Warts

Facts on Warts

  • Warts are small harmless tumors of the skin caused by a virus called the human papillomavirus.
  • The appearance of warts can differ based on the type of wart and where it is located on the body.
  • Most warts are well defined, with skin thickening.
  • Very few go on to develop hyperplasia or malignancy (found most often with genital warts).
  • The focus of this article is nongenital warts; when people want information about "warts," most commonly they mean nongenital warts.
    • Warts are common in children.
    • Most cases occur between ages 12-16 years.
    • Some warts disappear by themselves within six months.
    • Most will disappear without any treatment within three years.

Wart Causes

Warts are caused by the DNA-containing human papillomavirus (HPV). There are at least 100 genetically different types of HPVs.

  • The virus enters the skin after direct contact with recently shed viruses kept alive in warm, moist environments such as a locker room, or by direct contact with an infected person. The entry site is often an area of recent skin injury. The incubation time (from when the virus is contracted until a wart appears) can be one to eight months.
  • Contrary to popular mythology, touching a frog will not give a person warts.

Wart Symptoms and Signs

The three most common types of nongenital (not appearing on the genitals) warts and one uncommon type are these:

  • Common warts (verrucae vulgaris): These common warts typically develop on the hand, especially around the nail. Common warts are gray to flesh colored, raised from the skin surface, and covered with rough, hornlike projections.
  • Plantar warts (verrucae plantaris): Plantar warts, by definition, occur on the plantar surface, or bottom, of the foot. They usually occur in high-pressure areas such as the heel and the metatarsal heads (just behind the toes). Plantar warts usually grow into the skin, not outward like common warts. This growing into the skin makes plantar warts more difficult to treat.
  • Flat warts (verrucae plana): Flat warts are most commonly seen on the face and the back of the hands. They usually appear as small individual bumps about ¼ inch across. Flat warts may spread rapidly on the face from activities such as shaving.

When to Seek Medical Care for Warts

When to call the doctor

  • Call the doctor if the wart continues to worsen despite home therapy. If you see no improvement in the wart using salicylic acid after 12 weeks, call the doctor for an appointment to discuss other methods of wart removal.
  • Call the doctor if the wart changes shape or color. There is the possibility that you are not treating a wart.
  • Call the doctor if the wart starts bleeding after only a slight brush or bump or if you have difficulty stopping the bleeding while trimming the wart.
  • Anyone with genital warts (vaginal, anal) should see a doctor. The treatments described here are not appropriate for genital warts and should not be used.

When to go to the hospital

Aside from pain from plantar warts that cannot be controlled with over-the-counter medication, there is no need to visit a hospital's emergency department for wart treatment.

Wart Diagnosis

The diagnosis of a wart is made by its location and appearance. If uncertain as to the type of skin problem, the doctor may elect to perform any of several different tests.

  • Punch biopsy: This is a more invasive way of obtaining a sample of the questionable wart. The doctor will numb the area around the wart and take a deeper coring sample. This skin and questionable wart will be sent to a laboratory for further evaluation that is not possible in a doctor's office. See information about moles and mole removal.

Home Remedies for Warts

Home care is effective in making the wart or warts go away. No matter what technique you use, warts will disappear 60%-70% of the time. Techniques may be done with or without medication.

The ultimate goal of the medical therapies (not the surgical treatments) is to get your body to recognize the wart as something foreign and to destroy it, much like the body destroys a cold virus.

  • Salicylic acid therapy
    • Salicylic acid is available by many different trade names at the drugstore. It comes both as a liquid to paint on the wart or as a plaster to be cut out and placed on the wart tissue.
    • The area with the wart should be soaked in warm water for five to 10 minutes. The wart should then be pared down with a razor. A simple plastic razor works fine for this, then throw it away. Do not shave far enough to make the wart bleed.
    • Apply the salicylic acid preparation to the wart tissue. Do not apply it to other skin because of salicylic acid's potential to injure normal tissue.
    • Follow directions on the package for how long to apply the acid.
  • Cryotherapy: Over-the-counter products to freeze the area of the wart using dimethyl ether and propane are available.
    • Follow package instructions exactly. Do not get the product on surrounding intact skin.

Other alternative therapies mentioned by some articles include heat treatments and even hypnosis.

Wart Treatment

In addition to recommending the home care treatments, your doctor may choose to treat the wart more aggressively.

  • Liquid nitrogen: Liquid nitrogen or cryotherapy is used to deep freeze the wart tissue. With liquid nitrogen applied to the wart, the water in the cells expands, thus exploding the infected tissue. The exploded cells can no longer hide the human papillomavirus from the body's immune system. The immune system then works to destroy the virus particles.
  • Laser therapy: Lasers are simply very intense light sources. This light has an enormous amount of energy that heats the tissue enough that it vaporizes.
  • Other therapies mentioned in the literature include imiquimod (Aldara, Zyclara), cantharidin, and several other medications and methods that are usually suggested or administered by a physician.
  • Surgical removal: Surgery may be necessary when other treatment methods fail. This would involve numbing the region around the wart and cutting out the wart.
  • Destruction by scraping and burning the lesion; the wart area is numbed with a local anesthetic and then the doctor heats the tissue with an electric needle. The dead tissue is then scraped away with a curette ( a type of surgical tool).

Follow-up Wart Care

Follow the home care plan or treatment given to you by your doctor. Several of the wart-removal treatments, such as liquid nitrogen and laser therapy, may require repeat visits.

  • If your wart was treated with liquid nitrogen, laser therapy, or surgical removal, apply local wound care. Local wound care includes keeping the area covered with a sterile bandage, applying an antibiotic ointment, and looking for signs of an infection.
  • Signs of an infection include increasing redness and pain at the treatment site, red streaks going up an extremity toward the heart, pus coming from the wound, or a fever of 101 F or higher. If any of these occur, you need to follow up with your doctor or be seen in a hospital's emergency department.

Wart Prevention

Avoid touching warts on others or touching them on yourself (refrain from rubbing a warty finger across your face). Wear shower shoes in the gym locker room to lower your risk of picking up the virus that causes plantar warts from the moist environment.

Wart Prognosis

The prognosis for warts is usually good. Most warts will disappear without treatment in six months to three years. Home remedies are often effective. When home treatment does not work, there are several medical options that remove the wart. However, warts tend to reoccur.

Wart Pictures

A common wart shows up as a pink circle toward the top of the hand.
A common wart shows up as a pink circle toward the top of the hand. Click to view larger image.

A plantar wart can be seen on this foot in a common position on the heel.
A plantar wart can be seen on this foot in a common position on the heel. Click to view larger image.

Reviewed on 11/20/2017

Medically reviewed by Norman Levine, MD; American Board of Dermatology

REFERENCE:

Shenefelt, Philip D. "Nongenital Warts." Medscape.com. June 23, 2011. <http://emedicine.medscape.com/article/1133317-overview>.

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