Warts (Common Warts)

Warts are small skin growths that are usually harmless and that are caused by the human papillomavirus.

Warts are small, self-limited benign tumors caused by one of over 100 types of human papillomaviruses (HPV).

Warts respond variably to various treatment measures, or they may disappear spontaneously, which may take years. Over-the-counter treatments for warts include salicylic acid preparations and freezing kits. Warts may recur following treatment.

Genital warts are caused by touching the genitals of an infected person.

Different and common types of warts include:

• Common warts: Small, rough bumps typically flesh-colored or greyish with small black specks; they appear alone, usually on hands and fingers (common among children).
• Flat warts: Small, smooth lesions that form clusters on the face, legs, or back of the hands.
• Plantar warts: Hard, flat lesions (sometimes mistaken for corns) that affect the sole or the heel and may at times be painful due to the weight of the body.
• Filiform warts: Long, thin lesions that grow near the eyes and on the face and neck.
• Periungual and subungual warts: Lesions that grow around or beneath fingernails. They are common in people who bite their nails.
• Genital warts (condyloma acuminatum): Tiny, flat lesions that sometimes develop in groups on the genitalia (internal or external). They are more serious due to their associated emotional and social impact (e.g., embarrassment, isolation) and health risks (potential to develop into cancer). Transmission occurs during direct sexual contact, with lesions appearing from 1 to 24 months after sexual intercourse. This type of wart requires special treatment.

Warts are caused by infection with certain types of human papillomavirus (HPV). The virus causes the skin to produce excess keratin, making the site of the wart hard and rough. It affects the upper layer of the skin called the epidermis.

You can get HPV and develop a wart from any surface or object someone with warts has touched or used. Warts can affect people of all ages.

Warts are also spread through direct contact with a person who has warts. You may get genital warts by engaging in unprotected sexual activity with an infected person. A wart may appear weeks or even months after infection from someone else.

There is a familiar type of dome-shaped warts on the backs of fingers, toes, and knees. These warts often have small black dots on their surfaces, which represent multiple thrombosed (clotted) capillaries. Some people mistakenly call these dots "seed warts."

Warts vary depending on their type and location, but some indicators of warts include:

• Warts are often small fleshy, grainy bumps.
• Warts are often rough to the touch.
• Warts can be sensitive or painful, though not always.
• Warts can appear white, flesh-colored, tan, or even grayish.
• They may also be sprinkled with small, black pinpointed blood vessels.

Your doctor will complete a physical exam to diagnose warts based on their appearance. They will usually diagnose warts based on their appearance but may also use a small blade to scrape away the top layers of the wart to assess its texture. Many warts have black dots beneath the top layers. These are tiny, clotted blood vessels.

For persistent warts, you may need to see a dermatologist for specialized treatment. In some cases, your dermatologist takes a sample of the wart and completes a biopsy.

Common warts can be annoying to anyone. It is worth considering that, in normal people, half of all warts, on average, spontaneously go away within about 18 months. The information in this article is about the treatment of common warts. It does not apply to venereal or genital warts.

Over-the-counter treatment for common skin warts has long been based upon the use of products containing salicylic acid to destroy the wart. Newer nonprescription wart treatments include carbon dioxide aerosols to freeze warts.

Salicylic acid preparations

These are available as drops, gels, pads, and plasters. They are designed for application to many types of warts, from tiny ones to larger ones. Salicylic acid is a keratolytic medication, which means it dissolves skin protein (keratin), which makes up most of the mass of the wart and the thick layer of dead skin that often surmounts it.

Nonprescription freezing methods

Aerosol wart treatments that are available over the counter use sprays that freeze warts at a temperature of minus 90 F (minus 57 C). This compares with the liquid nitrogen used by most dermatologists, which is considerably colder (minus 320 F or 196 C). The over-the-counter products may not work nearly as well as the colder agents a doctor applies.

Duct tape

It has been reported that warts can be treated with duct (duck) tape or other nonporous tapes, such as electrical tape. This treatment requires that the tape be left in place all the time and removed only a few hours once per week. The tape must be replaced frequently. There is no firm scientific evidence that duct tape is effective, based on published studies that have shown mixed results.

Other Home Remedies

Garlic, Vitamin C paste, fruit juice soaks, and even hypnosis have been touted as natural treatments for warts, but none have been proven to be effective.

It is important to follow the directions when treating warts with nonprescription medications. If salicylic acid gets on normal skin, it can cause burning or redness but rarely infection or scarring. The skin returns to normal when the individual stops applying the salicylic acid product.

Still, it's probably better not to use salicylic acid on sensitive areas like the face or groin, where it's likely to make nearby skin raw and uncomfortable. It generally is recommended that salicylic acid not be used in people with diabetes or in areas where there is poor circulation.

Likewise, nonprescription freezing products are also reasonably safe but must be used carefully and only according to package instructions because they work by destroying living tissue.

Above all, wart treatments require patience. The fact that there is a wide variety of wart treatments is evidence for the fact that there is no single best therapy. Warts can appear and disappear without an identifiable cause and often disappear on their own without treatment. Warts are generally painless unless they are present in areas prone to pressure or friction like the palms and soles. Treatment methods may require several sessions over weeks, months, or longer.

Here is a practical approach to the treatment of warts:

1. Ignore warts. Eventually, they'll go away (although eventually can mean a long time -- even months or years).
2. With an uncomplicated case (a single wart on the face or one or a few on the hands), see a doctor for a quick freeze or electrical destruction. These methods are simple, although somewhat painful, and generally non-scarring.
3. With a difficult case, start by treating warts for a few weeks at home. Here are some examples:
   • Plantar warts: Warts on the bottom of the foot feel deep, but they are still within the superficial layer of the skin. Tender plantar warts can be rendered painless by paring the wart thinner without causing bleeding. Salicylic-lactic acid (Duofilm solution) in flexible collodion and plasters helps remove the thick overlying callus responsible for making the wart feel less like a marble in the shoe. Nonprescription aerosol freezing may be used, as well.
   • Common hand warts: These are typically unattractive although not painful. Salicylic acid often shrinks the wart, encouraging resolution, as can nonprescription freezing.

With an all-but-impossible case, don't try too hard. Don't make the treatment worse than the disease. Here are some examples:

• Warts under and around the nails: These are extremely resistant to treatment. One or two tries by the doctor are worth a shot, but if they fail, putting acid on them just makes them look rough and unattractive.
• "Mosaic" warts: These tiny warts can proliferate by the dozens or hundreds all over the sole. They don't usually hurt, and they rarely respond to any sort of treatment, although in this case, too, one or two tries at treatment may be in order.
• Flat warts: These are small, flat, flesh-colored bumps and may be numerous on one part of the body (for example on the face, arms, or groin). Getting rid of them with a light application of salicylic acid or other methods is easy enough, but they tend to recur.

If these treatments fail, see a doctor to freeze the wart with liquid nitrogen or burn it with an electric needle.

Other treatments a doctor may use include:

• Topical cantharidin
• Imiquimod (Aldara), an immune stimulator that is approved for use on genital warts but has been reported to be effective in some common warts as well -- note that it is quite expensive
• Injections of Candidin (an extract to test for sensitivity to Candida yeast)
• Injections of bleomycin, a chemotherapeutic agent used in cancer treatment
• Treatment with a contact-sensitizing agent
• Surgical destruction

Unless warts are very large and uncomfortable, surgical removal or aggressive laser surgery to remove the warts is generally avoided because of the likelihood of scarring. Since warts are caused by a virus, they may recur following attempts at surgical removal or any other type of therapy. Currently, there is no evidence that vaccination against sexually acquired HPV types has any effect on the prevention or treatment of common wart infections. However, the vaccine helps.

In general, warts are harmless and do not pose much risk. If you notice a wart that does not change much in terms of size, shape, or color, you may not need to see your doctor.

You should however seek medical attention if you are in your 50s and start developing new warts. Warts that bleed quickly or grow at a fast rate may be a sign of a serious condition or complication.

After getting rid of a wart, you will probably want to make sure it doesn't come back. Since HPV is a virus, you can never get rid of it in your body.

You can prevent future wart growth using preventative measures:

• Avoid touching another person's wart(s)
• Don't share towels, razors, or shoes
• Clean and cover open wounds like cuts and scrapes
• Wash your hands frequently
• Moisturize to prevent dry, cracked skin
• Don't chew or pick at your nails
• Wear flip-flops around pools, showers, and locker rooms

Vaccinate against HPV to help prevent and protect against the development of genital warts.