Warts…Not just caused by kissing frogs

Warts are benign (non-cancerous) skin growths caused by the human papillomavirus (HPV) infecting the top layers of the skin.  Warts can grow on any part of the body and are contagious.  They are spread by contact with the wart, or something that touched the wart.  It is easier to catch the virus that causes warts when there is a cut or scrap on the skin; which explains why so many kids get warts.  Scratching, nail-biting, and shaving are common ways warts are spread on the body.  It can often take a few months for the wart to grow large enough for one to see.  Anyone can get warts, but children, teens, and people with a weakened immune system are more prone than others.  In order to prevent the wart from spreading you should avoid scratching, picking, or biting at the site and avoid touching someone else’s wart.

There are a few different types of warts, depending on the location on the body and the appearance. Common warts grow most often on the fingers and hands.  They can be raised, rough, and have the appearance of black dots on the surface.   Plantar warts grow on the bottom of the feet, are usually flat, and grow inward sometimes causing pain with walking.  Flat warts can occur anywhere on the body and grow in large numbers.  They are usually skin-colored, slightly elevated, and flat topped.  Children tend to get them on the face; women commonly get them on the legs, and men most often in the beard area. Periungual warts occur around the nails and have a cauliflower-like appearance.  Genital warts occur on the genitalia of men and women, are sexually transmitted and highly contagious.

Warts are often self-limiting and treatment may not be necessary, especially in children.  There are some treatment options available if the wart is persistent, painful, or numerous in number.  Cryotherapy (freezing) is one of the more common treatments for warts performed in a dermatology office.  This treatment causes a blister to form between the wart and normal skin, ultimately causing the wart to fall off.  This treatment is well tolerated and often requires multiple in-office treatments 3-4 weeks apart.  There are several topical treatments available for warts as well. Cantharidin is a liquid that is “painted” over the wart and causes the skin to blister underneath, ultimately causing the wart to fall off.  This is performed in office and is useful for periungual warts.  Imiquimod, a topical cream, can be used for hard to treat common warts and stimulates the body’s immune system to attack the virus locally.  A prescription is required and this can be applied nightly to the affected area and washed off in the morning.  Topical retinoids have been shown to be useful for flat warts.  Salicylic acid applied topically to the wart under occlusion with silver duct tape is another treatment option and can be used nightly until the desired results are seen.  Other procedures include electrodessication and curettage (“burning and scrapping”), laser treatments, and surgical removal of persistent and difficult to treat warts.

There is no cure for the wart virus and they can reappear in the same site previously treated or develop in a new spot.  No matter the treatment option you and your dermatologist elect to pursue, persistence is key when it comes to the treatment  of warts on the body.

By: Robin Moran, PA-C, Dermatology Physician Assistant at USF Health

Robin Moran,PA-C