WHAT ARE WARTS?Warts are cauliflower-shaped growths on the skin, caused by a viral infection. The virus that causes warts is called the human papillomavirus ( HPV ). Warts are contagious; you get them through contact with someone who has them.
The medical term for wart is verruca . There are several types of warts. The common wart ( verruca vulgaris ) usually appears on the fingers or hands, or on the soles of the feet, and is often contracted at a young age. Warts on the soles of the feet are also called verruca plantaris .
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hand warts
(verruca vulgaris) |
hand warts
(verruca vulgaris) |
hand warts
(verruca vulgaris) |
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plantar warts
(verruca plantaris) |
plantar warts
(verruca plantaris) |
plantar warts
(verruca plantaris) |
There are also flat warts ( verruca plana ). These are smaller, often 1-3 mm in size, barely protruding, sometimes barely visible, and often several of them are clustered together. These types of warts are mainly found on the backs of the hands, forearms, legs, and sometimes on the face or neck.
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| flat wart (verruca plana) |
flat wart (verruca plana) |
flat wart (verruca plana) |
Another variant is the pointed wart or filiform wart ( verruca filliformis ). This is a wart that is very thin and very long. This type of wart is most common on the face, for example, on the eyelids, nose, or on or around the lips.
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| verruca filliformis |
verruca filliformis |
verruca filliformis |
Warts can also be transmitted through sexual contact. This is another type of wart, the genital wart , also called condyloma acuminata . These warts are also caused by an HPV virus, but a different type. See also genital warts (condyloma).Age-related warts( verruca seborrheica ) are something completely different. These are brownish, wart-like bumps, usually found on the trunk, that develop with age. It's not exactly known how seborrheic keratosis develops; it doesn't appear to be caused by a virus. See also the section on seborrheic keratosis .
This leaflet only covers common warts (verruca vulgaris).HOW IS A WART CAUSED?Warts are caused by a skin infection with the human papillomavirus. This is a contagious virus. You can get a wart through contact with someone who has warts, for example, by shaking hands with someone with hand warts. Foot warts are contracted in gyms and showers, probably by walking on infected skin flakes. It can take two to six months after infection, and sometimes even a year, for the wart to grow large enough to be visible.WHO CAN GET WARTS?Anyone can get warts, and most people develop hand warts or foot warts at a young age, for example, in primary school. Some people are more susceptible than others. Most people only suffer from warts for a few months or a few years, because their immune system clears them. Warts usually go away on their own. But unfortunately, this doesn't happen to everyone; some suffer from them for years, and foot warts, in particular, can be very persistent. Patients with a compromised immune system are prone to warts, and they can also grow very large and be untreatable. This occurs in HIV patients, in patients taking immunosuppressive medications such as prednisone or cyclosporine, and in children and adults with a compromised immune system.
Warts are more likely to develop if the skin is damaged. Warts can spread through scratches or through scratching; this is especially noticeable with small, flat warts (verruca plana).WHAT ARE THE PHENOMENA?Warts on the fingers or hands are often small, round, cauliflower-like growths. They can also appear under the nail. Plantar warts can be the same type, but can also be flattened or grow deeply. Deep-growing warts mainly occur on the soles of the feet and can cause pain.HOW IS THE DIAGNOSIS MADE?The diagnosis is based on the clinical picture, its appearance. They are easy to recognize. Occasionally, it can be confused with a corn if it's a wart located directly on a pressure point. By cutting or scraping away some skin flakes with a razor blade, layer by layer, you can see the difference. With a wart, black dots will eventually appear; these are clotted blood (pee bleeding) from blood vessels that can be found high in the wart.
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| plantar wart (verruca plantaris) |
dermatoscopy |
petioles |
HOW ARE FOOT WARTS AND HAND WARTS TREATED?Because warts usually disappear on their own, treatment isn't always necessary. One can also wait and see. Because warts are most common in children and all treatments are painful, waiting isn't such a bad idea. In about two-thirds of patients, the warts disappear spontaneously within two years. Treatment is useful if the warts cause symptoms (pain), are cosmetically very bothersome, or don't disappear on their own.
All treatments are aimed at killing the virus. Because the virus has grown into the living part of the skin, most treatments are painful. Sometimes, partially removing and irritating the wart is sufficient, after which the body's own immune system is stimulated and clears the wart. Creams (Aldara, imiquimod) that stimulate the body's own immune system are also available. But for common warts, there are simpler and less expensive methods.To point outThere are various wart tinctures and ointments on the market for application to warts. Most contain an acid (salicylic acid) that softens and dissolves the top layer of skin, the stratum corneum. Other additives may include lactic acid or dithranol. These wart tinctures must be applied daily, and it's best to cover them with a bandage. Warts cause thickening of the skin, and the harsh chemicals in the wart tinctures dissolve the stratum corneum and ultimately damage the wart. These products can damage the skin, but that's the intention. It helps to remove as much stratum corneum as possible yourself every day with a razor, callus file, pumice stone, or sandpaper. You can also soften the warts by soaking your feet in warm water for fifteen minutes. It's recommended to continue applying them for another two weeks if the wart appears to have disappeared, just to be safe. The treatment can be painful, the skin around the wart becomes damaged and irritated.Freezing with liquid nitrogenA wart can be frozen with liquid nitrogen. Liquid nitrogen is very cold (196 degrees below zero). It is supplied in steel containers. Hospitals stock it, and general practitioners can order it for a wart consultation. The nitrogen can be sprayed onto the skin with an aerosol can, or a cotton ball dipped in nitrogen and then applied to the skin. The goal is to freeze the wart and a small area of surrounding skin. The freezing process breaks the skin, creating a frostbite. Ideally, a thick blister will develop, which will then fall off, wart included. The skin heals within 4 to 7 days. The treatment often needs to be repeated several times. It can be combined with self-applying topical fluids or ointments. Freezing warts is painful, especially around the nails. Blood blisters and wounds can develop, and discoloration or scarring may occur. Warts around the nail are difficult to treat. Sometimes the nail needs to be removed. Freezing the skin around the nail can permanently damage the nail.
Freezing warts is a common treatment for hand warts, but plantar warts don't respond as well. This is because the skin on the sole of the foot is much thicker and has a thick stratum corneum. The freezing doesn't penetrate deeply enough. Skin infected with the wart virus remains, and the wart grows back.
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| blister after freezing |
Staining with etching chemical liquidsWarts can be treated in the doctor's office with caustic chemicals such as monochloroacetic acid, bichloroacetic acid, and trichloroacetic acid. These are aggressively caustic substances, primarily used for thick warts on the palms of the hands and soles of the feet. They are applied to the wart with a wooden stick dipped briefly in the solution. This also needs to be repeated frequently and can be painful.Surgical removalWarts can be excised with a small knife or scooped out with a sharp spoon, after first administering an anesthetic through injections. Afterward, the wound is cauterized with an electrocoagulation device. This offers a reasonably good success rate (approximately 80%). The disadvantage is the risk of permanent scarring, and the anesthetic is painful. The sole of the foot is not so easy to numb; injecting the anesthetic into the thick skin of the sole of the foot is difficult and painful.Burning away (electrocoagulation) or laser removal with the CO2 laserWith ablation, the wart and the surrounding skin are burned away using electrocoagulation. The electrocoagulation device has a small ball or electric loop that becomes very hot. The skin is first numbed, and then the wart is completely removed layer by layer. This is more efficient and precise than freezing, as the heat kills the virus. The CO2 laser works similarly and can also burn away a wart very precisely and layer by layer. The disadvantages of these techniques are the required anesthesia and the scarring that remains. For stubborn plantar warts, unfortunately, sometimes there is no other option.
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| electrocoagulation |
electrocoagulation |
electrocoagulation |
Other treatmentsFor very stubborn warts, there are several alternative treatments available, such as injecting a drug that inhibits cell division (bleomycin), applying cell division-inhibiting creams (Efudix, 5-fluorouracil), stimulating the immune system with products like imiquimod or interferon, and irradiating the verruca with X-rays (radiotherapy). These are all exceptional methods that are rarely used, and their effectiveness is difficult to predict.WHAT CAN YOU STILL DO YOURSELF?It's almost impossible to prevent hand warts. Plantar warts can be prevented by not walking barefoot in communal areas, such as locker rooms, showers, swimming pools, and gymnasiums.WHAT ARE THE OUTLOOK?Most warts disappear on their own within a few months to a few years. Most people develop a defense against warts and then don't get them again. Unfortunately, plantar warts and warts under the nails can be very persistent. |
