In chapter 6, Tom Sawyer is talking to Huck about a friend with warts who could’ve cured himself “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.”

Common warts are just that, common, and much more likely in children and young adults as their immune systems haven’t been well developed. They affect more than a third of school-age children.

Common warts are small grainy skin growths that occur most often on fingers or hands. They’re caused by a virus, the human papillomavirus. The virus is quite common and has more than 150 types, but only a few cause common warts. A few other HPV strains cause a different infection, which is acquired sexually. The HPV vaccine doesn’t protect humans from the common wart strains of virus.

Common warts are transmitted by an infected human’s touch or through shared objects such as contaminated towels — but not by handling frogs. This virus is only carried by humans. Some frogs and toads have warty bumps on their skin and they do excrete a foul tasting liquid from some glands behind their eyes as a defense mechanism, but it doesn’t carry the virus.

K. R. Soenjoyo et al in Dermatologic Therapy reviewed the treatment of viral warts in children and compared various treatment options with cures and side effects. They state the bumps aren’t malignant but can be extensive, painful or cosmetically embarrassing, and they can sometimes bleed.

Treatment also is challenging because of the high spontaneous cure rate (approximately two-thirds get well within two years with no treatment) and a lower threshold for the pain of the treatment in children. With that spontaneous recovery rate, you can see why “spunk-water” would work.

Cryotherapy using liquid nitrogen is the most common therapy. The freezing agent may be apply by a doctor using a cotton wool applicator or a spray gun. Children tend to tolerate the cotton wool applicator better. These applications are done in two- to three-weeks with treatments over three- to four-months with cure rates of 50 percent to 68 percent. Common side effects are pain and blistering.

Another common treatment is salicylic acid (sometimes combined with other agents) that’s applied once or twice daily. Overnight covering with duct tape after application of the salicylic acid is often recommended by pediatric dermatologists. Reported clearance rates ranged from 18 percent in six months to close to 100 percent at two years. Side effects are skin irritation and redness.

Many alternative therapies have been described but the studies are small, making it hard to make recommendations. A simple and painless treatment is overnight covering of the warts with plain (no medication) duct tape. Reported clearance rates in two studies were 16 percent over six weeks and 66 percent over two years. Side effects are minimal and minor.

Does it make you wonder about how to obtain “spunk-water?”

Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital. This column isn’t intended to replace the advice of your child’s physician.

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