Warts are non-cancerous (benign) skin growths that appear when a virus, human papillomavirus (HPV), infects the top layer of the skin (epidermis). Warts are contagious and can be spread by contact with the wart or something that touched the wart.
There are a few different types of warts differentiated by appearance and location of presentation.
Common warts - also called verruca vulgaris (VV)
· VVs are most commonly found on the fingers, around the nails, and on the backs of the hands
· Present most commonly in areas of broken skin, such as from biting fingernails or picking at hangnails
· VVs often have black dots that look like seeds (often called "seed" warts) that represent the blood vessels feeding the warts
· Warts often present as rough bumps
Foot warts - also called verruca plantaris or plantar warts
· Most often on the soles (plantar surface) of the feet
· Can grow in clusters (mosaic warts)
· Often are flat or grow inward from the pressure applied when walking
· Can hurt, feels like you have pebbles in your shoe
· Can have black dots
Flat warts – verruca plana
· Can occur anywhere but frequently on the face in kids, beard area in men, and legs on women or other areas of shaving.
· Are smaller and smoother than other warts
· Tend to grow in large numbers — 20 to 100 at a time
Filiform warts – verruca filiformis
· Look like long threads or thin fingers that stick out
· Often grows on the face - around the mouth, eyes, and nose
· Often grow quickly
· Typically seen in people with weakened immune systems
Your dermatologist can confirm the diagnosis of a wart generally by appearance and then treatment options can be discussed. Although most warts are harmless, your doctor may recommend a treatment specific to the type of wart that is present so that it doesn’t spread further on you or to others.
· Cryotherapy: this is the most commonly used treatment modality where the wart is frozen off with liquid nitrogen. The lesion will often blister after treatment and may require multiple treatments for full resolution.
· Cantharidin – your dermatologist applies cantharidin which will cause a blister to form under the wart. This medication is washed off in 4 hours and treatments are spread 2-3 weeks apart as necessary.
· Electrosurgery and curettage: for common warts, filiform warts and foot warts, electrosurgery (burning) is a good treatment option. Curettage involves scraping off (curetting) the wart with a sharp knife or small, spoon-shaped tool. These two procedures often are used together. The dermatologist may remove the wart by scraping it off before or after electrosurgery.
· Excision: The doctor may cut out the wart
· Candida or Bleomycin immunotherapy: these antigens are injected in the a couple warts to stimulate the immune system to fight off the wart virus from the inside out. Often there is pain or swelling at the site of injection immediately after. More rare side effects include fevers, chills, infection, lymphangitis, anaphylaxis.
· Laser treatment with pulse dye laser: this is used to target the blood vessels feeding the warts.