[Medical Insight 53rd] Symptoms and treatment of "T-eye and Warts" by dermatologists.

□ Broadcast Date and Time: October 11, 2024 (Fri) 10:20 pm
□ Producer in charge: Lee Siwoo
□ Author in charge: Kim Bae-jung and Kim Hyun-jung
□ Cast: Kwon Soon-hyo (Dermatologist at Gangdong Kyunghee University Hospital)
□ Broadcast channel
IPTV - GENIE TV No. 159 / BTV No. 243 / LG Uplus No. 145
SkyLife Number 90
Cable - Delive No. 138 / Hyundai HCN No. 341 / LG HelloVision No. 137 / BTV Cable No. 152

* The text below may differ from the actual broadcast content, so please check the broadcast for more accurate information.


◆ Kwon Soon-hyo: Hello, I'm Kwon Soon-hyo, a dermatologist. The story I prepared today is similar, but it's symptoms and treatments for other skin diseases, T-eye and Warts.

◇ Voice actor Park Sang-hoon: T-eye and warts, skin diseases that cause foreign body sensation in the hands and feet. T-eye and warts have similar symptoms, but unlike t-eye, which is caused by constant pressure, the warts caused by viral infection are not only ugly in appearance but also have strong reproductive power, making it easy to infect others. The smaller the lesion, the easier it is to treat and the lower risk of infection and recurrence. On the other hand, T-eye is characterized by a hard core pressing the surrounding sensory nerves into the skin, and it is said that the longer the prevalence period, the more pain can occur, and the problem with walking can cause back pain or general pain. Let's learn more about the symptoms and treatments of similar but different diseases, T-eye and Warts.

<Tiny eyes and calluses>
◆ Kwon Soon-hyo: It's a photograph that became the talk of the town a few years ago. It's the foot of world-famous ballerina Kang Soo-jin. They're very pretty and beautiful, but they're different from our feet. If you look at it, you can see that the joints, especially where the bones protrude, have very thick and round skin. Photos like this can be easily seen not only on ballerina Kang Soo-jin's feet but also on the feet of other athletes. A picture of soccer player Park Ji-sung was also a hot topic, and like Kang Soo-jin's feet earlier, you can see that the top of the toe has round eyes. Are these t-eye and calluses just for athletes? When I was young, I also experienced these tees and calluses, and when I was a student, I got together with my friends and played a famous video game. Once it starts, it goes on for three or four hours. Then the next day, the thumb blisters, and a few days later, it hardens and then falls off. This phenomenon is described as a PlayStation thumb. It refers to the phenomenon of calluses in friends who play these games hard. These calluses, these tines, these are common phenomena around you. But not everyone goes to the dermatologist. Most people with pain go to the hospital. First, we need a brief explanation of the structure of the skin to understand why calluses and tines hurt. Our skin is divided into three layers from the top: epidermis, dermis, and subcutaneous fat. The primary role of the epidermis is to protect the skin. The outermost layer of the epidermis is called the stratum corneum. These stratum corneum serve to protect the skin against repeated friction or pressure. Should I think about it? If the skin keeps rubbing something repeatedly, it can damage the skin, cause blood, and cause secondary infections. That's why the skin thickens the stratum corneum as a way to overcome the constant friction pressure. We describe the thickening phenomenon as calluses and t-eye. Therefore, calluses and tinoes can be said to be normal skin reactions to external stimuli up to a certain point. But after a certain point, it's now past the visible stage and it's going to the painful stage. To make it easier for patients to understand, I describe it as walking around with a piece of metal on the sole of the foot. When the stratum corneum thickens, it hardens and hardens, and at some point you feel pain as if you are stepping on a piece of metal. In that case, now you go to the hospital again. So far, I've used calluses and t-shirts. Technically, these two are different diseases. There is a picture on the left and a picture on the right. In the case of the picture on the left, like Kang Soo-jin's feet, there is a very round and hard skin on the top of the foot, especially where the bones protrude. On the other hand, in the case of the foot on the right, you can see that there is a very wide and round thick skin on the sole of the foot. These two are described as t-eye on the left and calluses on the right. T-eye and calluses are the same in that dark yellow and hard-touch skin, and the stratum corneum that I mentioned earlier is thickened. But the shape is a little different. In the case of the t-eye, it appears relatively narrow, and in the case of the calluses, it appears relatively wide. The most important difference is that in the case of T-Noon, there is a core protruding in a circle. This is a picture of a patient in T-Noon. If you look at the right side, this is a picture of this eye enlarged with a skin magnifying glass. It's white, and the wrinkles on the skin keep going, and at some point, they stop. And in between, there's something in the shape of a concentric circle like this, as if the tree had a ring. This is the picture I saw from the outside, and if it goes inside the skin, it looks like a pointed shape. Then if you think of walking around with this pointed hard object on your feet, this pointed object will poke you a lot. Stabbing this causes pain. In comparison, calluses are relatively less painful or absent because they don't have these central nuclei. Therefore, the t-eye and calluses can be distinguished by their shape and the presence or absence of a central nucleus.

<∀>
◆ Kwon Soon-hyo: Then there are calluses and spots, but many people ask if I really need to treat them. First of all, when patients come, the first thing to do is to distinguish between t-eye or calluses. And after the classification is over, you will always ask if it hurts or not. If it's determined to be a callus, but it doesn't hurt, I don't recommend treatment. The reason for that is the same as I mentioned earlier. I think calluses are a kind of defense mechanism for the skin to overcome repeated external stimuli, so it does not necessarily have to be eliminated, and even if they are eliminated, they will almost all recur under the premise that another stimulus is continuous. I'm telling you a joke like this. There's a callus on the t-eye. I want to get rid of this, how can I do it? If you do nothing and lie down for the rest of your life, it will disappear in a year or two. That's what I'm saying. That's how important repetitive stimulation is for calluses. On the other hand, T-eye often has severe pain. That's why I recommend treatment. Some treatments are recommended because of pain, and secondly, if the stabbing is repeated, inflammation that can cause inflammation in the area can cause wounds if it progresses further and we describe it as an ulcer. Second, bacteria can enter it and cause bacterial infections, so if you have a t-eye, I recommend treatment. Then, how do you treat calluses and t-eye? The basic treatment methods for both are the same. First of all, since the stratum corneum is thick, we need to treat this thick one thinly. And since external stimuli are important, treatments are needed to reduce these stimuli as much as possible. The treatment of thinning the stratum corneum is to shave it off in a nutshell. You can cut it with a knife or with a nail clipper. However, it is certainly necessary to be careful not to bleed or germs enter during the peeling process. That's why I recommend it as an exfoliator. If you stick it on, the stratum corneum will float. Then it would be easier to separate. That's why I recommend you to shave it off or call it through these salicylic acid bands. And to relieve this pressure, I recommend you to wear more comfortable shoes and put on additional pressure-relieving pads. However, it is not easy because it does not work well in practice and it often keeps moving every time I walk. In the case of T-Noon, in addition to that, additional surgical treatment is recommended. The picture you see here is a device called a punch. We often use a device called punch when we drill holes in paper in a circle. In dermatology, these punch instruments are also used to cut the skin in a circle. It is mainly used for biopsy. We have them in each size. Since there are 2mm to 7mm and 8mm in length, the pain will disappear quickly if the core of the T-eye core is removed using this instrument. And in addition to these physical methods, you can use cryotherapy or laser to remove these central nuclei. However, because of the reasons mentioned earlier, T-Noon will recur. The patient on the left is the same patient. As you can see in the picture on the left, there was a t-eye, and we removed the t-eye core well, but after three months, we can see that the t-eye core began to form again. When you have a t-eye, there are often people who remove it by self-cutting at home. If you do it on your own, you can have problems with secondary bacterial infections. Therefore, it is recommended that you do not try to solve the t-eye yourself, but visit a hospital and receive treatment in a more sterile state.

<Understanding the Warts>
◆ Kwon Soon-hyo: So, let's take a look at this picture based on what we've been talking about so far. In this case, it looks very similar to the shape we saw earlier in the tines and calluses. But it's a little different. It's densely packed and there are a lot of numbers. And some of them are in areas where the pressure is not really likely to reach. These symptoms are described as warts. Warts are a completely different disease from T-Noon. It may look similar, but it's a completely different disease. T-eye is the skin's response to external stimuli, as I mentioned earlier, but warts are skin symptoms caused by viral infection. The virus is called human papilloma virus. Warts are the symptoms of the virus penetrating into the skin when it comes into contact with the skin or mucous membrane. The eyes are usually formed in areas where there is a lot of strength in the hands and feet. But warts can develop anywhere. You can get it on your hands, too. Flat warts that occur in places such as the face are also a very common symptom. Like the t-eye I showed you earlier, it can also appear on your hands and soles. It can also occur in the anus and genital organs. So why are warts a problem? The first is because it spreads to other areas. For example, if a mantis is formed in one area, it does not stay still in that state, but it occurs in the next area or another part of my body. Let's take a look at this picture. I have a warts on my toes. You'll keep coming into contact with the second toe that the mantis keeps coming into contact with. Then, as it comes into contact, the virus is transmitted to the opposite second toe. It's like kissing, so it's called kissing words kissing warts. Because of these symptoms, it spreads sideways and patients will touch it. It's weird. Is this a t-eye? If you touch it, it will be transferred to your hand. And the hand will be a good route of infection to the face. That's why warts can spread throughout the body. Not much is known about the rate of spread, but warts depend on what type of virus is, what is your immune status, what is your skin condition, etc. For example, people with a lot of sweat on their hands and soles have the characteristic of spreading more warts. I also transfer it to someone else. I have a warts. Then not only can my wife transmit it to my child, but also to our co-workers. There is a study of many people in the West on which cases warts spread well. If you have a warts patient in your family, you are twice as likely to have warts as those who do not have them in your family. In addition, studies show that the possibility of spreading warts increases if there are patients in the class who use public bath facilities, frequently use swimming pools, or do not use aqua shoes when swimming. Therefore, warts will be a disease that must be treated because they can spread to other parts of my body and spread to others.

<How to distinguish between a mantis and a t-eye>
◆ Kwon Soon-hyo: How can I judge if it's a t-eye or a mantis that looks like this on my feet? First of all, if there are several together, there is a higher probability that they are more warts. And if it looks like it doesn't matter where the weight is put on, it's more likely to be a warts. Crucially, we make a distinction like this. Slightly shave off the thick dead skin cells in this warts. Then you can see blood or red spots underneath it. In that case, it is judged as a praying mantis. The reason is that underneath the warts there is a blood vessel that feeds these warts, so we diagnose them as warts by checking the existence of those blood vessels.

<Cure of the mantis>
◆ Kwon Soon-hyo: There must be a lot of people who have heard of the name. There are a lot of treatments for cryotherapy, laser therapy, and immunotherapy. What is the best treatment? A lot of people ask these questions. To start with the conclusion, it's nothing. Most treatments for warts have a cure rate of 60-70%, so it does not exceed 80%. It has a cure rate of about 3 out of 4 people being cured. Even if it is treated, about a quarter or half of them often recur over time. This is the same for any treatment. That's why there's no such thing as the best way to treat warts. However, there could certainly be the most appropriate treatment. The treatment of warts is largely divided into two. The first is how to destroy warts directly. The second method is to induce an immune response in the body. Treatment that directly destroys warts includes cryotherapy, laser, electrocultivation, bleomycin injection, verumal ointment, a drug called retinoid, and surgical resection. Treatment methods that induce immune responses in the body include DPCP immunotherapy, topical injection of MMR vaccine, and Aldara cream.

<Direct Warts Destruction Treatment>
◆ Kwon Soon-hyo: Among these, my most common treatments are cryotherapy or bleomycin injection, immunotherapy using DPCP, and topical injection using MMR vaccine. Let's take a look at the advantages and disadvantages of these treatments. First of all, it's frozen treatment. When it comes to the treatment of warts, it's a cryotherapy that you might know as a pronoun. -A very cold liquid nitrogen is sprayed over the warts at 196℃. Then the sprayed part will freeze. It will melt in a little while. This process of freezing and thawing destroys tissues, including the warts. It doesn't end with just one treatment. Repeated treatment is performed every two or four weeks, and when treated, it includes some normal skin around it. If you do the procedure, there is no reaction when you go home. However, after about 1 to 2 weeks, you will get a slight scab in that area. The scab is naturally eliminated after a month or two weeks. And if the treatment becomes a little stronger, the area may blister. Even if the blister occurs, I tell you to leave it as it is if it is not inconvenient. If I say it's too uncomfortable to walk or live, I'll tell you to pop the blisters cleanly and apply antibiotic ointment to prevent germs from entering. One of the reasons why cryotherapy is preferred is that there is no need for any action after the procedure. In other words, there is no need to disinfect, apply ointment, or attach a band-aid, except for blisters. The biggest drawback is pain. It hurts even when cold treatment is performed, but if it is short after cold treatment, it will cause pain for about a week in two to three days. Also, before cryotherapy, thick dead skin cells are shaved off. Bleeding can occur during the process. The treated area may have this pigmentation scar that looks white or black around it, just like the picture. When warts are treated around the nails, there are cases where the nails are damaged and the new nails appear a little strange. The second is the bleomycin injection. It's one of the representative anticancer drugs. It is an injection method that suppresses the proliferation of this warts and treats them by injecting this anticancer drug into the area where the warts are. Usually, it is used a lot for the treatment of thick warts that cannot be treated well in more than one or two places. The biggest drawback is that it hurts a lot during the injection. It hurts a lot because this medicine itself causes pain when it enters the skin. I told you earlier that freezing treatment hurts, but most people ask me what hurts more. Many people say that bleomycin injections are about 10 times more painful than freezing treatment. After the procedure, this black scab occurs two to three days later. Many people ask if my skin is necrotic after receiving this injection anticancer drug at this time, and they visit the hospital. It is a normal reaction, and it is a process in which the warts are removed cleanly as the black scab that looks like this falls. In the case of bleomycin injection, I usually avoid the tips of my hands and nails or around my nails. In the case of the ends of the hands and feet, necrosis may occur by making less blood in that area. In the case around the nails, it is usually avoided because it can induce deformation of the nails.

<In vivo immune response therapy>
◆ Kwon Soon-hyo: The third is DPCP immunotherapy, and from now on, it is a treatment method that induces an immune response in the body. The treatment method is largely divided into two stages. The first is sensitization and the second is treatment. Sensitization is a learning step that teaches you to attack this drug when you apply this drug called DPCP. I usually apply it on the inside of my arm. After applying it on the inside of your arm, you will get very red, itchy, or blisters a few days later. And then, with these signals, I'm determined that my body has gone through learning to respond to this drug called DPCP. Then, from then on, this drug is applied to the area where the warts are located. When we apply the drug, the area becomes very itchy and red, and in severe cases, blisters can occur. During this process, this treatment method in which the infected tissues of warts are destroyed and separated is called DPCP immunotherapy. Usually, when you apply the drug, it goes up slowly from a very low concentration and continues to apply it at intervals of one week while it goes up. It is applied repeatedly at a concentration where the itch is maintained for about 2-3 days. The biggest advantage of these DPCP immunotherapy is that there is no pain. There is no pain during this procedure because it is applying the medication. That's why it's one of the ways to do a lot of procedures for very young children. However, there is a drawback. The intensity of the immune response cannot be predicted. When you apply the drug, there are cases where the reaction is casual and there is no reaction, and in severe cases, that part can be very itchy. However, there are some cases where systemic itching or hives occur beyond that area. Therefore, although it rises slowly from very low concentrations, it is inevitable that these side effects can occur at some point. Also, there is a disadvantage of having to visit the hospital often and apply drugs. One of the disadvantages is that the sensitization area I mentioned earlier turns black and can cause scars and pigmentation. The following are topical injections using MMR vaccines. You may have heard of MMR vaccines. It will be a vaccination against measles, mumps, and rubella. In Korea, it is a vaccine that is mandatory for all children to get vaccinated. These vaccines are injected every two or four weeks in the area with warts. After we get vaccinated, you've often experienced redness, pain, or throbbing areas. It means that such an immune response is caused by injecting warts into it. The downside is that you have to get a shot, so of course it hurts. However, the advantage is that there is no inconvenience after the procedure. It compares with the fact that the cryotherapy was sick for a few days earlier. And if you get an injection in one place when you have multiple warts, you can aim for the effect of treating warts in other areas. There are also very few scars after treatment. Therefore, local MMR vaccine injections have been used a lot recently. However, as I mentioned earlier, most warts' treatments don't say what's better or what's worse. Therefore, when choosing a treatment method for warts, we recommend the best treatment for this patient by combining where the warts are, how big they are, how old they are, their gender, and their immune status.

<Civilian therapy 'Yulmu'>
◆ Kwon Soon-hyo: There is a lot of Yulmu when it comes to warts treatment. The Yulmu pack was used to treat flat warts and was cured. You can see a lot of comments like this. There is certainly a record of the use of Yulmu in traditional medicine to treat warts. And even in neighboring Japan, the Yulmu extract eaten is approved for this treatment of warts. However, other countries except Japan have not yet been used to treat warts, which is an extract of yulmu. Research that can prove it is also extremely insufficient. Therefore, it can be said that Yulmu powder, Yulmu pack, and Yulmu patch, which you may be using a lot of folk remedies, lack evidence for the treatment of warts.

<The Water Witch>
◆ Kwon Soon-hyo: The last one is the water mantis. It has a similar name, but it's a completely different kind of virus from warts. It usually occurs in young children. If you have atopic dermatitis, you have more water mantis, and it has a very large number of water mantis and lasts longer. Characteristically, in this photo, as long as the center is dug deep like a navel, these bumps about half a centimeter in size occur. Unlike previous warts, warts are known to heal naturally over time as they age. However, the problem is that it is cosmetic if it is visible from the outside because of the face, or if the guardian wants treatment, most of the cases are recommended at daycare centers, kindergartens, or schools where the child attends. In that case, they do the treatment of weaving the water mantis themselves. It is more cautious in treatment because pain can occur and scarring can occur.

<Medical AI Q&A>
◆ Kwon Soon-hyo: Viewers sent me questions about t-eyed and warts. Shall we check it out together?

◇ Y-GO (AI Anchor): When I bought a T-eye remover from the pharmacy and removed the T-eye on the sole of my foot, my skin was dug about 0.3cm. What kind of care do you need?

◆ Kwon Soon-hyo: In this case, it seems that you've removed the t-eye well. In other words, it seems that you have removed the core well. However, since this person did not remove the tinea pig while sterilized, it is necessary to observe with the possibility of secondary bacterial infection or recurrence in mind. If you have symptoms of a secondary bacterial infection, that is, pain or swelling, then it is recommended that you visit the hospital.

◇ Y-ON (AI Anchor): I'm looking for laser treatment for flat warts, but I'm worried because the laser used by each hospital is different. What is the difference between CO2 laser and abum yag laser?

◆ Kwon Soon-hyo: Both lasers can be used for the treatment of flat warts because they are lasers that destroy the target skin tissue by applying heat. In fact, there are no studies comparing the effects of these two. But I think the effect will be almost the same in theory.

◇ Y-GO (AI Anchor): My father has diabetes and has been hiking a lot lately. It's said to have a t-eye. How should I manage it?

◆ Kwon Soon-hyo: Foot care is very important for people with diabetes. Once a wound is formed and a problem occurs, it is often not cured and causes continuous problems, so you have to watch with constant interest in managing diabetic feet, but you probably overlooked the initial symptoms when you were hiking. Most of them may have symptoms such as redness, tingling, soreness, or swelling before developing T-eye, but they seem to have progressed to T-eye by missing it. First of all, you need to visit the hospital for treatment for the already formed t-eye. In the future, you will need to receive a little more education on how to manage symptoms before these symptoms occur and continue to manage them.

◇ Y-ON (AI Anchor): How can I prevent warts and tines?

◆ Kwon Soon-hyo: In the case of T-eye, we need a way to reduce the pressure. As I introduced earlier, you can try braces shoes or pressure distribution pads. Secondly, in the case of warts, it is important to avoid contact with the warts patient or the path of infection of the warts. There is a park in front of my house. I've seen elderly people walking around in line barefoot in the park. You seem to be practicing barefoot walking, which has been popular for a few years, and through these barefoot walking behaviors, the virus of warts in the soil can spread the skin. Therefore, I don't recommend this method. I recommend you to wear aqua shoes when you go to the swimming pool or the beach. There are a lot of people who come here because they moved here.

<Remember this>
◆ Kwon Soon-hyo: I feel sorry whenever I see a person who misunderstands warts as a t-eye or raises them with folk remedies such as Yulmu. Please remember that the earlier you receive treatment, the higher the treatment effect and the shorter the treatment period. Today, I hope this broadcast will help you live a healthy and happy life. Thank you.