Warts (verruca) are small growths that appear most frequently on the hands and feet. Sometimes they look flat and smooth (flat warts), and other times they have a cauliflower-like appearance. Warts are caused by different forms of Human Papilloma Virus (HPV). They are most common in children, but they can occur in people of all ages and can spread from person-to-person or from one part of the body to another.

Warts are benign (noncancerous) but can be persistent. Nearly ½ of warts disappear after 1 year without treatment and up to ¾ after 2 years. Several treatments are often necessary before clearance. The wart growth can be destroyed but if the virus persists, the warts may continue to recur until the body eliminates the virus from the skin.

Types of Warts:

Common warts (verruca vulgaris) can appear anywhere on the body, although they most often appear on the back of fingers and hands, forearms, toes and knees. These skin-colored to pink small bumps have a cauliflower-like texture. Some lesions are filiform or long and slender. They can range in size from as small as a pinhead to as large as a marble and may appear singly or in multiples. They can occur around and even underneath fingernails and thus be difficult to treat.

Flat (plane) warts are flesh-colored or white, with a slightly raised, flat surface and they usually appear in multiples. Flat warts are more common among children and teens than adults.

Genital warts appear around the genital and pubic areas. It is also possible to get genital warts inside the vagina and anal canal or in the mouth. The lesions start small and soft but can become cauliflower-like and quite large. They often grow in clusters. They are sexually transmitted and highly contagious. In fact, it is recommended you generally avoid sex with anyone who has a visible genital wart. The virus persists for life and recurrences are common. Genital warts should always be treated by a heath care professional. Patients with genital warts are at higher risk for cancer of the genital region, including cervical or vaginal cancer in women and penile cancer in men. The recent HPV vaccine given to young women is designed to target the type of HPV that causes these warts and can lead to cancer.

Plantar warts appear on the soles of the feet and can be painful since they are on weight-bearing surfaces and are very firm. They have a rough, slightly raised, cauliflower-like appearance and may have a small black specks in them. They often appear in multiples and may combine into a larger wart called a mosaic wart. Plantar warts can be very difficult to treat.

Treatments for warts include:

Over-the-Counter Treatments

  • Nonprescription freezing products (dimethyl ether), aerosol sprays that freeze the warts. These products are not nearly as cold as the liquid nitrogen treatment, and thus may be less effective.
  • Salicylic acid preparations, which dissolve the tissue that makes up the wart and the thick layer of skin that covers it. It comes in gels, pads, drops and plasters and takes several weeks to eradicate the warts.
  • Duct tape, which most likely irritates the wart tissue to cause the body to attack the wart and the wart virus.

In Office Treatments

  • Cryotherapy, in which the wart and adjacent skin is frozen using liquid nitrogen, a liquid which is – 300 degrees F. This creates a blister and wart often comes off with the blister skin.
  • Electrodessication, in which a hyfrecation machine sends an electric current into the wart to destroy the tissue with heat.
  • Laser removal, which either vaporizes the wart (ablative lasers like CO2 or Erb:YAG) or destroys the blood vessels supplying the wart and using heat to destroy the wart (pulsed-dye laser)
  • Shave technique, which involves numbing the site and shaving the wart with a sharp blade.

Since warts are self-limited and there are OTC options, it is reasonable to not treat or to attempt home treatments. If the warts are numerous, irritating, painful, rapidly growing or resistant to OTC therapies after a few months, contact our skin specialists. We can assess your warts and recommend treatment plans.

Remember, the body’s immune system must eliminate the virus before you can ensure clearance. The virus can live a ½ inch from the obvious wart.

We highly recommend being seen quickly for any lesion on or around the genitals because of the potential for transmission to others and the risk of future cancer.