WARTS: TYPES, CAUSES, AND THE LATEST TREATMENTS

Medically Reviewed by Dr. Rosmy Barrios 

Warts are a common skin condition affecting millions worldwide. They are small, rough growths that can appear on any body part. While warts are usually harmless, they can be unsightly and cause discomfort.

This article explores the types of warts, their causes, and the latest treatments available.

What Are Warts and What Causes Them?

Warts are by-products of human papillomavirus (HPV)^[1], a highly infectious virus that is transmitted through direct contact with an infected person or object. Factors like prolonged stress, swimming in public pools, or having a weakened immune system can increase the susceptibility.

Children and teenagers are especially very susceptible to developing warts. Estimates suggest that, on average, 1 in every 3 teenagers has a wart. Warts affect 3-5% of adults and up to 10% of the population.

Are All Warts Caused by HPV?

All warts are caused by specific strains of HPV, of which there are over 100. These are not the strains capable of causing female reproductive cancer, which does not produce any warts.

HPV proliferates under warm, moist conditions, influencing whether its contact with the skin results in a wart. There is a higher chance that exposure to damaged, moist skin will produce a wart.

Does a Low Immune System Cause Warts?

A low immune system can make a person more susceptible to warts. The immune system fights off infections, including the HPV virus. When the immune system is weak, it is less effective in fighting the virus, leading to the development of warts.

Prolonged stress can contribute to warts by weakening the immune system.

What Deficiency Causes Warts on Hands?

Currently, there is no single vitamin deficiency definitively proven to cause warts on hands. Some studies suggest there is a potential connection between lower vitamin B12 levels and an increased risk of contracting a wart^[2]. Sustaining a healthy immune system might help your body fight HPV infections more easily.

Signs and Symptoms of Warts

Warts can vary in their appearance depending on their location and type. There are some common signs and symptoms to look out for.

How to Identify a Wart

Warts are usually small, rough growths that can be flesh-colored, pink, or brown. They can have a cauliflower-like appearance, feel soft or bumpy, and may have black dots in the center. Warts can also be flat or raised and appear alone or in clusters.

Warts can occur on any body part where the virus can enter the skin. Common parts of the body they manifest include:

• Hands
• Fingers
• Around the nails
• Face (rare)
• Elbows
• Knees
• Feet
• Genitals

Warts may be painful if compressed, growing near a sensitive area, or stood on. They may also impact nearby tissues, such as how the nails grow.

Occasionally, warts are confused with calluses, corns, and skin tags that may look similar. Calluses and corns result from friction or pressure on the skin. Skin tags are small, harmless growths that do not arise from a virus.

How to Differentiate Between a Wart and Skin Cancer?

As some cancers are associated with viruses, including HPV, warts may seem like a form of skin cancer. However, warts are usually harmless and do not possess the same characteristics as a skin tumor. Skin cancer can have a variety of appearances, including scaly, crusty, or bleeding patches.

While very rare, some warts can turn into a type of low-grade skin cancer known as a verrucous carcinoma.^[3]

If unsure, it is best to consult a doctor for a proper diagnosis.

Types of Warts

There are several types, each with its unique characteristics and location on the body^[4].

• Common warts: Common warts, also known as verruca vulgaris, are the most common type. They usually appear on the hands, fingers, and around the nails. Common warts have a rough, fleshy, and grainy appearance. They also may have black dots in the center.^[5]
• Plantar warts: Plantar warts appear on the underside of the feet. They could have a rough surface and hurt to walk or stand on. There are two subtypes of plantar warts^[6]:
  • Myrmecial-type plantar warts: These warts look like domed lesions with a smooth surface. They may contain black or brownish dots, tiny burst blood vessels. This type tends to cause pain while a person is walking or standing.
  • Mosaic-type plantar warts: These are similar to myrmecial-type warts but are more prominent and cover a larger foot area. They refer to a cluster of fused plantar warts, creating a more extensive, mosaic-like wart. HPV strains cause them type 2.
• Flat warts: Flat warts, also known as plane warts, are small, smooth, and flat-topped warts that can appear in large numbers. They often occur on the face, hands, and arms. Flat warts are typically flesh-colored or slightly pink.
• Filiform warts: Long, narrow warts called filiform warts frequently develop around the lips, nose, or eyes. They have a filamentous or finger-like appearance and can be flesh-colored or slightly brownish.
• Periungual warts: Periungual warts appear around or under the nails. They can impact nail growth and may be painful.^[7]
• Genital warts: Genital warts, also known as condylomata acuminata, are specifically found in the genital area, including the genitals, anus, or mouth. They are brought on by particular strains of the HPV virus, which are spread during intercourse. Genital warts have a cauliflower-like appearance and can vary in size and number.^[8]

In addition to these common types of warts, there are also some less frequent types:

• Cantharidin warts: Cantharidin warts appear after treatment with cantharidin, a blistering agent derived from blister beetles. Cantharidin is applied to the wart to cause a blister to form underneath it, lifting the wart off the skin for easy removal.^[9]
• Butcher's warts: Butcher's warts are a type of common wart that can be transmitted from animals to humans, particularly from handling or processing raw meat.
• Focal epithelial hyperplasia (Heck's disease): Focal epithelial hyperplasia^[10], also known as Heck's disease, is a rare type of wart that has an ethnic predilection for the indigenous populations of North America but is not restricted to this population. Multiple soft, pink, and dome-shaped warts in the mouth characterize it.

Each type of wart has a different appearance and often requires a specific treatment approach. If you are unsure about the type of wart you have, consult a medical professional for an accurate diagnosis and appropriate treatment.

Risk Factors

Anyone can develop warts, but some people are more at risk than others. These risk factors include:

• Having a weak or compromised immune system, especially those with AIDS or who underwent an organ transplant
• Having a history of warts
• Being in contact with someone who has warts
• Walking barefoot in public areas
• Biting or picking at nails
• Having damaged skin
• Working with raw meat frequently, such as at a butchery
• Those with skin conditions like eczema that leave the skin vulnerable and exposed

How to Prevent Warts Transmission?

Warts are highly contagious when in direct contact with an infected person or object. It is important to take precautions to prevent the spread of warts.^[11]

To prevent warts transmission, it is essential to:

• Avoid touching warts on yourself or others
• Wear flip flops or sandals in public areas where warts can spread, such as in communal locker rooms, showers, or pools
• Ensure your feet remain dry and use clean socks every day
• Keep your hands clean and avoid biting or picking at nails
• Refrain from sharing personal items such as as towels or razors with with someone who has warts
• Throw out any instruments, nail files, used bandaids, or other personal items that have made close contact with the wart
• To avoid damage, keep your skin hydrated and healthy
• Cover a wart if you have one, and do not scratch or pick at it

Diagnosing Warts

If you suspect you have a wart, it is important to consult a doctor for a proper diagnosis. They will examine the wart and may perform a biopsy to confirm the diagnosis.

Do Warts Go Away on Their Own?

Most warts may go away on their own without treatment. However, if left untreated, this can take 12-24 months or longer. They can also spread to other areas of the body or other people.

It is advisable to get treatment to hasten the healing process and stop warts from spreading.

Home Remedies for Warts

Home remedies do not have guaranteed success for everyone, and their effectiveness often lacks scientific backing.

Popular home remedies for warts include^[12]:

• Aloe vera
• Apple cider vinegar
• Aspirin
• Banana peel
• Bee propolis
• Castor oil
• Clear nail polish
• Dandelion weed
• Duct tape
• Garlic
• Orange peel
• Pineapple
• Potato
• Tea tree oil
• Vitamin C
• Vitamin E

All of the above remedies attempt to dry the wart out, dissolve it, inhibit HPV, suffocate it, or support the immune system in removing the wart on its own.

There is no direct evidence that any of the above remedies work effectively, except for aspirin, which contains salicylic acid. Aspirin is less effective than a proper wart-removal salicylic acid gel.

If a wart causes significant discomfort, does not improve, or spreads, it is best to consult a doctor for more effective treatment options.

When Should I See a Doctor?

You should see a doctor if:

• You have a wart that is painful, bleeding, or changing in appearance
• You are having trouble removing a wart, and it impacts your quality of life
• You have a wart on your face or genitals
• You have a weakened immune system
• You have a history of warts that keep coming back
• You are unsure if the growth is a wart or something else

Treatment Options for Warts

Various treatment options for warts are available based on the type and location of the wart.

• Over-the-Counter Topical Medications: Over-the-counter topical medications, such as salicylic acid, can effectively treat warts. These medications remove the wart’s top layer, eventually causing it to fall off.^[13]
• Liquid Nitrogen (Cryotherapy): Liquid nitrogen, also known as cryotherapy, is a standard treatment for warts. Liquid nitrogen is used in this method to freeze the wart, causing it to fall off. This might be a painful procedure that takes several sessions.
• Cantharidin: Cantharidin is a chemical applied to the wart to cause a blister to form underneath it. The blister facilitates the wart removal by lifting it off the skin.^[14]
• Laser Therapy: Laser therapy is a non-invasive treatment that causes the wart to come off by utilizing a laser to damage the blood vessels supplying the wart.
• Surgical Removal: When a wart is large or resistant to previous treatments, surgery may be required to remove it. This involves cutting or scraping off the wart under local anesthesia.
• Electrosurgery: Electrodesiccation involves using an electric current to burn off the wart. This treatment may require local anesthesia and can cause scarring.

Do Warts Come Back After Treatment?

In some cases, warts may come back after treatment. This is because the wart-causing virus may persist in the body even after the removal of the wart. It is essential to take precautions to prevent the spread of warts and seek treatment if they return.

Latest Advancements in Wart Treatment

Researchers constantly look for new and improved ways to treat warts. Some ongoing research areas include:

• Immunotherapy involves using the body's immune system to fight the virus. Various immune-boosting treatments have shown to be effective in treating warts, including^[15]:
  • Histamine antagonists
  • Zinc and Vitamin D3
  • Microbial antigens (immune stimulants)
  • Interferon therapy (immune-boosting molecules)
• HPV vaccination may lower the risk of acquiring genital warts, as observed in some populations. While unrelated, the MMR vaccine, Bacillus Calmette-Guérin vaccine, and the Mw vaccine stimulate the immune system and effectively treat warts at low doses.
• Photodynamic therapy uses light to activate a medication that kills the virus. When coupled with topical skin ointment, phototherapy is promising for the treatment of resistant warts.^[16]

Conclusion

Certain Human papillomavirus (HPV) strains cause warts, which are a common skin condition. They are often unsightly and uncomfortable, but there are many treatment options available. It is essential to take precautions to prevent warts from spreading and seek treatment if they do occur. With the latest advancements in wart treatment, there is hope for those who suffer from this common skin condition.

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