A.Vogel Talks Periungual warts

Periungal warts often appear around the folds of your finger and toe nails and can be trickier to treat than ordinary warts

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An introduction to periungual warts

Periungual warts usually manifest around the nails of your fingers and toes, and can cause a considerable amount of discomfort, even growing and extending under the nail itself.

It is for this reason that periungual warts are often more difficult to treat than common warts or verrucas, as conventional medicines like salicylic acid cannot properly reach the affected area.

The warts can also cause a substantial amount of harm to the nail itself if they are left untreated, often being responsible for onychauxis (abnormal nail growth) and cuticle damage, even raising the nail itself and causing permanent disfigurement.1

If you notice any warts appearing near this area, it is important that you speak to your doctor and try to treat the affliction as soon as possible. Periungual warts are quicker to heal if they are caught in their infancy, and you might be able to avoid passing the virus on to another person.

1http://www.warts.org/periungual-warts.html

The causes of periungual warts

The causes of periungual warts will always revolve around the contraction of HPV, the virus responsible for outbreaks of warts. In the case of periungual warts in particular, you should try to take notes of specific triggers such as stress or indirect contact, and be aware of any vulnerabilities that you might have, such as a weakened immune system or poor nutrition.

  • HPV virus: The Human Papilloma Virus, or HPV, is a contagious viral infection often found in those with an impaired or immature immune system. There are many different strains of the disease, with some even estimating that there are potentially over a 100 different subtypes. Some variants of HPV, mainly HPV-16 and HPV-18 are responsible for the development of cervical cancer, which is why many young girls are now inoculated against these strains. Warts, however, are harmless and benign, often caused by the HPV-1, HPV-2, and HPV-4 subtypes, and therefore can be contracted by anyone. The virus works by triggering the keratinocytes, the cells responsible for producing keratin. This tough protein is often found in your hair, skin and nails and in an outbreak of HPV, it continues to grow on the surface of your skin, manifesting as warts.  A weakened immune system however, is not the only issue that can make you more susceptible to catching the affliction – skin that is damaged or brittle can also play an influential role as the virus will find it easier to permeate the epidermis and infect the carrier
  • Weak immune system: Your immune system works as your body’s first line of defence, with the immune cells operating like a Special Forces unit, attacking pathogens and eliminating any threats to the rest of your body. However, certain medical conditions like hypothyroidism, HIV or anaemia or lifestyle habits such as stress, poor nutrition and poor hygiene, can weaken your immune system. When your immune cells become fatigued or sluggish, they will be unable to properly defend your body against contracting the HPV virus and will not be able to muster a suitable counterattack against the contagion. In these instances, episodes of warts can become prolonged, with the virus persisting over a longer period of time, even spreading to other areas of your body. In periungual warts, this can be dangerous as the skin lesions stimulated by a ferocious outburst of warts can cause lasting or even permanent damage to your nails
  • Poor nutrition: The importance of a healthy immune system cannot be overstated and your diet can play a vital part in keeping your immune cells strong and well-nourished. If you splurge on salty, sugary or fatty snacks and drink generous amounts of alcohol and caffeinated beverages, then your immune system and other areas of your body will start to suffer. The inflammatory chemicals in these foods will increase your production of histamine, eventually exhausting your immune cells and making you more vulnerable to viral infections like HPV. When your diet lacks essential nutrients, it can also have dire consequences for your digestive system, liver function and skin, with vitamin deficiencies often being a leading cause of anaemia, hypothyroidism and some forms of bone disease. Instead of fatiguing your body, you should be trying to maintain your immune system by increasing your intakes of wholegrains, fruit, vegetables and plain water
  • Stress: Stress is infamous for the terrible affect it can have on your immune system, as well as other crucial areas of your body like your digestive system and liver function. When you experience stress, it can trigger your sympathetic nervous system and your primordial ‘fight or flight’ reflexes. Once this has happened, your body will raise your blood pressure and redirect the flow of nutrients away from your skin to your major organs. It can also slow down your digestive process, leaving you constipated and with no way of flushing the toxins from your body. The immune system will try to produce more inflammatory chemicals like adrenalin, which will exhaust the adrenal glands and eventually make you more vulnerable to infections. Your skin will also suffer during this time as certain toxins might be excreted through your epidermis rather than your liver or bowels, making it weaker and easier for the HPV virus to penetrate
  • Bad habits: Where you ever told to stop biting your nails a child? Unfortunately this particular quirk can claim some of the blame when it comes to spreading the HPV virus. This is because when you bite your nails you also weaken the skin surrounding the cuticle, making it dryer, more brittle and easier to permeate. These warts can then get carried to your face by your hands if you continually rub your cheeks or lips, making it essential that you try and avoid doing this during an episode of periungual warts. It’s also crucial that you examine your hygiene practices as well – this is not to imply that you are unclean in any way, but rather to emphasise the importance of drying yourself properly. The HPV virus loves damp, warm environments so drying your feet and hands thoroughly can prevent the disease from entering your skin and protect you against a secondary bacterial infection
  • Direct contact: If you are aware that a friend or a family member has contracted the HPV virus, it would probably be best to avoid physical contact with them until their bout of warts has cleared up. This doesn’t mean that you should shun your acquaintances; just be mindful that there is a possibility of infection and take sensible precautions. If you have children and are worried about them contracting the affliction from their friends, try to keep them covered up and encourage them not to share articles of clothing with the infected party. It might seem impolite, but these measures should lower your risk of catching the HPV virus and prevent you from spreading the virus yourself to your nearest and dearest
  • Indirect contact: The HPV virus can thrive on inanimate objects, making secondary contact one of the primary ways that the disease is spread. If you share a towel, an article of clothing or even a bathroom floor with an infected friend or relative, then the infection can be spread to you as you are coming into direct contact with a contagion. This is why children often contract verrucas from their local leisure centre or swimming pool – plenty of bodies, and ideal conditions can encourage the virus to develop and widen the scope of its potential victims.

The symptoms of periungual warts

The symptoms of periungual warts can be difficult to miss as it often involves small portions of rough skin appearing over an extremely visible area of your body – your fingers. It can be reassuring to learn more about your symptoms though, so you have an idea of what to expect and are conscious of any recurrent symptoms that might be out of the ordinary.

  • Dry, rough bumps: Dry, hardened skin is a leading symptom of warts, usually caused by an excess of the rough protein keratin. During an episode of periungual warts, the area surrounding your nails will most likely suffer from this unpleasant side-effect, with the cuticle of your nail often becoming brittle and prone to flaking. The warts themselves will manifest a small, toughened lump of skin and may vary in size as they develop.
  • Skin discolouration: It’s quite normal for your skin to become discoloured during an outburst of warts, especially around the affected are. Warts can appear pale and greyish in colour, although some can darken over time. Fortunately, this particular symptom should start to diminish as your wart heals, returning to its normal pigment after it has faded completely
  • Clotted blood vessels: If you’re suffering from warts, you’ve probably noticed a collection of small, dark pinpricks peppered over the lesion itself. These are generally a sign of a clotted blood vessel. When your blood vessels – the tiny valves responsible for pumping nutrients around your body – rupture, it can cause blood plasma to seep into the surrounding skin tissues. This is not normally considered to be a serious symptom but it can be uncomfortable, particularly in an area like your fingers, which are constantly moving
  • Onychauxis: Onychauxis refers to an overgrowth or thickening of the nail and can sometimes appear in periungual warts if the virus has been allowed to rampage. Your fingernails or toenails might harden and become discoloured, but with regular treatment they should eventually return to normal. Occasionally onychauxis can be a sign of a larger problem, such as reduced circulation. It’s very important that you keep an eye on your nails during an outbreak of periungual warts – when the warts start to spread under your nail, it can cause the nail to rise or even become disjointed
  • Stress: Stress is a psychological symptom often associated with visible skin conditions. In the case of periungual warts, stress might have less to do with the physicality of the virus, and more to do with the discomfort involved. When painful warts start to appear around your fingers, it can affect how you socialise with friends and how you hold objects like a pen. If you are unable to perform basic tasks like writing or typing, it can become extremely frustrating and stressful for the sufferer, exacerbating their feelings of anxiety and apprehension.

Home remedies

Warts are such a common skin condition that a variety of home remedies have appeared over the years, some of which are very effective at treating the infection.

Nevertheless, should you notice any worrying changes in your symptoms or experience any discomfort, you should try and speak to your GP as soon as possible.

  • Relax: Stress might be a natural emotion to experience alongside a contagious skin condition like periungual warts, however it can be toxic for your immune system. If you continue to feel panicked and apprehensive, it will only exaggerate your physical symptoms and exhaust your immune system. The best thing you can do for yourself and your body is to try and find ways of keeping calm and relaxing. Seize this opportunity to enjoy some respite on your couch with a good book or go outside for a brisk walk. Indulge in activities that you enjoy, like taking a nice long soak in the bath. You could even give yoga a go as this gentle exercise is brilliant for balancing your stress levels and teaching you proper breathing techniques
  • Break the habit: Are you an anxious nail-bitter? If so, it’s a habit you had better learn to kick and fast. Maintaining your epidermis and keeping your skin strong and healthy should be your priority and biting your nails will only make you more vulnerable to warts and other unpleasant skin infections. Try to resist the urge and if you have any children, make sure that they too are not indulging in this compulsion
  • Good nutrition: Your diet is critical when it comes to supporting your immune system and maintaining the health of your body. If you overindulge in process fats and refined sugars, it will take its toll on your immune system, stimulating the release of inflammatory chemicals and exhausting your adrenal glands. Instead, try to reduce these culprits and increase your intake of fruits and vegetables that are rich in essential vitamins and minerals like magnesium, zinc, vitamin C and iron. These can help to strengthen your skin cells and maintain your immune system, encouraging your immune cells to fight back against any potential viruses. Wholegrains and oily fish are also an excellent source of B vitamins and omega-3 fatty acids, which can help to improve your digestion. Make sure you also reduce your consumption of caffeinated or alcoholic drinks and instead focus on drinking more water so you can keep healthy and hydrated
  • Apple cider vinegar: Apple cider vinegar is often used in the treatment of skin conditions due to its anti-bacterial and anti-inflammatory qualities. The vinegar has a high acidic content which makes it particularly effective at destroying the external symptoms of a wart, breaking down the excess keratin until the wart simply peels away. You might notice that your wart may change colour during this process but this is perfectly normal and should diminish when the wart finally breaks away from the rest of the surrounding skin. Apple cider vinegar can be applied topically to the affected area and it can also be taken internally to boost the immune system. Your Health Food Store stocks a range of apple cider vinegar products if you are interested in this treatment
  • Garlic paste: Research has illustrated that garlic can be very effective as a treatment for warts. The herb does contain natural anti-fungal and anti-bacterial properties, which are able to reduce the spread of bacterial infections and viruses. Garlic can be applied to your warts by being diluted with a little water until it forms a paste. You may have reapply this paste consistently throughout the day and you should be careful not to apply raw garlic to the affected area without mixing with water first
  • Tea tree oil: Tea tree oil is a common ingredient in many skin care and cosmetic products, in part due to its anti-sceptic and anti-inflammatory qualities. The oil can also be especially effective against warts due to its content of terpinen-4. Terpinen-4 is an anti-microbial compound that is particularly useful when it comes to attacking certain strains of the HPV virus, making it extremely beneficial as the oil deals with the main causal factor of the outbreak rather than its superficial appearance. Tea tree oil should always be diluted with a little water before applying directly to your skin, and you may have to reapply this remedy frequently throughout the day
  • Thuja cream: Thuja is a variant of evergreen that is often used to ward off viral infections like the common cold. Extracts of the thuja are also used in the treatment of warts, a skin condition caused by the HPV virus. If you are interested in trying thuja ointment, you will be pleased to know that Your Health Food Store stock a variety of thuja based products which can be applied directly to your outbreak of warts. Just be aware that thuja is not suitable for breastfeeding or pregnant women.

Herbal remedies

Herbal remedies can work on two fronts – first by treating the internal infection and secondly, by relieving any external symptoms. Our remedies are aimed at strengthening your immune system and easing the physical appearance of your warts.

  • Neem cream: Neem has been used in herbal medicine for centuries due to its natural anti-bacterial and anti-viral qualities, often as a treatment for rough or irritated skin. Neem Cream is made from extracts of neem leaves and can be used to ease skin complaints like warts by nourishing dry, brittle skin. This remedy may not be suitable for pregnant or breast feeding women as well as those who suffer from nut allergies
  • Echinaforce®: Echinaforce® is often used as preventative measure against viral infections such as the flu or cold. This is because the remedy is brilliant at strengthening the immune system and made from organic extracts of Echinacea, a flowering plant that has been used in herbal medicines for centuries. This remedy might not work to relieve the physical symptoms of your warts but it will give your immune system a boost, making you less vulnerable towards contracting infections and viruses.

Conventional medicines

If you have ever experienced an episode of warts, the odds are that you are familiar with some of the following treatments.

However, while it is important that you speak to your doctor about any health concerns you might have, you should be aware that conventional medicines often involve a range of unpleasant side-effects.

It is vital that you understand the possible consequences of any treatment that you might undergo and that you speak to your doctor about any potential side-effects.

  • Topical creams: Most over the counter topical creams, like bazuka gel, contain high levels of salicylic acid. This formula will not combat the underlying cause of your warts, the HPV virus, but it will work on reducing the external symptoms and relieving their physical appearance. This can make it useful if you are concerned about the visibility of your warts but it will not prevent them from reappearing at another stage in your life
  • Salicylic acid: Salicylic acid is more concentrated that typical pharmaceutical creams and works similarly to its shop-bought counterpart. It will not work on treating your internal symptoms but it may reduce the appearance of periungual warts by moisturising and exfoliating the dry bumps of excess skin
  • Cryotherapy: Cryotherapy is usually only used if your warts are persisting despite any other prior treatments, and will not be recommended for young children. The process can be quite uncomfortable and painful as it involves liquid nitrogen being applied to your wart. This does effectively destroy the infected skin cells but it can also cause nasty side-effects like blistering. Multiple rounds of cryotherapy might be necessary to banish your warts
  • Laser Surgery: Laser surgery is the most common surgical approach to removing warts but it will only be recommended if all other treatment options have failed. The surgery works by burning away any warts with a strong beam of light. This form of treatment will not diminish the spread of the HPV virus and it can sometimes leave permanent scarring.

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