About warts and verrucas

Why do you get warts? 

Some people are more likely to get warts than others. Warts are contagious and spread easily by direct contact. Viruses cause warts and verrucas (plantar warts). The virus that causes warts is called human papillomavirus (HPV). The virus causes the top layer of skin to grow rapidly, forming a wart. More than 100 HPV subtypes are known. You are more likely to get infected by one of these viruses when your skin is damaged or cut in some way. 

Warts can spread via direct contact with the wart or something that touched the wart. This is called inoculation. Plane, or flat, warts can be very numerous and may be inoculated by shaving or scratching. You can infect yourself again by touching the wart and then touching another part of your body. You can infect another person by sharing used towels, razors, or other personal items. After you’ve had contact with HPV, it can take many months of slow growth beneath the skin before you notice a wart. It is unlikely that you will get a wart every time you come in contact with HPV. 

Different types of warts

The characteristics and symptoms of warts depend on the type of warts. There are 8 categories of viral warts in general, usually classified by both their location on the body and their appearance.

Foot warts & Verrucas (Plantar warts)

The term ‘plantar warts’ is used for those warts that occur under the bottom of your feet. The bottom of your foot is its ‘plantar’ surface. These warts are also called verrucas because the latin word for them is verrucae. 

Verruca 

Verrucas are also called plantar warts. The term ‘plantar warts’ is used for those warts that occur under the bottom of your feet. The bottom of your foot is its ‘plantar’ surface.

Verrucas look like hard, thick patches of skin with dark specks. Plantar warts are sometimes located on the heel and toes. They usually grow back into the skin because the weight of the person, that pushes the warts onto the sole of the foot. Foot warts can be painful especially when present on weight-bearing areas of the foot during standing and walking. It is common for plantar warts to have clotted blood vessels appearing as black dot in the middle, with a surrounding hard, white area. 

Verrucas (plantar warts) include one or more tender inwardly growing ‘myrmecia’ on the sole of the foot. 

Mosaic wart

A mosaic wart is usually a group of Verrucas (plantar warts) tightly clustered together in a small area on the foot. Mosaic warts are most often due to untreated warts that grow to an inch or more in circumference of the foot. They spread into clusters of several warts. They often develop on the palms of the hands and as palmar warts on the soles of feet. 

Flat warts / Plane warts (verruca plana) 

Flat warts, also referred to as plane warts or water warts. They are flat, smooth and are normally round shaped. Their colour is usually yellowish, brownish or same colour as your skin. Plane warts often called juvenile warts, probably because they are seen most often in children. They arise usually on the face, hands, neck, or legs, and tend to grow in significant numbers of 20 to 100 all clustered together at a time Plane Warts are caused by the HPV virus. Water wart, or Molluscum contagiosum are caused by a poxvirus 

Seed wart or Common warts (verruca vulgaris) 

Common warts, also known as seed wart, arise most often on the backs of fingers or toes, and on the knees. Common warts can be easily recognized by the rough, cauliflower-like appearance of the surface. Common warts may appear anywhere on the body, but are most common on the knuckles, fingers, and elbows. These warts on hands and fingers are thickened bumps. And they are also known as papules or plaques. They may have some tiny black or dark dots. Those dots are clotted blood vessels. Often people think the dots are the actual wart “seed”. But they’re not. Common warts tend to cause no discomfort unless they are in areas of repeated friction or pressure

Warts are a very common skin condition caused by a virus that results in small growths on the skin. These are usually painless but they can be unsightly and can possibly become itchy or bothersome depending on the location of the warts. 

Why do warts itch? Friction on the wart is a possibility. If you have verrucas, the skin and the wart are in constant contact with your shoes or socks.  Or the wart is in contact with the floor when you’re walking barefoot. This contact will cause the area to itch. Another reason is the virus that caused the wart: HPV. Some of the HPV viruses have itching as one of their symptoms. 

Common warts appear on the hands as well as other parts of the body. If this type of warts appears on a part of the body, which is continually rubbed against, it may cause itching. 

Flat warts may also cause itching. Verrucas appear on the soles of the feet and is being in contact with socks, shoes or the hard surfaces of floors. This may cause itching to occur. Subungual or periungual warts – appear under and around the toenails or fingernails – which may cause itching. 

Although the above types of warts may cause some itching, there are two specific kinds of warts that cause an uncomfortable need to scratch. This includes: genital warts and molluscum contagiosum warts. Genital warts, which grow in the pubic area or in/on the vagina or around the anal or genital area, are considered very itchy. This is caused by HPV infection, and is one of the most widespread sexually transmitted diseases. 

Molluscum contagiosum warts have itching as its primary symptom. Molluscum contagiosum warts are sometimes called water warts. They appear on the skin of the chest, upper thighs, and abdomen and occasionally on the mucous membranes. Unlike common warts, this type has a flesh-coloured appearance with a dimple in the center and usually occurs in clusters. Infections happen often in swimming pools, day care centers, schools and at work. This type of warts is closely related to and caused by a poxvirus. 

Black wart 

Seborrhoeic warts or black warts are are always begign, thus non-cancerous warty growths that occur on the skin. They usually do not need any treatment. Seborrhoeic warts used to be called senile warts. They usually look like greasy or crusty spots that seem to be stuck on to the skin. The colour varies but usually they are dark brown or black. 

Senile warts are usually round although they can also be oval in shape. Some seborrhoeic warts have an irregular shape. Their size can vary from around one centimeter to several centimeters in diameter. Seborrhoeic warts tend first to appear around the age of 40. Some families have a predisposition to this type of warts. The actual cause of seborrhoeic warts is unknown. It is more common to develop several seborrhoeic warts as you become older. Also, as time goes by, each wart tends to grow slightly and become darker. They can occur anywhere on your body, other than on your palms or soles. Senile warts do not spread and they are not cancerous. The main problem is that they can sometimes look unsightly, particularly if they develop on your face.  

Brown wart 

Brown warts are also seborrhoeic keratoses like black. Like black warts this is a basal cell papilloma. Seborrhoeic keratoses are very common harmless, often pigmented, growths on the skin. In the UK more than half the men and more than third of women would have at least one black or brown wart. By the age of 40 30% of the population is affected. By the age of 70 it increases to 75%. They are also found in younger people. Seborrhoeic keratoses are harmless, but are often considered to be a nuisance. They can itch, become inflamed, and catch on clothing. Many people dislike the look of them, particularly when they occur on the face.  

Seborrhoeic keratoses have a rough surface, and range in colour from golden brown to mid brown to almost black. They can affect anyone, but on dark- skinned people they can also appear as multiple small dark brown or black bumps, especially on the face and the neck; in such a case this is called Dermatosis Papulosa Nigra. Seborrhoeic keratoses can cause worry by becoming inflamed or bleeding. If there is any doubt, a skin biopsy can be done to confirm the diagnosis. Individual seborrhoeic keratoses can be removed successfully. However, new seborrhoeic keratoses will continue to appear. Removal may not be funded by the local NHS service.  

It is recommended that you see a GP if your warts are painful, rapidly multiplying, interfering with any of your daily activities, are unresponsive to home treatments, or if any of them change in appearance or colour.

Other types of common warts

Periungual warts prefer to grow at the sides or under the nails and can distort nail growth.  

Filiform warts, they’re the kind that witches in movies and fairy tale books have on their chins or noses. A filiform wart has a finger-like shape and usually is flesh-coloured. It often grows on or around the mouth, eyes, or nose. 

Genital warts are often transmitted sexually and grow on genitals. Genital warts predispose to cervical, penile and vulval cancer. See your GP if you have genital warts or you’re not sure

Wart virus

The wart-causing virus can be passed on by close skin-to-skin contact, as well as through contact with towels, socks or shoes. A person whose skin is damaged, wet, or comes into contact with rough surfaces is more likely to catch the infection. For example, a person with scratches or cuts on the soles of their feet is more likely to catch verrucas in and around public swimming pools. It’s hard to completely avoid coming into contact with the wart-causing virus HPV. Taking the following precautions can help prevent warts and verrucas: 

• Wear flip-flops in communal showers.
• Cover your wart or verruca with a waterproof plaster when you go swimming
• Avoid touching other peoples warts, as well as sharing towels, socks or shoes
• Don’t share your towels, shoes or socks
• Don’t scratch or pick your wart or verruca as it’s more likely to spread
• If you use nail files or pumice stones on your wart or verruca don’t use these on other areas of your skin
• Prevent shaving over warts on your your face, legs or other parts of the body. This can make the wart-causing virus to spread
• Prevent scratches or bites in a wart
• Avoid biting fingernails

As we all have different immune systems some of us may develop warts when we come into contact with HPV, while others don’t. The risk of catching warts from another person is fairly small, but it exists. Genital warts are much more contagious. 

Warts on hands & fingers 

It is common for warts to grow on fingers and hands. Although warts can be bothersome in some ways, despite their appearance, most warts are harmless. However, this does not mean that warts should simply be ignored. Most people do not want to develop complications later on, and they do not want warts to affect the appearance of their skin 

Common warts or seed warts are small, grainy skin growths that occur most often on your fingers or hands. These warts feel tough when touched.  Common warts or seed warts often feature a pattern of tiny black dots — sometimes called seeds — which are small, clotted blood vessels 

Common warts are caused by a virus and are transmitted by touch. Children and young adults are more likely to develop common warts on fingers and hands. Common warts usually disappear after a while, but many people choose to remove them because they find them bothersome or embarrassing

Hand warts 

Palmer warts occur on the hands, and verrucas grow on the bottom of the foot. 

On average palmer warts are small, about the size of a pencil eraser. But some warts grow bigger. Sometimes palmer warts can grow in clusters; those are called mosaic warts.  

In some warts, little black dots appear, leading people to call them “seed” warts. Palmer warts stick up above the skin of the hand. The risk of getting a hand wart from another person is small. A person’s risk of getting a wart varies. Those with a weakened immune system are more susceptible. But those with healthy immune systems can also develop warts. Virtually everyone will have warts at some point in their life. 

Finger warts 

Finger warts are small, grainy growths on fingers; they can be fleshy depending on where they are. Warts on fingers come in a wide range of shapes and sizes. Most often they are round, white and have a black dot in the middle, this is a clotted blood vessel. The blood vessels grow into the core of the wart to supply it with blood. Warts on the hands and fingers are not cancerous. Warts on fingers are usually more pronounced than on feet. Warts are usually painless. But a wart that grows in a spot where you have a pressure point, on a finger or under your feet, can be painful. Children hate finger warts, especially the fleshy variety; no one wants to “hold hands” in the playground if you have a wart. By picking or biting them they will bleed, and tend to spread easier. 

Verruca on the hand

Warts and verrucas (plantar warts) come in all shapes and sizes. They can affect any part of the body, but are more common on the hands and feet. Verrucas, which are warts on the feet, are infectious lumps that also crop up on the hands, and occur in about 5% of children. They are caused by a type of human papilloma virus that enters through direct contact with the skin. Children and teenagers are most at risk but some people seem to be more susceptible than others. Verrucas are small, grainy or fleshy growths depending on where they are. They are round, often white and have a black dot in the middle (from a blood vessel). Warts don’t usually hurt (except for those emotional scars), but if they grow on pressured places they tend to be painfull.

Infected warts 

Warts are caused by viral infections, though they sometimes are accompanied by pus and blood, which is caused by bacteria. Treating a wart with pus usually involves the use of topical or oral antibiotics, and occasionally, your GP will recommend a combination of both. 

Warts containing pus are highly contagious, and the infection can easily spread to other people and to different parts of the body. Also call the GP if a wart or the skin around it is: 

• Painful 
• Red
• Bleeding 
• Swollen 
• Oozing pus 

Hot compresses should be applied to a wart with pus to facilitate healing and to promote the drainage of pus. A wart with pus should never be lanced at home in an attempt to drain the pus, because this could worsen the infection and cause it to spread. A hot compress can be applied several times a day, however, a clean compress should be used each time to avoid reintroducing bacteria to the area. Symptoms of a wart with pus can also include inflammation at the site, redness, pain, and an increase in temperature over the area. Fever, chills, and body aches can also occur if the infection becomes systemic. 

The colour of pus can vary and can range from a light straw colour to dark brown, or even black. Red or pink pus is caused by the combination of blood and pus, however, this does not indicate a more serious infection than pus without blood. Also, pus can be watery in consistency, or thick and sticky. Again, the consistency or amount of pus is not a reflection of the seriousness or type of infection. 

If a wart with pus begins to drain on its own, the area should be gently washed with mild soap and warm water. An over-the-counter antibacterial ointment can then be applied, and the area should be covered with a sterile bandage. If the wart continues to drain pus, it should be kept covered to avoid spreading the infection, and you should notify your GP. 

Painful verruca 

Verrucas are plantar warts found particularly over the pressure areas of the feet (heel and ball). They may cause pain, particularly with walking. Occasionally leg or back pain may result from altered posture or gait disturbance. A wart on the sole of the foot is more likely to cause discomfort than warts in other areas such as the hands. Pain is reason to consider treatment. If you have a verruca and also have diabetes or another medical condition that makes you prone to infections or slow to heal, see your doctor. A verucca can get infected. In people with diabetes, foot infections do not heal easily. 

Corn vs Wart 

People often confuse verrucas (plantar warts) and corns because they look so similar and also appear in the same areas of the feet. Even doctors sometimes find it difficult to make a right diagnosis. However, verrucas and corns are completely different. Although warts can appear all over the body, corns are only found on the feet. The main differences between verrucas and corns are in location, appearance and number. 

Verrucas mainly occur on the heel and the ball of the foot or the underside of the big toe. Corns usually occur between and on top of the toes but occasionally they can also appear on the ball and the heel. The appearance of a wart will have a dry, crusty surface with tiny black dots deep inside while the corn will have a surface which is thick and callused and there will be no black dots. The warts often develop in clusters while corns are always single and may be found in several different areas on the same foot. Verrucas are often passed on when walking barefooted on communal surfaces such as public swimming pools and showers. They are caused by the human papilloma virus (HPV) and are contagious. Direct contact with the virus can infect your skin through a scratch. The virus then grows inward, causing thickening and damage to the skin and the appearance of warts. 

Corns usually appear when a prominent bone in the foot presses against the inside of your shoe. The pressure causes the skin to thicken just at that point making a hard surface. This hard surface then becomes the core of the corn that penetrates deep into the foot. The corn becomes cone-shaped with the point facing inward which in turn presses into the foot cause pain. This can become very uncomfortable and feels as if you are walking with a stone in your shoe. Corns are not contagious but warts are. 

Treatment for warts on hands or fingers 

Common hand and finger warts are small, grainy skin growths. They are rough to the touch, common warts also often feature a pattern of tiny black dots — sometimes called seeds — which are small, clotted blood vessels. 

Seeds — which are small, clotted blood vessels. 

The goals of treatment are to destroy the wart, stimulate an immune system response to fight the virus, or both. Treatment may take weeks or months. Even with treatment, warts tend to reoccur or spread. Doctors generally start with the least painful methods, especially when treating young children. 

Salicylic acid 

Prescription-strength wart medications with salicylic acid work by removing layers of the wart in stages. Studies show that salicylic acid is more effective when combined with freezing. 

Cryotherapy 

Freezing therapy done at a GP’s office involves applying liquid nitrogen to your wart. Freezing works by causing a blister to form under and around your wart. Then, the dead tissue sloughs off within a week or so. This method may also stimulate your immune system to fight viral warts. You may need more than one treatment. 

Bichloroacetic or trichloroacetic acid 

If salicylic acid or freezing isn’t working, your doctor may try bichloroacetic or trichloroacetic acid. With this method, the doctor first shaves the surface of the wart and then applies the acid with a wooden toothpick. It requires repeat treatments every week or so. Side effects are burning and stinging. 

Laser 

Laser treatment. Pulsed-dye laser treatment burns (cauterizes) tiny blood vessels. The infected tissue eventually dies, and the wart falls off. The evidence for the effectiveness of this method is limited, and it can cause pain and scarring. 

Treatment for foot warts 

Verrucas (planter warts) and palmer warts will often eventually go away without treatment. If they bother you, however, you can treat common skin warts in a variety of ways. Even if a treatment is successful, the wart can reappear. 

Salicylic acid 

Prescription-strength wart medications with salicylic acid work by removing layers of a wart a little bit at a time. Studies show that salicylic acid is more effective when combined with freezing. 

Cryotherapy 

Freezing therapy done at a GP’s office involves applying liquid nitrogen to your wart. Freezing works by causing a blister to form under and around your wart. Then, the dead tissue sloughs off within a week or so. This method may also stimulate your immune system to fight viral warts. You may need more than one treatment. 

Bichloroacetic or trichloroacetic acid 

If salicylic acid or freezing isn’t working, your doctor may try bichloroacetic or trichloroacetic acid. With this method, the doctor first shaves the surface of the wart and then applies the acid with a wooden toothpick. It requires repeat treatments every week or so. Side effects are burning and stinging. 

Surgery 

Surgery is an option if home treatment and treatment at your doctor’s office have failed. Surgery for warts is usually quick and effective. No single surgical method is more effective than another in removing warts. Generally, doctors start with the surgical method that is least likely to cause scarring. The most common types of surgical treatment for wart removal include: 

Electrosurgery and curettage. Electrosurgery is burning the wart with an electrical current. Curettage is cutting off the wart with a sharp knife or a small, spoon-shaped tool. The two procedures are often used together. 

Laser wart removal 

Laser surgery uses an intense laser light beam to burn the wart tissue and it’s blood supply, thereby destroying the wart. A new type of laser has been developed to treat several different types of skin lesions called the Pulsed Dye Laser. This new laser has promise in the effective treatment of warts. 

Pulsed-dye laser treatment burns closed (cauterizes) tiny blood vessels. The infected tissue eventually dies, and the wart falls off. The wart will naturally fall off after a few weeks. Using laser to remove warts is usually not considered a first choice for wart removal The evidence for the effectiveness of this method is limited, and it can cause pain and scarring. However, it is sometimes used when the warts are widespread, very large or all other treatments have failed. Laser can be used as a last resort treatment for warts. Laser is suitable to treat large areas in one sitting. Laser treatment is considered safe. 

An anesthetic is often needed to numb the area being treated with laser and the treated area will possibly be painful for a few days after the treatment. Five or more treatments may be needed for stubborn warts. It is usually more expensive than other treatments. 

There is little advantage to removing warts with a laser unless the warts are very large (mosaic warts) or there are a large number to be removed. The risks associated with the use of the laser are the same as for cutting the warts out. These risks include infection and the development of scartissue after healing. 

Salicylic acid treatment for warts 

Topical acids can also be a useful means of treating warts. The advantage to this form of treatment is the fact that they are nearly painless and there is no restriction of activity. The down side to this form of treatment is that it frequently requires several treatments and the failure rate is higher than surgical excision of the wart. Meta-analysis on 77 relevant studies showed that combined therapy of salicylic acid and cryotherapy had a higher cure rate than either salicylic acid or cryotherapy alone. The results of the pooled analysis found a cure rate of 58% (38-78%) in the combined cryotherapy and salicylic acid trials. Aside from the use of salicylic acid and aggressive cryotherapy there is insufficient evidence from research to support the use of other therapies. 

A salicylic acid solution: 

Before applying such solution you have to soak the area of the wart in warm water. The procedure softens the skin and the effect of applicated solution will be better; 

Treatment of warts with this acid solution is carried out before going to bed: you must apply it directly to the affected areas; healthy skin should not be exposed to the drug. Then bandage the warts or cover the area with a plaster. In the morning you wash the acid away. After a long-term treatment warts soften under the influence of the drug and can be removed with a pumice stone. 

Salicylic ointment: 

Sixty percent salicylic ointment is also often used to remove warts. For a better effect clear the affected skin with warm water before applying the ointment. Wait until your skin dries out, and only then proceed to the application of ointment. Cover the affected skin with a thin layer of ointment. 

The treated surface should be bandaged, which is why such procedures are usually conducted before going to bed. In the morning you process the wart with a pumice stone. The course of treatment is strictly individual and must be continued until the complete warts disappearance. 

Salicylic acid pads for warts:

This method of treatment is more comfortable compared to the previous ones. In almost any pharmacy you can buy special pads for warts removal. They contain sulfur and salicylic acid. Due to the keratolytic effect of salicylic acid the described pad softens, dissolves and rejects cornified stratum of your skin. 

Before you stick salicylic acid pads for warts on the affected area, you need to steam it and make it dry. The plaster must stay on your skin for two days. Afterwards you remove it and soak the warts in warm water. The softened layers of skin can be gently removed by using pumice. 

Repeat the procedure several times if the warts do not disappear after the first try. 

Trichloroacetic Acid for Warts 

There are several of wart acid removal products nowadays and the most common and effective wart removal is salicylic acid. Trichloroacetic acid (TCA) is often seen too. TCA is also used for cosmetic treatments and tattoo removal. TCA is a clear liquid that is applied by a health care professional once each week on the surface of the wart, until it turns white and shrinks. TCA is also available over-the-counter, in a concentration up to 80% solution, and can be used safely at home. Also available is a weak solution, which is also equally effective in removing warts. 

Patients should make sure that a health care professional or dermatologist is the one applying the TCA, to prevent irritation. Treatment might take at least six to ten weeks for the warts to be completely removed. TCA’s action is usually controlled, and can prevent the danger of scarring of the skin. It is also safe to use in pregnant women, since there are no studies that can verify that it can affect the health of the mother and the baby. 

Trichloroacetic Acid Side Effects on Warts  

Upon application, trichloroacetic acid may cause some mild discomforts. In the treatment, the patient might feel one of the following: 

-Burning sensation, until the solution dries up. 

-Swelling of area, where the TCA is applied. 

-Tenderness of the area. 

-Skin irritation, but not in the whole body. 

Remember to call or go immediately to a dermatologist, when the discomfort felt becomes prolonged or becomes severe. Symptoms such as wheezing, chest tightness, fever, itching, swelling of the lips, tongue or throat and rashes may be severe manifestations. 

Acid treatment for verruca 

Warts and verrucas (plantar warts) come in all shapes and sizes. They can affect any part of the body, but are more common on the hands and feet. There is no difference in treating common warts and verrucas. While you have a wart or verruca, you should also take steps to avoid passing it to others. All these acid treatments work equal on warts and verruca, it’s based on the principal of softening or killing the skin cells that contain the virus and form the wart.  Use a file or pumice stone to remove the old skin regularly.  New skin will grow underneath, this is healthy tissue and free from virus. It’s important to persevere with the treatment. 

Consult a doctor before treating a wart or verruca yourself if you have poor blood circulation, for example because of diabetes or peripheral arterial disease.