Warts (Common Warts)

Medical Author : Gary W. Cole, MD, FAAD

Medical Editor : William C. Shiel Jr., MD, FACP, FACR / Melissa Conrad Stöppler, MD

Illustration of a wart on the thumb with a callout detail.

 

Wart facts

  • Warts are small, self-limited tumors caused by human papillomavirus (HPV) infection.
  • Types of warts include common warts, flat warts, plantar warts, periungual warts, and filiform warts.
  • Warts typically disappear on their own with time, but it may take years.
  • Warts respond variably to a variety of treatment measures.
  • Over-the-counter treatments for warts include salicylic-acid preparations and freezing kits.
  • Warts may recur following treatment.
    Illustration of a genital wart. The human papillovirus (HPV) is visible near the wart and which is responsible for the wart. The blue cells represent the immune cells.

    What are warts? Are warts contagious?

    Warts are local growths in the skin that are caused by human papillomavirus (HPV) infection. There are over 100 types of HPVs. Some HPV types infect the genital and oral mucosa and produce large, unpleasant masses, some of which may become cancerous. Other, HPV types are responsible for common skin warts and are not associated with cancer. Although warts are considered to be contagious, it is not uncommon for just one family member to have them. In addition, they often affect just one part of the body (such as the hands or the feet), but they can be spread to other areas by picking them. 
    Examples of (1) dome-shaped wart, (2) plantar wart, (3) flat (plane) wart, (4) periungual wart, and (5) filiform wart.

    What are the symptoms and signs of the different types of warts?

    • There is the familiar type of dome-shaped warts on the backs of fingers, toes, and knees.
    • Plantar warts are found on the sole (plantar surface) of the foot (not to be mislabeled as a Planter's wart).
    • Flat ("plane") warts may arise on the face, legs, and other parts of the body, often in large numbers.
    • Periungual warts are warts around or under the nail.
    • Filiform warts have a single long stalk, often on the face.
      Treating a wart with salicylic-acid application.

      What is the treatment for warts?

      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 great big lumpy ones. Salicylic acid is a keratolytic medication, which means it dissolves the protein (keratin), which makes up most of both 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 minus 196 C). The over-the-counter products do not work nearly as well as the colder agents applied by a doctor.

      Duct tape

      It has been reported that warts can be treated by covering them with duct (duck) tape or other nonporous tape, such as electrical tape. This treatment requires that the tape must be left in place all the time and removed only a few hours once per week. The tape must be replaced frequently. Many are of the opinion that this is no better than a placebo, based on published studies.
      A woman reading the label of over-the-counter wart medication at the drug store.

      Is using over-the-counter wart treatments safe?

      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. 
      A doctor discussing a boy’s wart treatment.

      Are wart treatments effective?

      Above all, wart treatments require patience. The fact that there are 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. Some warts sprout daughter warts near the main wart and others don't. Warts are generally painless unless they are present in areas prone to pressure or friction like the palms and soles. Certain warts, even of the same type, respond to treatment, while others (even on the same person at the same time) don't. Treatment methods may require many sessions over weeks, months, or longer.

      Here is a practical approach to the treatment of warts:

      1. Ignore the 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 nonscarring.
      3. With a difficult case, start by treating the 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-acid drops and plasters help remove the thick overlying callus and make 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 can make them smaller and go away, in some cases, 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 oneself just makes them look rough and unattractive.
      • "Mosaic" warts: Tiny, so-called "seed warts" can proliferate by the dozens or hundreds all over the sole of the foot. 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 pimples and may be numerous on one part of the body (for example on the face, arms, or groin). Getting rid of them by a light application of salicylic acid or other method is easy enough, but they have a tendency to recur.
        Laser surgery removal of a wart on a finger.

        What if wart removal treatments fail?

        If these treatments fail, see a doctor to freeze the wart with liquid nitrogen or burn it with an electric needle. First, however, make sure that the doctor treats warts in this manner (or some related manner) since some primary doctors do not use special methods and may refer individuals to a dermatologist.

        Other treatments a doctor may use are

        • 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 (a extract to test for sensitivity to Candida yeast);
        • injections of bleomycin, a chemotherapeutic agent used in cancer treatment;
        • surgery.
        Unless warts are very large and uncomfortable, surgical removal or aggressive laser surgery to remove the warts is generally avoided. Since warts are caused by a virus, they may recur following attempts at surgical removal or any other modality of therapy.

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