Nail Clinic: Warts

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Learn how to keep you and your clients safe from this unsightly and contagious skin condition.

A wart is one of those skin conditions that is common enough to have spawned an entire mythology. We've all heard the stories about warts being spread by frogs or toads (and even witches), along with the dozens of folk remedies supposedly proven to heal them. However, warts themselves are less straightforward than you'd think. Caused by the human papillomavirus (HPV), warts, like other viruses, can lie dormant for months or years before signs of them physically manifest. That's why they often seem to appear from nowhere—and can disappear just as suddenly. However, warts are extremely contagious, and as a nail technician you need to know exactly how to keep you and your clients safe.

Getting the Facts

According to the American Academy of Dermatology (AAD), several types of warts exist:
Common warts grow on fingers, around nails and on the backs of hands, commonly appearing where the skin has broken. Clients who tend to bite their fingernails or pick at a hangnail may be prone. They can also be called seed warts, due to the appearance of black dots on the wart (the dots are actually blood vessels).
Plantar warts most commonly appear on the soles of the feet. When they grow in clusters, they're sometimes called mosaic warts. This type of wart is usually flat, not raised—the pressure of walking often flattens them. Plantar warts can cause pain; people often complain that it feels like they're walking on a pebble.
Flat warts are smoother and smaller than other types, and often grow in multiples. In children they may appear on the face while adults get them on the beard area (men) or on the legs (women), possibly caused by irritation from shaving.

Regardless of type, warts can take a while to appear on skin after HPV has entered the body. "Warts are caused by a virus that usually gets into the skin from a cut, and it can take up to two years from exposure to when the warts actually appear," says Sandra Marchese Johnson, MD, FAAD, from Johnson Dermatology in Fort Smith, Arkansas, and author of Warts: Diagnosis and Management: An Evidence Based Approach. She notes that some people, including those with weakened immune systems, are more likely to catch the virus than others.
Unfortunately, working as a nail technician where you are frequently touching and working with other people's skin, you're likely to be exposed to the virus. "People get warts from other people," says Dr. Robert Brodell, professor of internal medicine, dermatology, at Northeastern Ohio Universities College of Medicine in Warren, Ohio. "For example, they can occur from walking on the ground with bare feet or through skin-to-skin contact. They can be spread from one person to another, or on the same person from one body part to another area of the body."

Treatment
Once a person has developed warts, treatment should begin as soon as possible. "Treat them early," Brodell emphasizes. "Though it’s true that immunity may eradicate warts without treatment, we cannot tell whose warts are going to go away on their own. Plus, the larger and more numerous the warts, the harder they are to eradicate."
Johnson describes some of the popular treatments for warts:

  • Cryotherapy (freezing) is the preferred method for removing common warts on adults and older children; repeat treatments may be necessary, but pain is minimal
  • Electrosurgery (burning) or laser treatments can be used for warts that have persisted after other types of treatments
  • Salicylic acid plasters or chemicals may be used to eliminate plantar warts
  • Peeling methods (with salicylic acid, tretinoin, glycolic acid or other formulas) may help treat flat warts

"For warts on the hands and feet, we often freeze them with liquid nitrogen, treat them with certain blistering chemicals, or use vascular lesion laser treatments to clog up blood vessels in the wart," explains Brodell. “I also often prescribe home treatments with 17% salicylic acid as an adjunctive during the office treatments. For difficult warts that aren't responding, we may inject them with interferons or a candida antigen to gear up the local immunity so that the body may begin to reject the warts."
Though traditional treatments are often sufficient to get rid of the problem, warts can reoccur—at least for a time. "Most treatments work in about 70% of people, but people who get warts tend to get more until the body recognizes it as abnormal," says Johnson.

Careful Clients
To help protect your clients and yourself from warts, prior to services, give first-time clients a questionnaire and don’t hesitate to ask about current conditions such as broken skin, warts or other concerns. Even if she doesn’t report any warts on her skin, remember that because HPV can be present without the wart having yet appeared, your client might not know herself. Therefore, you need to protect yourself from warts by wearing gloves during a service.
Help protect your client from warts by keeping her hands and feet in tip-top shape. "Keep her skin healthy," recommends Johnson. "Don't cut her cuticles—you want the cuticle there as protection." Also discourage her from picking at her skin and nails. Keep the skin on her hands and feet "sealed" with an application of lotion—retail a cream for home use between appointments. This can also help provide a barrier to stop the virus.<
Brodell further suggests that you alert your client about any warts that you may discover on her skin. Tell her that she must see a dermatologist for treatment before you can continue to provide services.
Though there are no foolproof ways to avoid coming into contact with HPV, your clients can take preventative steps to lessen their risk of being infected. Conway C. Huang, MD, director of dermatologic surgery and cutaneous laser surgery at the University of Alabama at Birmingham in Birmingham, Alabama, suggests that clients avoid walking barefoot in public places, such as gym locker rooms or around public pools, and practice good hygiene (regular washing) to avoid the virus.
Warts can be unseemly in appearance, easily spread and tricky to cure, so protecting yourself and your clients should always be your top priority. If you notice warts on a client, encourage her to get the problem fixed immediately. Once the warts are gone, they should be gone for good—but, fortunately, she'll keep coming back!

Tracy Morin is a freelance writer and editor based in Oxford, MS.