PDS SKIN FAQs: All About Warts

Nobody likes warts. Not only are they ugly and embarrassing, they can also interfere with daily activities ranging from walking to having a healthy sex life! Want to know more about this common skin condition? Read on. This article answers some of the most F requently A sked Q uestions ( FAQs ) on warts that the dermatologists of the Philippine Dermatological Society (PDS) encounter in their clinical practice.

Q: What are warts?

A: Warts are benign, infectious skin growths, caused by a virus, that appear on the outer layer of the skin or mucous membranes. This viral infection is caused by a family of viruses called human papillomavirus (HPV) which stimulates the skin cells to grow more rapidly than normal.

Warts are usually painless and don’t itch. They are mildly contagious from person to person and from one area to another on the same person.

Q: Are there different kinds of warts?

A: Yes, warts come in different varieties such as common warts , flat warts , plantar warts , and genital warts .

Common warts appear as small, hard, raised bumps on the skin with a rough, irregular or spiked surface and clearly defined borders. They are usually the same color as the skin, but sometimes darker. Common warts often grow on the fingers and on the back of the hands. They may also grow around the nails ( periungual warts ), or underneath them ( subungual warts ). They begin very small (1-3 mm) and may grow larger. They occur more frequently in areas of broken or damaged skin, for example, where fingernails have been bitten or hangnails picked. Common warts cause no discomfort unless they are in areas of repeated trauma.

Flat warts are smaller and smoother than common warts. These pinhead-sized, flat lesions can occur anywhere and are often numerous. In children, they are most common on the forehead and cheeks, and sometimes on the arms. As a result of irritation from shaving, adult men may have them on the beard area while women may develop these flat warts on their legs.

Plantar warts : are found on the soles of the feet. Clusters of these are called mosaic warts . Unlike common warts, plantar warts do not protrude above the surface because the pressure of walking flattens them back into the skin. When cut, the surface may present with small, black dots or bleeding points which represent the small blood vessels feeding the wart. Plantar warts are most annoying because they can become extremely painful and debilitating causing difficulty in walking or running.

Genital warts : often appear as pedunculated cauliflower-like growths seen primarily on moist, non-hair bearing areas of the skin. They tend to be small and flat but can be thin and raised. They vary in color (gray to pink) and size. Unlike some other types of warts which are rough and scaly, genital warts are usually soft. They can occur within the vagina or on the cervix in women, or on the genitalia, around the anus or within the rectum in both men and women.

The virus that causes genital warts rarely causes warts of the hands and feet but can cause warts in the mouth. The incubation period (the amount of time between the actual infection and the appearance of the wart) has been estimated at 4 to 6 weeks from the time of contact, and it can be as long as 2 to 3 months before any symptoms are identified. People can be infected with and transmit the virus without having any symptoms at all!

Q: How does one get warts?

A: Warts are acquired from other persons by direct skin contact, although sometimes they may be spread indirectly. Warts may also be spread to the one and the same person by auto-inoculation: this means that if a person scratches his/her wart, the viral particles may be spread to another area of the skin. It may take as long as 12 months for the wart to appear from the time of first contact.

While the risk of catching hand, foot and flat warts is small, genital warts, on the other hand, seem to be more contagious. Genital warts are very common in the sexually active population. Thus, it is important to use precautions (such as use of condoms, examination of sexual partners and early treatment) to limit the spread of genital warts to one’s sexual partner.

Q: Do all people develop warts?

A: The development of warts depend on the degree/frequency of exposure to the virus. Warts are more likely to grow on skin that has already been damaged, which explains why warts occur more often in children who bite their nails, scratch their hands or pick at their hangnails.

Some people are more prone to catch the wart virus than are others. Patients with a weakened immune system due to drugs or a medical illness are particularly susceptible to developing wart virus infections.

Q: Do all warts need treatment?

A: Sometimes, the treatment can be more uncomfortable and troublesome than the wart itself. Thus, many people just leave their warts alone. Besides, warts in children tend to disappear spontaneously, with 90% often resolving within 2 years of appearance.

In adults, warts do not disappear as easily and spontaneously as in children. Treatment is warranted especially in cases of long-standing genital warts which have the potential to develop into cancerous lesions. Women with genital warts have an increased risk of developing cancer of the cervix. These women should have a complete gynecologic examination including regular PAP smears, even after treatment.

Q: How are warts treated by dermatologists?

A: Depending on the type of wart and age of patient, dermatologists often use a variety of treatments for warts.

Common warts in young children are treated by topically (externally) applied chemicals such as cantharidin or mixtures of salicylic acid and lactic acid , which are applied on a regular basis for several weeks until favorable results are obtained. This causes little discomfort but treatment should be temporarily discontinued if the wart becomes sore. Salicylic acid plasters that can be cut to approximate the size of the wart are also used.

For older children and adults, cryotherapy (freezing the wart using liquid nitrogen) is generally preferred. This treatment is less painful and rarely causes scarring. However, it may be uncomfortable for a few minutes and may result in blistering for several days. Repeat treatments at one to three week intervals are often required. Electrosurgery/electrocautery (burning using electrical pulses) is also a common office procedure done by dermatologists to remove warts. Carbon dioxide and pulsed dye lasers have also been used in the treatment of warts.

Flat warts can be treated with either electrosurgical techniques under local topical anesthesia, or peeling with either salicylic acid , tretinoin or other surface peeling preparations . Peeling is especially recommended if the warts are numerous.

Plantar warts are difficult to treat because the main portion of the wart lies below the skin surface. Treatments include scraping the wart down and applying a salicylic acid plaster which penetrates and breaks down the wart. Another method usually reserved for very stubborn foot warts in adults is to prick or inject the wart with a chemical called bleomycin , after numbing the area with a local anesthetic. Surgical methods of removing plantar warts also include laser surgery , electrocautery or excision . Lastly, the dermatologist may recommend a change in footwear or the use of a corn-pad with a hole cut in it to reduce pressure on the wart when walking. Methods to reduce foot sweating are also used.

Genital warts are perhaps the most difficult to treat because of their location. All genital warts must be identified and located. External warts are more visible and therefore easier to diagnose by sight. Warts on the vagina and cervix in women are not visible: therefore, actual screening and diagnostic tests are required via colposcopy . Examination of the rectum in both sexes is mandatory. Research has shown that 60-90% of partners exposed to genital warts will develop growths. If no signs of infection are found during an initial examination, subsequent periodic screenings are advisable. Periodic treatments with acids or freezing may be needed.

Podophyllin or imiquimod cream which can be used at home may be prescribed by dermatologists. One of the various surgical treatments may be done to treat very stubborn or very large genital warts. It is important that the patient’s sexual partner also be examined . Genital warts are often very difficult to cure and successful treatment is not guaranteed even with multiple treatments.

Q: Can I treat my warts without seeing a dermatologist?

A: Although some wart remedies are available without a prescription, you might mistake another kind of skin growth for a wart. You could end up treating a much more serious condition as though it were a benign wart. And remember: early and correct diagnosis is what allows for higher success rates when treating more serious skin conditions. If you have any doubts about either the diagnosis or the right way to treat a wart, it is best to seek a dermatologist’s advice. As with any skin concern, self-diagnosis and treatment is not advisable.

Q: How can I prevent myself from getting warts?

A: First, avoid direct skin contact with another wart. Always protect your skin from injury and wash hands frequently. Do not wear other people’s shoes. Also, make it a point to wear footwear in public locker rooms or showers. To keep from spreading warts, don’t scratch them! Warts spread readily to small cuts and scratches. With regards to genital warts, the best way to not pass them on is to not have sex. Otherwise, use a condom or ask your partner to use a condom for protection as this may help slow its spread. Always bear in mind that some carriers of warts do not even have any symptoms at all!

Q: What are the most common complications encountered after wart treatment?

A: After removal by cryosurgery or electrocautery, infection may sometimes reappear at the treatment site. Also, warts may not disappear completely after treatment. In addition, new warts may appear again or spread after treatment. Minor scarring or formation of keloids in redisposed persons may also occur after removal.

Q: Can a wart grow back?

A: Yes, especially if treatment has been inadequate. Sometimes it will seem as if new warts appear as fast as old ones go away because the old warts have shed the virus into the surrounding skin before they were treated. This will result in new “baby” warts growing up around the original “mother” warts. The best approach is to treat new warts as quickly as they develop to prevent the shedding of the virus into the nearby skin. An examination by your dermatologist can help assure that the treated wart has resolved completely.