- Viral warts are a viral infection of the skin where grainy lesions grow on the skin surface.
- Warts most commonly appear on the hands and fingers but they can also affect the feet, face, genitals, and knees.
- Warts are mostly Benign and not cancerous but can resemble certain cancers.
- Warts are often small and the same color as the skin, but this can vary depending on type and severity.
What causes warts?
- Human papillomavirus (HPV) is the causative agent for viral warts.
- The virus enters the skin after direct contact with recently shed viruses or by direct contact with a person who is infected.
- It takes a long time for the symptoms to appear because the incubation period of the viral is around 6-12 months.
Anyone can get warts.
Some people get a wart virus (HPV) more often than others. Such as:
- Children and teens: A virus can easily enter the skin when you have a cut or scrape on your skin surface. This explains why so many children get warts.
- People who have the habit of biting their nails or picking at hangnails.
- People with a weakened immune system such as those with HIV/AIDS or people who had organ transplants.
Yes, it is highly contagious and spreads from person to person by direct or indirect contact.
- It can spread from one place on your body to another, for example, warts from the hands can spread to the face through touch or nail-biting.
- You can get warts from touching a wart on someone’s body.
- Some people get a wart after touching something that another person’s wart has touched, such as a towel.
- Warts are likely to grow commonly on parts of the body that people shave such as the beard area in men and the legs in women.
- Sexual transmission (for genital warts).
What are the different types of warts and where they can grow?
- There are different types of warts in the body. The type is determined by where it grows on the body and how it looks.
1. Common warts (vurruca vulgaris)
- Children frequently get common warts.
- Commonly grow on the fingers, around the nails, and on the backs of the hands.
- More common where the skin was broken, such as from biting fingernails.
- May have black dots that look like seeds (often called “seed” warts).
- Most often feel rough in texture, grey/brown in color, and dome-shaped.
2. Plantar warts (foot warts)
- Most often grow on the soles (plantar surface) of the feet.
- Can grow in clusters (mosaic warts).
- It can appear as flat or grow inward (due to pressure while walking, which causes warts to grow inward).
- Can be painful and feels like pebbles in your shoe.
- Can have black dots.
3. Flat warts
- Can occur anywhere.
- Children usually get them on the face.
- The common site for men is in the beard area, and women tend to get them on their legs.
- Smaller and smoother than other warts.
- Often Multiple in number — 20 to 100 at a time.
4. Filiform warts
- Looks like thin fingers or long threads that stick out.
- Commonly grows on the face: around the mouth, eyes, and nose.
5. Genital warts
- Grows on the genital areas of the body
- It spread through sexual transmission
- Periungual warts
- They arise around the nails and difficult to diagnosis
- They may lead to permanent nail dystrophy
6. Butcher’s warts
- A ‘cauliflower’-type lesion, most commonly seen in meat handlers.
- Small grainy lesions usually painless
- Dome-shaped or flat
- Lesions occur singly or in clusters
- Rough to touch, sometimes can be smooth in texture
- Skin colored, brown, or grey in color
- Black pinpoint dots
- Examining warts: A dermatologist can tell whether you have a wart by looking at it.
- Biopsy: Skin biopsy can be performed by removing the wart and sending it to a lab for examination under the microscope.
How do you treat a warts?
- In case of children, warts often go away without treatment.
- In adults, warts usually do not disappear as easily and quickly as they do in children.
Medical Treatment
Topical agents:
- Salicylic acid is the first-line therapy that is painless and most commonly used. It is available without prescription in the dispensaries. It is applied over warts every day. It takes many weeks of treatment to have good results. Stop the treatment for a short time when the wart or the skin around the wart starts to feel sore.
- Cantharidin: A dermatologist will paint the wart with cantharidin, which causes a blister to form under the wart. After a week, the dermatologist will clip away the dead wart.
- Trichloroacetic acid (TCA 80%)
- Tretinoin: Effective for the treatment of flat warts
- Podophyllin: A cytotoxic compound used commonly for the treatment of genital warts
- 5-fluorouracil cream
- Contact sensitizers: diphenylcyclopropenone (DCP)
Systemic agents:
- Retinoids
- Cimetidine
- Intravenous cidofovir
Intralesional agents:
- Bleomycin: An anti-cancer medicine, bleomycin is injected into warts. The shots may hurt. It has certain side effects, such as nail loss if given in the fingers.
- Interferon-alpha: It is a naturally occurring cytokine with antiviral, antibacterial, anticancer, and immunomodulatory effects
Cryotherapy (Freezing)
It is the most common treatment used for common warts in adults and older children.
It can cause dark spots and repeated treatment sessions may be needed.
Electrosurgery and curettage
Electrosurgery (burning) is a good treatment for common warts, filiform warts, and foot warts. Curettage involves scraping off (curetting) the wart. These two procedures often are used together. This procedure is painful and often leaves a scar.
Excision of the warts
If the warts are hard-to-treat or do not provide satisfactory improvements, excision may be done to remove warts.
Laser treatment
Laser treatment is used as an option, mainly when warts do not respond to other therapies.
Photodynamic therapy
A photosensitizer (5-Aminolevulinic acid (ALA)) is used topically and kept under occlusion, then followed by photoactivation with red light or with blue light to treat flat warts.
Immunotherapy
This treatment uses the immune system of the patient to fight against warts. It is used when warts remain in spite of other treatments. For example,
- Application of a chemical, such as diphencyprone (DCP), to warts, causes a mild allergic reaction around the treated warts. This reaction may cause warts to disappear.
- Interferon shots can boost the immune system which gives the body the ability to fight the virus.
- There is no cure for the wart virus.
- It can return to the same site or appear in a new spot. This is due to the shedding of the virus cells by the old virus into the skin before the warts are treated. Because of this new warts grow around first warts.
- Treat your new warts as soon as they appear. It is the best way to prevent the spread and new growth of warts.
What are the consequences of warts if not treated?
- Disfigurement: unappealing lesion on hand, fingers, feet, and face leading to an ugly appearance.
- Infection
- Pain
- Cancer: genital warts are linked to anal cancer and cervical cancer.
Are warts dangerous?
Most warts are harmless unless they are painful and ugly looking causing embarrassment.
If left untreated, warts may get bigger in size, new warts may appear, and the chances to spread to someone else increases. Hence the early treatment is necessary for a good outcome.
- Calluses and Corns (clavi)
- Lichen planus
- Seborrheic keratosis
- Skin tags (acrochordon)
- Squamous cell carcinoma
Can I treat warts at home?
Yes, You can get some wart remedies without a prescription and treat the warts yourself at home. This may be enough to get rid of some warts.
Some home remedies include-
- Daily Application of Salicylic acid which is available without prescription.
- Adhesion Therapy is performed by applying duct tape to the wart daily and changing the tape every few days might peel away layers of the wart. This method is painless and inexpensive
- Hot water immersion (45ºC) for 30-45 minutes, 2-3 times per week
- Raw garlic cloves
- Tea tree oil
When to consult a dermatologist?
The only problem with self-treatment at home is that sometimes you might be mistaken for another kind of skin growth for a wart. Some skin cancers look like warts.
Consult a dermatologist immediately if –
- A suspicion that the growth is not a wart.
- A wart on your face or genitals.
- Multiple warts.
- Warts that hurt, itch, burn, or bleed.
- Warts that have become infected
- Change in appearance of the wart
- Spreads easily to other parts of the body
- Comes back after removal
- A weakened immune system (diabetes, AIDS, etc.).
- You have Diabetes. Do not try to remove any wart on your foot if you have diabetes.
What can I do to prevent warts from spreading?
- Do not pick or scratch at warts.
- Cover warts with a bandage to prevent it from spreading
- Wash your hands after touching warts
- Wear waterproof covering shoes in public showers, locker rooms, and pool areas.
- Do not touch someone’s wart.
- Keep feet dry (in case of foot warts), as moisture allows warts to spread.
- Avoid brushing, clipping, or shaving areas that have warts
- Use condoms to prevent genital warts
- Vaccination is available to prevent infection against human papillomavirus. For example Gardasil protects against HPV type 6 and 11 which is responsible for 90% of genital warts.
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