Growth of warts - Causes, Treatment & When to See a Doctor

What is Growth of warts?

Warts are small, rough skin growths caused by infection with certain types of the human papillomavirus (HPV). When people talk about the “growth of warts,” they are usually referring to the appearance of new warts or the enlargement of existing ones. These growths can appear anywhere on the body, but they are most common on the hands, feet, face, and genital area. While most warts are harmless and may regress on their own, they can be painful, cosmetically distressing, or spread to other skin surfaces.

Warts are classified according to their location and appearance, the most common types being:

• Common warts (Verruca vulgaris): Rough, dome‑shaped lesions, often on fingers or elbows.
• Flat warts (Verruca plana): Smooth, slightly raised spots that tend to occur in clusters on the face, neck, or legs.
• Plantar warts: Appear on the soles of the feet; they can be painful when walking.
• Filiform warts: Long, thread‑like growths that usually occur on the eyelids, neck, or lips.
• Genital warts (Condyloma acuminata): Appear in the genital or anal area and are sexually transmitted.

Understanding why warts grow and what influences their spread helps patients make informed decisions about treatment and prevention.

Common Causes

Wart growth is principally driven by infection with HPV, but a number of factors increase the likelihood that the virus will cause visible skin lesions.

• Human papillomavirus (HPV) infection: Over 100 HPV subtypes exist; types 1, 2, 4, 27, 57 are most often linked to non‑genital warts, while types 6 and 11 cause genital warts.¹
• Skin trauma or micro‑abrasions: Cuts, scrapes, or even excessive rubbing create entry points for the virus.
• Weakened immune system: Immunosuppression from medications, HIV, organ transplantation, or chronic illness permits more robust viral replication.²
• Moist or warm environments: Public pools, gyms, and communal showers keep skin moist, facilitating viral spread.
• Frequent hand‑to‑mouth or nail‑biting habits: Transfer of virus from infected surfaces to vulnerable skin.
• Age: Children and teenagers have higher incidence due to developing immunity and greater skin exposure during play.
• Genetic predisposition: Certain HLA types (e.g., HLA‑DR7) are linked to a higher susceptibility.
• Occupational exposure: Healthcare workers, food‑service employees, and those handling livestock may encounter HPV more often.
• Existing skin conditions: Psoriasis, eczema, or other dermatoses that compromise the skin barrier can encourage wart formation.
• Sexual activity: Direct contact with an infected partner leads to genital warts.

Associated Symptoms

Although warts themselves are the primary manifestation, they often appear alongside other signs or symptoms:

• Itching or mild irritation around the lesion.
• Localized pain, especially with plantar or filiform warts that pressure nearby nerves.
• Bleeding when the wart is scratched or irritated.
• Hyperkeratotic (thickened) skin surrounding the wart.
• Secondary bacterial infection (redness, warmth, pus) if the lesion is frequently rub‑d or picked at.
• In genital warts: discharge, burning during urination, or discomfort during intercourse.

When to See a Doctor

Most warts are benign, yet certain signs warrant prompt medical evaluation:

• Rapid increase in size or number of warts.
• Warts that bleed heavily, become painful, or develop ulceration.
• Lesions that do not respond to over‑the‑counter (OTC) treatments after 2–3 months.
• Warts in sensitive locations (eyes, mouth, genitals) or causing functional impairment.
• Evidence of secondary infection (pus, spreading redness, fever).
• Any skin growth that looks markedly different from a typical wart (e.g., asymmetrical, variegated color) – it may mimic skin cancer and needs confirmation.

Diagnosis

Healthcare providers rely on a combination of visual assessment, patient history, and occasionally laboratory work.

1. Clinical examination: Dermatologists can often identify warts by their characteristic rough surface, black dots (thrombosed capillaries), and “stuck‑on” appearance.
2. Dermoscopy: A handheld magnifier that reveals the vascular pattern and helps differentiate warts from other lesions.
3. Biopsy: Rarely needed, but if a lesion is atypical or does not respond to therapy, a punch or shave biopsy can rule out malignancy.
4. HPV typing (PCR): Used mainly for genital warts or in research settings to identify high‑risk HPV strains that may be linked to cancer.
5. Immune work‑up: If warts are extensive or recurrent, clinicians may assess HIV status, complete blood count, or immunoglobulin levels.

Treatment Options

Therapy depends on wart type, location, patient age, immune status, and personal preference. Treatments may be performed at home, in a pharmacy, or by a clinician.

Over‑the‑Counter (OTC) Options

• Salicylic acid preparations: 17–40% concentrations applied daily to soften keratin. Effective for common, plantar, and flat warts after 6–12 weeks.³
• Cryotherapy kits (dimethyl ether/propane): Self‑administered freezing; less potent than clinic‑based liquid nitrogen but useful for small lesions.

Clinic‑Based Medical Treatments

• Liquid nitrogen cryotherapy: Rapid freezing (−196 °C) destroys wart tissue. Usually 1–4 sessions needed.⁴
• Cantharidin application: Causes blistering under the wart; suitable for children because it is painless.
• Electrosurgery & curettage: Physical removal with a small electric current; used for resistant or large warts.
• Laser therapy (CO₂ or pulsed dye laser): Vaporizes wart tissue; considered when other methods fail.
• Topical immunotherapy: Imiquimod 5% cream stimulates local immune response; useful for genital warts and recalcitrant common warts.
• Intralesional immunotherapy: Injection of antigens such as Candida albicans or MMR vaccine to provoke systemic immunity.⁵
• Prescription salicylic acid or retinoid creams: Higher potency formulations for stubborn warts.

Systemic Treatments (for extensive or refractory disease)

• Oral cimetidine: An H2‑blocker that may modulate immune response; evidence is limited.
• Systemic retinoids (Acitretin): Used in severe, widespread warts, especially in immunocompromised patients.
• Antiviral therapy (e.g., podophyllotoxin for genital warts): Topical gel applied by patients under provider instruction.

Home Care Measures

• Regularly file or gently debride the wart after soaking in warm water (helps salicylic acid work).
• Keep feet dry and wear breathable footwear to prevent plantar warts.
• Avoid picking or scratching; use a separate nail file for each wart to reduce spread.
• Cover warts with waterproof dressings when swimming to minimize transmission.

Prevention Tips

Because HPV is highly contagious, the best strategy is a combination of personal hygiene and environmental caution.

• Hand hygiene: Wash hands with soap and water after touching potentially infected surfaces.
• Foot protection: Wear flip‑flops in public showers, pools, and locker rooms.
• Avoid direct skin‑to‑skin contact with suspicious lesions.
• Do not share personal items: Towels, razors, socks, or manicure tools.
• Maintain healthy immunity: Balanced diet, regular exercise, adequate sleep, and managing chronic illnesses.
• Vaccination: The 9‑valent HPV vaccine (Gardasil 9) protects against the most common wart‑causing types, especially genital warts. CDC recommends vaccination for adolescents aged 11–12 years, with catch‑up up to age 26 (and some recommendations up to 45).⁶
• Prompt treatment of existing warts: Reduces the risk of spread to other body sites or to close contacts.

Emergency Warning Signs

Key Take‑aways

Wart growth is a common, usually benign skin condition driven by HPV infection. While many warts resolve without treatment, persistent or painful lesions benefit from clinician‑guided therapy. Maintaining good skin hygiene, protecting vulnerable skin, and staying up‑to‑date with HPV vaccination are the most effective preventive measures. Always consult a healthcare professional if warts spread rapidly, become painful, bleed, or show signs of infection.

References

1. Mayo Clinic. Warts. 2023. https://www.mayoclinic.org/diseases-conditions/warts/symptoms-causes/syc-20371050
2. Centers for Disease Control and Prevention. Human Papillomavirus (HPV) and Immunocompromised Hosts. 2022. https://www.cdc.gov/hpv/parents/immunocompromised.html
3. Cleveland Clinic. How to Treat Warts at Home. 2024. https://my.clevelandclinic.org/health/diseases/15125-warts
4. American Academy of Dermatology. Cryotherapy for Warts. 2023. https://www.aad.org/public/diseases/a-z/warts-treatment
5. Harvey, A. et al. “Intralesional Immunotherapy for Recalcitrant Warts.” Dermatologic Therapy, vol. 34, no. 5, 2021, p. e15057.
6. World Health Organization. Human papillomavirus (HPV) vaccines: WHO position paper. 2023. https://www.who.int/publications/i/item/WHO-VPD-2023.03