Warts are benign growths which are the result of a specific viral infection in the top layer of the skin. Although they may occur at any age, they are most common in the 10-20 year-old age group. It is estimated that 10% of teenagers have warts. Almost everyone will get one or more warts in their lifetime. As with other infections, warts may be transmitted from one individual to another.

The viruses that cause warts are in the human papillomavirus (HPV) family. There are many different subtypes of this virus that cause different types of warts in different locations of the body. In different locations, they have different appearances. This accounts for the many confusing names given to warts. For instance, the plantar warts are merely warts found on the soles (plantar area) of the feet. The main types of warts are common warts (verruca vulgaris), plantar warts, flat warts, and genital warts.

  • Common warts are usually raised and rough, and occur most commonly on the hands. They can appear in clusters.
  • Plantar warts (foot warts) are located on the soles of the feet. They grown down into the skin from the pressure of standing, which can make them painful.
  • Flat warts are small and smooth, growing in clusters most often on the legs or face.
  • Genital warts occur on the genitalia of women and men and are sexually transmitted. Some types of genital warts are associated with cancer of the genitalia.

How do you get warts?

Warts are transmitted directly by touching another person with warts, or indirectly by touching an object with the wart virus on it. The HPV virus enters the skin through a small scratch or wound. This explains why warts often appear around the fingernails where the skin is often dry or cracked. After the skin becomes infected by the HPV virus, these skin cells start to reproduce more rapidly. This creates small bumps where the skin is a bit thicker than the surrounding skin. It may also have a slightly different color. It may take months for the growth to develop after contacting the virus.

Why do some people get warts and others don’t?

The virus is very common. Most people who are exposed to the virus do not develop warts. This is because their body’s immune system recognizes the HPV virus and attacks it before it can start a growth. Children are more susceptible to warts because their immune systems often have not sufficiently matured to recognize that the wart virus is foreign and should be attacked. Childhood warts often disappear without treatment as the body develops the ability to fight them off. However, some adults do not develop the ability to fight off the wart virus and can be susceptible to warts as well.

Do warts need to be treated?

In children, warts can disappear without treatment over a period of several months to years. However, warts that are bothersome, painful, or rapidly multiplying should be treated. Warts in adults often do not disappear as easily or as quickly as they do in children, so treatment is usually recommended. Multiple treatments are often necessary to clear warts.

What about the problem of recurrent warts?
Sometimes it seems as if new warts appear as fast as old ones go away. This may happen because the old warts have shed virus into the surrounding skin before they were treated. In reality new “baby” warts are growing up around the original “mother” warts. The best way to limit this is to treat new warts as quickly as they develop so they have little time to shed virus into nearby skin. A check by your dermatologist can help assure the treated wart has resolved completely.

How are warts treated?

There are multiple treatments for warts, none of which is 100 percent effective. Treatment may destroy an individual wart, but the wart virus may remain in the surrounding skin causing more warts to appear. The most common treatments for warts are listed below:

No treatment: Childhood warts that are small and not bothersome to the child may be best left alone. Over 90 percent will go away within a period of years. However, they may continue to grow and treatment often will prevent them from spreading.
Freezing (Cryotherapy): This destroys the top layer of skin and peels off much of the wart. Multiple treatments may be required.
Salicylic acid: There are many over-the-counter medications containing salicylic acid, which helps to peel offthe top layers of skin. When applied over 2-3 months, they may be effective in removing a wart with relatively little discomfort.
Electrosurgery (curettage and electrodessication): This is typically reserved for warts that are resistant to other treatments. The area is numbed with local anesthetic and cauterized to destroy the wart tissue. Scarring often results and the healing process may take 4 to 6 weeks.
Laser therapy: Both the VBeam pulsed dye laser and the Erb:Yag laser have been shown to be safe and effective treatment for warts. The VBeam laser targets the excess blood vessels within the wart, turning the area black for 10-14 days but doesn’t cause an open wound. While it is possible to eliminate warts after just one treatment, it is more common to require a few treatments for successful removal. The Erb:yag causes direct destruction of the wart virus, resulting in a small open wound that takes about 3-4 weeks to heal. Usually one treatment is effective with the Erb:Yag laser.
Cantharidin: This is a blistering agent that is applied painlessly during your clinic visit. Over the next several days, it induces a blister at the application site. The wart peels off along with the blister. Several treatments may be required.
Bleomycin: When injected into warts, this medication causes localized destruction of the skin cells and the wart virus at the same time. The area forms a scab that takes about 2-3 weeks to heal.
Candida Ag Sensitization: Tiny injection of candida antigen is placed into the warts to induce an immune response. Candida antigen is a purified protein from yeast that can stimulate the immune system.
Prescription Medications: These are often used in conjunction with the above modalities to improve the chance of success. Aldara® cream helps your body fight off the wart virus by increasing the immune response locally. This cream is particularly effective for genital warts, but may be effective for other types of warts as well.

How can Dr. Margaret Mann and The Dermatology Center help me with my warts?

As a dermatology specialist, Dr. Mann receives many referrals from other dermatologists in the Orange County area for the treatment of warts that are resistant to conventional therapies like liquid nitrogen therapy and salicylic acid applications. We have all the therapeutic options mentioned above and will advise you on which treatments may be most appropriate for you or your child. We are familiar with multiple therapeutic options, and will devise a treatment plan that meets your needs.

If you have any questions, please contact us at (615) 266-3376 (DERM).