Warts

What Is It?

Warts are small skin growths caused by the human papilloma virus (HPV), which infects the top layer of skin. There are more than 40 different types of HPV. The wart virus can be transmitted from one person to another either by direct contact, or indirectly when both people come in contact with a surface, such as a floor or desk.  

People may come into contact with HPV by walking barefoot in public places, such as gyms and shower floors or by sexual contact. HPV also can be transmitted in the same person from one spot on the body to another. It is easier for HPV to infect a person when the person's skin is scratched or cut. 

Warts can appear at any age but are more common in older children and are uncommon in the elderly. A wart's appearance varies with its location and the type of virus that has caused it. For example, flat warts commonly appear on the face, neck, chest, forearms and legs. Most warts go away after a year or two, but some last for years or come back after going away.  

Warts can itch or bleed. When warts are located in areas that are rubbed against clothing or bumped frequently, they can become irritated and the skin around them can become painful. 

Symptoms

The two types of warts seen most often are common warts and plantar warts.  

• Common warts have a rough surface and well-defined borders. They are round or irregular in shape and usually range from 2 millimeters to 10 millimeters wide (the size of a pencil eraser or smaller). Common warts are firm and can be light gray, flesh-colored, yellow, brown or gray-black. They occur most often near the fingernails and on the backs of the hands, but they also can appear on the elbows and knees. Common warts usually do not hurt.  

• Plantar warts appear on the bottom (sole) of the foot. They are flattened by the pressure of standing on them and can be dotted with tiny, clotted blood vessels that look like dark pinpoints. Plantar warts often are painful, especially when they're on a weight-bearing part of the foot. Plantar warts may require vigorous, repeated treatment before they go away. 

Other types of warts include:

• Genital warts appear on and near the genitals of men and women, as well as inside the vagina and on the cervix in women.

• Cervical warts appear on the cervix and sometimes develop into cervical cancer. 

• Mosaic warts appear on the feet. They are groups of many small, closely set plantar warts.  

• Filiform warts appear on the eyelids, face, neck or lips. They are long, narrow growths that usually grow straight out from the skin.  

• Flat warts appear on the face and along scratch marks. They are smooth, flat-topped, yellow-brown papules and are more common in children than in adults.  

• Pedunculated warts appear on the head and neck, scalp and beard and are shaped like cauliflower. 

Diagnosis

A doctor usually can diagnose warts by looking at them. Sometimes, the doctor will have to take some tissue from a wart and analyze it under a microscope. An HPV test can also be performed on samples taken from the cervix during a woman's pelvic exam.  

Expected Duration

Even without treatment, warts may disappear in months or years on their own. However, there is always a chance they will come back. 

Prevention

It is difficult to prevent all warts. You can reduce your chances of getting warts by avoiding skin contact with existing warts and with contaminated floors, such as those in locker rooms and around swimming pools. Vaccination, abstinence or safe sex techniques (such as condom use) can reduce the risk of genital warts. 

The vaccine for HPV can prevent infection with the most common viral strains responsible for genital warts; by preventing these infections, the vaccine can also reduce the risk of cancers, including cervical, anal and penile cancers, that complicate chronic infection with these viruses. Vaccination is recommended for 11 to 12 year-old boys and girls; vaccination earlier (at age 9) or later (age 13-26 for females, 13 to 21 for males) may be recommended in some cases.

Treatment

Most warts disappear within a year or two, even if they are not treated; however, without treatment warts may spread. Many people choose to have warts treated either because of minor pain or for cosmetic reasons. Treatment depends on the location of the wart, its type and size, a person's age and health, and his or her willingness to follow through with repeated treatments.  Genital warts should be treated and monitored in order to detect or prevent related cancers. 

Over-the-counter liquids and patches containing salicylic acid can decrease the size of a wart, but they should not be used on the face or genitals. Your doctor may treat a wart by applying certain medications or acids, freezing it (cryotherapy) or surgically removing it. 

When To Call a Professional

If you think you might have a wart, you should show it to your doctor at your next visit to make sure it is a wart and to discuss treatment. 

Seek help if your wart causes pain, bleeds easily, spreads easily to other areas of the body or comes back, or if you want the wart removed for cosmetic reasons. You also should see your doctor if you develop genital warts, so they can be treated. 

Prognosis

Warts usually disappear within a year or two and are little more than an inconvenience. But because they shed virus particles into the surrounding area, they are contagious and can cause new warts to appear nearby. In some people, warts may be a more chronic (long-lasting) problem. These people may have individual warts that won't go away or they keep getting new warts. Warts that continue to persist or grow despite treatment should be examined by your doctor since some skin cancers can masquerade as warts. 

Additional Info

American Academy of Dermatology
https://www.aad.org/

American Podiatric Medical Association (APMA)
https://www.apma.org/