Overview
Warts are small, benign growths of the skin caused by infection with the human papillomavirus (HPV). They can appear anywhere on the body but are most common on the hands, fingers, and feet. Although they are not cancerous, warts can be painful, cosmetically distressing, and sometimes spread to other areas of the skin.
Who is affected? Anyone can develop a wart, but the condition is most prevalent in children and young adults. According to the CDC, up to 10–15 % of the general population will have at least one wart at some point in their life. The prevalence is higher in school‑aged children (≈20 % in ages 5–12) and in individuals with weakened immune systems.
There are many types of warts, each with distinct appearances and preferred locations:
- Common warts (verruca vulgaris) – rough, dome‑shaped lesions on hands and fingers.
- Plantar warts – painful lesions on the soles of the feet.
- Flat warts (verruca plana) – smoother, flatter lesions often on the face, neck, or limbs.
- Filiform warts – thread‑like growths around the eyes, nose, or mouth.
- Periungual warts – occur around the fingernails or toenails.
Symptoms
Most warts are painless, but symptom severity depends on the type and location. Common signs include:
- Raised, rough surface: Typical of common and plantar warts.
- Flat, smooth patches: Seen with flat warts, often 1–5 mm in diameter.
- Black dots: Tiny thrombosed capillaries that look like pinpricks; a hallmark of plantar warts.
- Pain or tenderness: Especially with plantar warts when standing or walking.
- Itching or irritation: Can occur if warts are in areas prone to friction.
- Bleeding: May happen if the wart is scratched or cut.
- Distorted nail growth: Periungual warts can cause ridging or separation of the nail plate.
- Rapid spread: Autoinoculation (spreading to adjacent skin) is common, especially with common warts.
Causes and Risk Factors
All warts are caused by infection with certain strains of human papillomavirus (HPV). Over 100 HPV types have been identified; roughly 30 are associated with cutaneous warts. The most common subtypes are HPV 1, 2, 4, and 27.
How the virus spreads
- Direct skin‑to‑skin contact: Touching an existing wart.
- Indirect contact: Contact with contaminated surfaces (gym equipment, towels, showers).
- Micro‑trauma: Small cuts or abrasions provide an entry point for the virus.
- Moist environments: Warm, damp areas (public pools, locker rooms) increase viral survival.
Risk factors
- Age: Children 5–12 years have the highest incidence.
- Immune status: Immunosuppressed individuals (e.g., organ‑transplant recipients, HIV patients) are more prone to persistent warts.
- Skin integrity: Frequent cuts, cuts from manicuring, or athlete’s foot increase risk.
- Occupation: Jobs involving frequent hand contact (healthcare, food service, trades) raise exposure.
- Smoking: Some studies link smoking to a higher risk of cutaneous warts (NIH).
Diagnosis
Diagnosis is usually clinical, performed by a primary‑care provider, dermatologist, or podiatrist.
Physical examination
- Visual assessment: Size, shape, texture, and location are noted. The presence of black dots (thrombosed vessels) helps differentiate plantar warts from calluses.
- Dermatoscopy: A handheld magnifier may be used to view vascular patterns.
Additional tests (rarely needed)
- Biopsy: If there is uncertainty about the diagnosis or suspicion of malignancy (e.g., a lesion that does not respond to standard treatment).
- HPV typing: Mostly for research or in immunocompromised patients; not required for routine care.
Treatment Options
Because warts are benign, treatment is optional. Many resolve spontaneously within 2 years, especially in children. Treatment is pursued for pain, functional impairment, cosmetic reasons, or rapid spread.
Topical Medications
- Salicylic acid (18–40 %): First‑line for common and plantar warts. Applied daily after soaking the lesion; works by keratinolysis.
- Topical immunotherapies: Imiquimod 5 % cream stimulates local immune response; useful for flat warts and periungual warts.
- Cantharidin: A blistering agent applied by a clinician; causes painless separation of wart tissue.
- Podophyllotoxin: Occasionally used for genital warts; not first‑line for cutaneous warts.
Procedural Options
- Cryotherapy: Liquid nitrogen freezing (−196 °C) destroys wart cells. Typically 2–4 sessions spaced 2–3 weeks apart.
- Electrosurgery & curettage: The wart is shaved off after electrical coagulation; effective for large or stubborn warts.
- Laser therapy: CO₂ or pulsed‑dye lasers vaporize tissue; reserved for resistant cases.
- Intralesional injection: Candida antigen, mumps antigen, or bleomycin can provoke an immune response to clear warts.
Systemic Options
Systemic therapy is rarely needed for cutaneous warts but may be considered in extensive disease in immunocompromised patients. Options include oral cimetidine or antiviral agents, though evidence is limited.
Lifestyle & Home Care
- Soak the wart in warm water for 10 minutes before applying salicylic acid to improve penetration.
- Cover the wart with a waterproof bandage after treatment to prevent spread.
- Avoid picking or cutting the wart; this can cause bleeding and increase contagion.
Living with Warts
Even after successful treatment, warts can recur. Here are practical tips for day‑to‑day management:
- Keep the area clean and dry: Moisture encourages viral persistence, especially on the feet.
- Protect the skin: Use waterproof gloves when handling chemicals or prolonged water exposure.
- Footwear: Wear breathable shoes and change socks daily to reduce plantar wart risk.
- Hand hygiene: Wash hands with soap after touching a wart; consider using a separate towel.
- Monitor for new lesions: Early detection allows for prompt treatment and reduces spread.
- Psychological impact: Visible warts can affect self‑esteem. Counseling or support groups may be helpful, especially for adolescents.
Prevention
Because HPV is highly contagious, preventive measures focus on limiting exposure and protecting skin integrity.
- Hand hygiene: Wash hands frequently, especially after contact with communal surfaces.
- Avoid sharing personal items: Towels, razors, nail clippers, and footwear.
- Foot protection in public areas: Wear flip‑flops in pools, locker rooms, and communal showers.
- Cover cuts and abrasions: Use clean bandages to prevent viral entry.
- Use protective gloves: For occupations with frequent hand contact or when gardening.
- HPV vaccination: Current quadrivalent (HPV 6/11/16/18) and non‑avalent vaccines protect against many mucosal HPV types, but do **not** prevent cutaneous warts. Nonetheless, vaccination remains a key public‑health tool for related cancers.
Complications
While warts are benign, complications can occur, particularly when left untreated or in high‑risk individuals.
- Painful lesions: Plantar warts can cause difficulty walking or standing.
- Secondary bacterial infection: Scratching or picking may introduce bacteria, leading to cellulitis or impetigo.
- Nail dystrophy: Periungual warts can damage the nail matrix, causing permanent nail deformities.
- Scarring: Aggressive removal techniques may leave permanent scars, especially on the face.
- Psychosocial distress: Persistent or facial warts can cause anxiety, depression, or social withdrawal.
- Spread to other body sites: Autoinoculation can cause a proliferative “wart storm,” especially in immunosuppressed patients.
When to Seek Emergency Care
- Severe, unrelenting pain that is not relieved by over‑the‑counter measures.
- Rapid swelling, redness, or warmth around a wart suggesting a deep infection (cellulitis).
- Fever (>38 °C/100.4 °F) accompanied by a painful wart.
- Significant bleeding that does not stop after applying direct pressure for 10–15 minutes.
- Signs of an allergic reaction after a wart treatment (hives, difficulty breathing, swelling of the face or throat).
If you have a compromised immune system and notice a sudden increase in the number or size of warts, seek prompt medical evaluation.
References
- Mayo Clinic. Warts - Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/warts/symptoms-causes/syc-20356184 (accessed July 2026).
- Centers for Disease Control and Prevention. Human Papillomavirus (HPV) and Warts. https://www.cdc.gov/hpv/parents/warts.html (accessed July 2026).
- National Institutes of Health, National Library of Medicine. Human Papillomavirus (HPV) Overview. https://www.ncbi.nlm.nih.gov/books/NBK447164/ (accessed July 2026).
- World Health Organization. HPV and disease. https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer (accessed July 2026).
- Cleveland Clinic. Wart Treatment Options. https://my.clevelandclinic.org/health/diseases/16639-warts (accessed July 2026).
- British Journal of Dermatology. Management of common warts: A systematic review. 2022;186(2):209‑220. doi:10.1111/bjd.21012.