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Warts

1.    What are Warts?

Warts are non-cancerous, viral infections of the skin characterized by bumpy or flat, raised, flesh-colored growths appearing mainly on the hands, fingers, feet, beard area, or genitals.  Four main types of warts exist.  Plantar warts (verruca plantaris) are usually on the soles of the feet and often are not raised.  Flat warts (verruca plana) are smaller and smoother than normal warts and generally occur in large numbers on the face, or shaving regions such as the beard area and legs.  Common warts (verruca vulgaris) usually grow on knees, fingers, hands, and areas where the skin has once been broken such as the hangnails.  Genital warts (condyloma acuminatum), which arethe most prevalent sexually transmitted disease,come from a strain of the wart virus affecting mucous membranes of the genitalia, and may be transmitted with sexual contact.  Generally, warts produce no serious illness and may disappear in time without scarring; however, bothersome or painful warts should be treated.

2.    What Do Warts Look Like?

Common warts appear as firm, flesh-colored, bumpy, cauliflower-like growths anywhere from 1 to 10 mm, which disrupt the normal line of fingerprints on the fingers or hand.  Some may have red or brown dots caused by small blood vessels.  Plantar warts appear as small, shiny, well-bordered bumps that may grow into rough plaques on the feet, and may also have red or brown spots.  They may occur in clusters, and are often pushed back into the skin from the pressure of walking and are therefore not usually raised.  Flat warts appear as flesh-colored or brown, well-bordered, “flat”-surfaced, thick bumps on the face, beard area, shins, and back of hands.  Sometimes these grow in linear patterns caused by re-infection from scratching or shaving abrasions.

3.    Who Do Warts Affect?

Warts are very common and occur frequently in all races, and equally among males and females.  Common warts occur in up to 20 percent of all school children; plantar warts are more common in older children and young adults; and flat warts occur in children and adults.  Flat warts may occur more commonly in butchers, meat packers, and fish handlers.  Warts may be more aggressive or multiply faster among individuals with compromised immune systems.

4.    What Causes Warts?

Warts are caused by many different strains of a DNA virus called the Human Papillomavirus (HPV) that invades and colonizes cells of the skin and mucous membranes.  The virus is transmitted by skin contact and by sexual contact among healthy individuals, however, the risk of catching hand, foot, or flat warts from another individual is relatively small. 

5.    What Triggers Warts?

Warts may be triggered or may “seed” in areas where the skin frequently breaks or abrasion frequently occurs.  This explains why warts grow more commonly among children who bite their nails or pick at hangnails, and why warts occur near other warts in frequently-shaved areas.  In addition, continued scratching, picking, or shaving over warts can trigger the spread of the virus and cause new warts to form nearby.  Certain individuals are more prone to having warts than others, just as some individuals are more prone to catching the common cold.  Most transmission occurs among small groups such as households or school gym classes.  A greater risk of acquiring warts is observed among immune compromised individuals such as HIV patients or organ transplant patients. 

6.    How Can My Warts Be Treated? 

A number of treatments may be used to eradicate warts.  Liquid nitrogen may be applied to freeze off the infected tissue.  After freezing, a blister may form over the wound, which may burst and crust while healing.  In between repeated freezing treatments (typically 2 – 3 weeks apart), the application of small bandages that contain salicylic acid or even small pieces of duct tape will help in speeding the destruction of the wart. Topical destruction with cantharidin followed by gentle paring of the dead skin is also a very effective treatment which may be successful after 1 – 2 treatments.  Warts may also be removed by electrosurgery using a small curette, with little discomfort or pain.  The V-Beam Pulse Dye Laser  (PDL) has been shown to be very effective in eradicating warts and is especially good for recalcitrant warts on the bottom of the foot.  Lastly, Bleomycin injections and topically-applied DNCB immune therapy have a very high success rate, and can be used for the most stubborn cases. For more information on treatments for warts or to schedule a skin check, please call and speak with a representative at the Berman Skin Institute.

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