Warts

What are warts?

Warts are small skin growths caused by the human papilloma virus (HPV), which infects the top layer of skin. There are more than 40 different types of HPV. The wart virus can be transmitted from one person to another either by direct contact, or indirectly when both people come in contact with a surface such as a floor or desk.

People may come into contact with HPV by walking barefoot in public places such as gyms and shower floors, or by sexual contact. HPV also can be transmitted in the same person from one spot on the body to another. It is easier for HPV to infect a person when the person's skin is scratched or cut.

Warts can appear at any age but are more common in older children and are uncommon in the elderly. A wart's appearance varies with its location and the type of virus that has caused it. For example, flat warts commonly appear on the face, neck, chest, forearms, and legs. Most warts go away after a year or two, but some last for years or come back after going away.

Warts can itch or bleed. When warts are located in areas that are rubbed against clothing or bumped frequently, they can become irritated and the skin around them can become painful.

Symptoms of warts

The two types of warts seen most often are common warts and plantar warts.

Common warts have a rough surface and well-defined borders. They are round or irregular in shape and usually range from 2 millimeters (mm) to 10 mm wide (the size of a pencil eraser or smaller). Common warts are firm and can be light gray, flesh-colored, yellow, brown, or gray-black. They occur most often near the fingernails and on the backs of the hands, but they also can appear on the elbows and knees. Common warts usually do not hurt.
Plantar warts appear on the bottom (sole) of the foot. They are flattened by the pressure of standing on them and can be dotted with tiny, clotted blood vessels that look like dark pinpoints. Plantar warts often are painful, especially when they're on a weight-bearing part of the foot.

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Other types of warts include:

Genital warts appear on and near the genitals of men and women, as well as inside the vagina and on the cervix in women.
Cervical warts appear on the cervix but are generally not due to types of HPV linked to cervical cancer.
Mosaic warts appear on the feet. They are groups of many small, closely set plantar warts.
Filiform warts appear on the eyelids, face, neck, or lips. They are long, narrow growths that usually grow straight out from the skin.
Flat warts appear on the face and along scratch marks. They are smooth, flat-topped, yellow-brown papules and are more common in children than in adults.
Pedunculated warts appear on the head and neck, scalp, and beard and are shaped like cauliflower.

Diagnosing warts

A doctor usually can diagnose warts by looking at them. Sometimes the doctor will recommend a biopsy, in which a sample of tissue from a wart is removed and analyzed under a microscope. An HPV test is usually performed on cervical samples as part of a routine Pap smear.

Expected duration of warts

Even without treatment, warts may disappear in months or years on their own. However, there is always a chance they will come back.

Preventing warts

It is difficult to prevent all warts. You can reduce your chances of getting warts by avoiding skin contact with existing warts, and with contaminated floors such as those in locker rooms and around swimming pools. Abstinence or safe sex techniques (such as condom use) can reduce the risk of genital warts.

The vaccine for HPV can prevent infection with the most common viral types responsible for genital warts as well as HPV types linked to cervical, anal, and penile cancers. Vaccination is recommended for 11-to-12-year-old boys and girls; vaccination earlier (at age 9) or later (age 13 to 26 for females, 13 to 21 for males) may be recommended in some cases.

Treating warts

Most warts disappear within a year or two, even if they are not treated; however, without treatment warts may spread. Many people choose to have warts treated either because of minor pain or for cosmetic reasons.

Treatment depends on the location of the wart, its type and size, a person's age and health, and his or her willingness to follow through with repeated treatments. Plantar warts can be quite painful and require vigorous, repeated treatment before they go away. Although not required in all cases, treatment of genital warts is common, especially if they treated and monitored in order to detect or prevent related cancers.

Over-the-counter liquids and patches containing salicylic acid can decrease the size of a wart, but they should not be used on the face or genitals. Your doctor may treat a wart by applying certain medications or acids, freezing it (cryotherapy), using laser therapy, or surgically removing it.

When to call a professional

If you think you might have a wart, you should show it to your doctor at your next visit to make sure it is a wart and to discuss treatment.

Seek help if your wart causes pain, bleeds easily, spreads easily to other areas of the body, or comes back, or if you want the wart removed for cosmetic or other reasons. You also should see your doctor if regular monitoring or treatment has been recommended for genital warts.

Prognosis

Warts usually disappear within a year or two and are little more than an inconvenience. But because they shed virus particles into the surrounding area, they are contagious and can cause new warts to appear nearby. In some people, warts may be a more chronic (long-lasting) problem. These people may have individual warts that won't go away, or they keep getting new ones. Warts that continue to persist or grow despite treatment should be examined by your doctor, since some skin cancers can masquerade as warts.