Viral warts are very common benign lesions caused by infection with human papillomavirus (HPV). These small, noncancerous growths appear when your skin is infected with one of the many viruses of the human papillomavirus (HPV) family. The virus triggers extra cell growth, which makes the outer layer of skin thick and hard in that spot. While they can grow anywhere you have skin, you're more likely to get one on your hands or feet.
What Are Warts?
Viral warts are caused by infection with the human papillomavirus (HPV), a double-stranded DNA virus. There are more than 150 known HPV types, only some of which infect the skin, giving rise to a variety of clinical presentations. Infection begins in the basal layer of the epidermis, causing proliferation of the keratinocytes (skin cells) and hyperkeratosis, and production of infectious virus particles - the wart. Warts are growths of the skin and mucous membranes (inside the mouth or genitals) that are caused by a virus known as the human papillomavirus (HPV).
The type of wart depends on where it is and what it looks like. The virus causes thickening of the top skin layer. Warts are usually acquired from person-to-person contact. The virus is not highly contagious but can cause an infection by entering through a small break in the skin. In the same way, warts can be spread to other places on the body (self-inoculation).
How Warts Spread
HPV is spread by direct skin-to-skin contact or autoinoculation. If a wart is scratched or picked, a wart may develop under the fingernail (subungual wart) or virus may be spread to another area of skin. Warts are highly contagious and are mainly passed by direct skin contact, such as when you pick at your warts and then touch another area of your body. You can also spread them with things like towels or razors that have touched a wart on your body or on someone else's. Warts like moist and soft or injured skin.
Fairy tales are wrong; you can touch or kiss all the frogs and toads you like because they won't give you warts. Having a wart on your nose -- or anywhere else, for that matter -- doesn't make you a witch, either.
Types of Warts
Common Warts (Verruca Vulgaris)
Common warts (verruca vulgaris) present as cauliflower-like papules with a rough, papillomatous and hyperkeratotic surface ranging in size from 1 mm to 1 cm or more. They may be solitary or multiple. These flesh-colored growths are most often on the backs of hands, the fingers, the skin around nails, and the feet. They're small -- from the size of a pinhead to a pea -- and feel like rough, hard bumps. They may have black dots that look like seeds, which are really tiny blood clots. Typically they show up where the skin was broken, perhaps from biting your fingernails. This can also transfer the virus from your hands to your face.
Plantar Warts (Verruca Plantaris)
Plantar warts (verruca plantaris) include tender inwardly growing myrmecia on the sole caused by HPV 1, and clusters of superficial less painful mosaic warts due to HPV 2. Does it feel like you have pebbles in your shoe? Check the soles of your feet. These warts got their name because "plantar" means "of the sole" in Latin. Unlike other warts, the pressure from walking and standing makes them grow into your skin. You may have just one or a cluster (called mosaic warts). Because they're flat, tough, and thick, it's easy to confuse them with calluses. Look for black dots on the surface.
Plane Warts
Plane warts are typically multiple small flat-topped skin-coloured papules located most commonly on the face, hands, and shins. On the shins and beard-area of the face the virus is often spread by shaving resulting in numerous warts. The upside of these warts is that they're smaller (maybe 1/8 inch wide, the thickness of the cord that charges your phone) and smoother than other types. The downside? They tend to grow in large numbers -- often 20 to 100 at a time. Flat warts tend to appear on children's faces, men's beard areas, and women's legs.
Filiform Warts
A filiform wart is a cluster of fine fronds emerging from a narrow pedicle base usually found on the face. These fast-growing warts look thread-like and spiky, sometimes like tiny brushes. Because they tend to grow on the face -- around your mouth, eyes, and nose -- they can be annoying, even though they don't usually hurt.
Butcher's Warts
Butcher's warts are specifically caused by HPV 7 infecting the hands of butchers and others whose occupation involves chronic exposure to a cold moist environment.
Periungual Warts
Children and adolescents are most likely to develop periungual warts, especially if they bite their nails. Treatment can stop or slow down the growth of these warts, but they may still spread or recur. Periungual warts form around the nails. At first, they may be the size of a pinhead, smooth, shiny, and translucent. Over several weeks or months, they may grow to the size of a pea and have a cauliflower-like appearance. Warts can also turn brown, gray, or black. Eventually, they may form in clusters. Larger periungual warts sometimes cause pain and discomfort.
Who Gets Warts?
Because each person's immune system responds differently to the virus, not everyone who comes in contact with HPV will get a wart. And if you cut or damage your skin in some way, it's easier for the virus to take hold. That's why people with chronic skin conditions, such as eczema, or who bite their nails or pick at hangnails are prone to getting warts.
Kids and teens get more warts than adults because their immune systems haven't built up defenses against the many types of HPV. People with weakened immune systems -- like those with HIV or who are taking biologic drugs for conditions like RA, psoriasis, and IBD -- are also more susceptible to getting warts because their body may not be able to fight them off.
Diagnosis
Cutaneous viral warts are usually diagnosed clinically. Pinpoint red or black dots (papillary capillaries) are revealed when the wart is pared down. Patent capillaries cause pinpoint bleeding. Skin biopsy is sometimes required when squamous cell carcinoma cannot be excluded clinically, such as in an organ transplant recipient susceptible to both.
Treatment of Warts
Treatment may not be required in all cases as most warts resolve spontaneously, especially in children. Treatments do not kill the virus, but work by removing virus-containing skin. Persistence with the treatment and patience is essential!
Over-the-Counter Treatments
Peeling Products
Over-the-counter gels, liquids, and pads with salicylic acid work by peeling away the dead skin cells of the wart to gradually dissolve it. For better results, soak the wart in warm water, then gently sand it with a disposable emery board before you apply the product. Be sure to use a new emery board each time. Be patient -- it can take several months.
Duct Tape
Study results are mixed, but covering warts with duct tape may peel away layers of skin and irritate it to kick-start your immune system. Soak, sand, and put duct tape on the area (use silver stuff because it's stickier). Remove and re-do the process every 5-6 days until the wart is gone. If it works for you, the wart should be gone within 4 weeks.
Medical Treatments
Topical Treatment
Topical treatment is applied once daily to the wart.
Cryotherapy
Cryotherapy with liquid nitrogen is repeated at one to two-week intervals to cause peeling of the surface layer. It is uncomfortable and results in blistering for several days or weeks. Treatment is required frequently to prevent the wart regrowing between appointments. A hard freeze using liquid nitrogen might leave a permanent white mark. For adults and older children with common warts, your doctor will likely want to freeze them off with liquid nitrogen. (Because the nitrogen is so cold, it can cause a stabbing pain for a little while, which is why it's not used for small children.) You'll probably need more than one session. It works better when you follow up with a salicylic acid treatment after the area heals. Cryosurgery can cause light spots on people who have dark skin. Cryotherapy is often a quicker treatment than salicylic acid, but a person may still require three or four treatments spaced 2 to 3 weeks apart. This treatment has a success rate of 50-70%.
Electrosurgery (Curettage and Cautery)
Electrosurgery (curettage and cautery) has been used for large and resistant warts. Under local anaesthetic, the growth is pared away and the base burned. The wound heals in two weeks or longer (depending on the site); even then, 20% of warts can be expected to recur within a few months. This treatment leaves a permanent scar which can be painful to walk on if located on a pressure site. Doctors may use one or both of these methods after they numb the area. Electrosurgery burns the wart with an electric charge through the tip of a needle. It's good for common warts, filiform warts, and foot warts. Your doctor could also use a laser. Curettage is scraping off the wart with a sharp knife or small, spoon-shaped tool. Another option is excision, slicing the wart off or cutting it out with a sharp blade.
Cantharidin
"Painting" a wart with this liquid makes a blister form underneath it, lifting it off the skin. When the blister dries (after about a week), the wart comes off with the blistered skin. Cantharidin is often the way to treat young children because it doesn't hurt at first, though it may tingle, itch, burn, or swell a few hours later.
Prescription Creams
For stubborn warts, peeling creams with glycolic acid, stronger salicylic acid, or tretinoin could do the trick. Diphencyprone (DCP) and imiquimod (Aldara) irritate your skin to encourage your immune system to go to work there. 5-Fluorouracil is a cancer medicine that may stop your body from making extra skin cells the same way it stops tumors from growing.
Injections
Your doctor may use a needle to put medicine into the wart to help get rid of it. Bleomycin, a cancer drug, may stop infected cells from making more. Antigen injections: A doctor may recommend injecting an antigen to treat stubborn warts. An antigen is a toxin or foreign substance that induces an immune response. This provoked response should kill the virus and eliminate the growth.
Laser Therapy
A doctor may recommend laser therapy if other treatments do not work. The goal is to burn off the wart, but different chemicals may have varying success rates. A study from 2011 suggests that aminolevulinic acid may be more effective than other chemicals, including the organic dye used in pulsed dye laser therapy. However, scientists need to carry out more research to determine the best laser treatment for periungual warts.
Surgical Removal
In severe cases or when the wart is causing complications, a doctor may recommend surgery. However, this may not be an option for all periungual warts. The surgery takes place in several stages called curettage and cautery. First, the surgeon scrapes or cuts the wart away. Then they use heat to seal the wound. Although success rates are approximately 65-85%, 30% of people may experience scarring or warts that reappear.
When to See a Doctor
If you're not sure your skin growth is a wart (some skin cancers look like them), it doesn't get better with home treatment, it hurts, or you have a lot of them, check with your doctor. If you have diabetes or a weakened immune system, you should have a doctor take a look before you treat a wart yourself.
Prevention and Home Care
A person can take steps at home to reduce the appearance of periungual warts. Wait: The AAFP suggests that “watchful waiting” is a remedy, especially for new warts. Most periungual warts eventually disappear without treatment. Quit biting: Nail-biters should try to quit the habit as quickly as possible. It increases the risk of periungual warts and other skin infections. Reduce stress: Stress diminishes the response of the immune system. This can make a person more vulnerable to infection or slow healing time. To manage stress: eat a balanced diet, exercise regularly, get enough sleep, try techniques such as deep breathing, meditation, or progressive muscle relaxation.
To prevent periungual warts, a person would have to ensure that they do not contract HPV. This may be difficult because the virus is prevalent. To avoid contracting HPV: Wash the hands regularly. Avoid biting or picking at the fingernails or cuticles. Wear protective gloves when washing the dishes. Do not share towels, nail polish, or other personal items. If a colleague, friend, or loved one has warts, avoid touching them, the surrounding area, and items that have come into contact with them. Disinfect nail clippers and similar equipment after each use.
If a person is planning to visit a nail salon, the following tips may help to reduce the risk of contracting periungual warts: Ensure that salon workers change their gloves between clients. Request that the technician uses a new pumice stone. Check that the technician throws away nail files and cuticle sticks after each client and adequately disinfects other tools. Do not shave the legs before a salon visit. There is always a risk of breaking the skin, which can allow HPV to enter the wound.
Prognosis
Viral warts are more persistent in adults, but they clear up eventually. They are likely to recur in patients that are immunosuppressed, for example, organ transplant recipients. Even while treatment is underway, warts are contagious. It is difficult to treat periungual warts with any method. The recurrence rate is high. With prompt treatment, warts are more likely to heal quickly, but no single method is guaranteed to work. Every treatment is usually effective within 12 weeks. Scientists need to conduct more research to determine the best treatment method. Even if left untreated, these warts often resolve on their own.