts on thin skin. Warts on thick or callous skin like plantar warts might involve even more treatments.
  • Laser treatment – often with a pulse dye laser or carbon dioxide (CO2) laser. Pulse dye lasers (wavelength 582 nm) work by selective absorption by blood cells (specifically haemoglobin). CO2 lasers work by selective absorption by water molecules. Pulse dye lasers are less destructive and more likely to heal without scarring. CO2 laser works by vaporizing and destroying tissue and skin. Laser treatments can be painful, expensive (though covered by many insurances), and can cause little scarring when used appropriately. CO2 lasers will require local anaesthetic. Pulse dye laser treatment does not need conscious sedation nor local anesthetic. It takes 2 to 4 treatments but it can require many more for extreme cases. Typically, 10-14 days are required between sessions.
  • Infrared coagulator – an intense source of infrared light in a small beam like a laser. This works essentially on the same principle as laser treatment. It is less expensive. Like the laser, it can cause blistering pain and scarring.
  • Duct tape occlusion therapy involves placing a piece of duct tape over the wart. The evidence as to whether or not it is effective is poor. Thus it is not recommended as routine treatment

Treatment with the Clarker

Before the Clarker was available on the market the best procedure to remove warts was applying salicylic acid (Keratolysis). This has been traditionally the preferred method of removing warts as it can be safely performed by the patients themselves without incurring in any particular health risk and it does not usually leave any scars. This treatment is still the most cost effective, as salicylic acid is rather inexpensive and not dangerous.

The main inconvenience is that the patient has to go through several sessions in order to get rid of the warts.

Why can the Clarker eliminate all kinds of warts without anaesthesia, without recurrence and leaving no scars?

The Clarker has been calibrated so that the its micro lightening (plasma) only destroys a very tiny layers of skin tissue at a time. Therefore the Clarker precision makes it easy for the clinician not to affect the dermis when curing warts and hence cause neither damage nor scars. Additionally the Clarker generates very high localised temperatures that instantly destroy the Human Papilloma Virus thus the wart will not reappear after appropriate treatment with the Clarker.

The Clarker is a very useful instrument for warts removal because it can be used by appropriatelly trained non medical personnel as well as dermatologists to permanently eliminate any type wart after only one session. The risk of damaging the healthy skin are very low.

removing warts with the Clarker:

  • Does not require anaesthetic
  • Does not involve excision
  • The warts can be successfully removed within one session
  • The risks of scarring the patient are minimised

As stated, there is no need for sedation nor local anaesthetic in most parts of the body affected by the warts. However when the warts are on particularly sensitive parts of the body (ie genitalia), it may be preferable to use a local anaesthetic or ring anaesthesia in order to avoid discomfort to the patient. Depending on the patient sensitivity to pain, ring anaesthesia may be sufficient.

Examples of Clarker Applications for wart removals

Smiley face

This wart appeared appeared in this young patient’s nose.

Smiley face

This is how the patient looked only one month after the removal procedure. The healing time was extremely fast due to the young age of the patient. As it possible to see the hole was still preserved.

After the wart was removed the Tip of the Clarker was carefully inserted into the hole of the piercing. The tip of the Clarker was used inside the hole in order to destroy all the possible remaining residues of Human Papilloma Virus. Therefore although this was not the easiest case to treat using other procedures it did not present particular difficulty with the Clarker.

Of course the patient has not had any wart recurrence.

This patient had two classical verrucas vulgaris on his finger. The patient tried cryotherapy without success because it was not performed enough times to be effective. The Clarker was applied only once on the two warts and after healing no scar nor recurrence occurred. The patient did not require anaesthetic.

The photos above depict two different patients.

On the top left a patient with a bad case of periungual wart. The Clarker was applied only once to remove the warts. On the top right the after picture of the patient hand after healing from the treatment.

The bottom left picture depicts the patient with both verruca vulgaris on the back of his thumbs as well as periungual warts. 60 days after the treatment with the Clarker there were neither sign of warts nor scars.

This was identified by the dermatologist as a filiform wart, therefore there was no risk of a malignant growth and clearly excision for histological examination was not required.

Should it be necessary to examine a possible cancerous condition it is recommended to perform a traditional excision to make sure to also examine the the apparently healthy tissue. If it is necessary to stop the bleeding then the Clarker can be applied for that purpose as it can operate as a coagulator on an open wound.

In this figure the Clarker has just been applied to the wart. It has been destroyed levelling it with the surrounding skin. As mentioned earlier, when the wart is levelled off with the sorrounding skin the risk of scarring is very low.

This is the same patient 60 days after the the removal with the Clarker. There is neither sign of the previous wart nor any scar.

In this case the patient had numerous flat warts (verruca plana) on the face. All the spots were removed without anaesthetic in a single 15 minute session.

The same patient one month after.

Basic protocol for wart removal with the Claker

 The warts are particularly easy to remove with the Clarker. Each wart is different therefore it can be removed in different ways with the Clarker. Additionally different dermatologists have different approaches for wart removal with the Clarker.

The safest way to remove warts is by applying the Clarker at lowest power from start to finish. However the more experienced dermatologists have learned to remove the largest portion of the wart with the Clarker at high or medium power. This is done in order to save time. Then when most of the wart is removed the Clarker is applied at low power to slowly remove the tiny remaining parts of the wart and destroy any trace of HPV causing the least possible damage.

It is always advisable to take photos of the treated areas before the treatment in order to assess possible growth of new lesions and to demonstrate that any new lesions do not persist on the areas already treated with the Clarker.