Warts
Treatment of common and genital warts using an approach appropriate to their location and type
What is warts?
Warts are growths caused by the human papillomavirus infecting the top layer of skin. The virus makes those cells multiply faster than their neighbours, and the result is a firm, rough lump with tiny black dots in it, which are clotted capillaries.
They spread by contact, most easily where skin is damp or broken: shared bathroom floors, swimming pools, a shaving nick, a bitten nail. Scratching one wart seeds others alongside it. Children get them most, and anyone whose immune system is suppressed gets more of them and keeps them longer.
Where a wart sits changes how it looks and how it behaves. On the sole, body weight pushes it inwards into a verruca that hurts to stand on. Around a nail it lifts the nail fold and is stubborn. On the face and neck they are flatter and softer. Genital warts come from the same family of virus and are managed along a separate route, so mention them at the consultation. Most warts in a healthy person clear within two years without treatment, and that fact sets the bar for how hard to chase one.
What you might notice
- Rough raised growths on the skin
- Small soft tags of skin catching on clothes
- Hard skin building up under the foot
How it is diagnosed
A dermatologist recognises a wart by sight and by paring it. Shaving the hard surface with a blade reveals the pinpoint black dots and shows what has happened to the skin lines: a callus keeps its lines running across it, and a wart interrupts them. That distinction is the main one on the sole, where a corn and a verruca look alike.
Squeezing is the other test. A verruca hurts when pinched from the sides, and a corn hurts when pressed straight down.
A biopsy is rarely needed. Your dermatologist will take one if a single lesion in an adult has been growing steadily, bleeds without being knocked, has an irregular edge, or has not answered a proper course of treatment, since a skin cancer on the sole or around a nail can look very like a stubborn wart.
Recovery
Freezing takes seconds and stings for a few minutes afterwards. A blister, sometimes a blood blister, forms within a day and dries into a scab over a week. You can wash, work and walk normally throughout. Sittings are two to three weeks apart, and a hand wart usually takes three to six of them.
Cautery and laser are done under local anaesthetic and leave an open wound about the size of the wart. Keep it dry and dressed for a week to ten days while it fills in. A verruca on a weight-bearing part of the sole is sore to walk on for the first few days, so book it when you can take it easy.
The wart has gone when normal skin lines run straight across the site. Recurrence in the same spot is common, because the virus can still be present in the skin around it. Keeping feet dry, not sharing towels and covering the site in shared showers are what stop the next one.
If it is left untreated
Leaving a wart alone is a reasonable choice and often the right one in a child. Two thirds clear within two years with no treatment at all, and freezing a child's hand repeatedly is unpleasant for a result that was coming anyway.
Left alone, warts do tend to multiply. One on a finger becomes several, and picking or biting them spreads them fastest. On the sole a verruca thickens and can become genuinely painful to stand on. On the face, shaving over them scatters them along the jaw.
Two situations need a doctor instead of patience. A lesion that keeps growing, bleeds on its own or looks unlike your other warts should be examined and may be sampled, since not everything rough is a wart. And if you have diabetes, poor circulation in the feet or a suppressed immune system, have a foot lesion treated under medical supervision instead of with over-the-counter acid, because a burn on a numb foot heals badly.
Questions about warts
Can I pass warts to my family?
Yes, though it takes more contact than people expect. The virus spreads through direct skin contact and through damp surfaces, so bathroom floors, shower trays, shared towels and shared nail clippers are the usual routes at home. Broken or softened skin lets it in far more easily than intact skin, so a family member with a shaving nick or eczema is more at risk than one without. Practical steps help: keep the wart covered when it is being treated, use flip-flops in shared showers, do not share towels or files, and dry feet properly. Complete separation is unnecessary, because most people have already met the virus and their skin simply deals with it.
Why does my wart keep coming back after being frozen?
Freezing destroys the visible wart, and the virus can still be present in the skin that looked normal around it. When those cells multiply, a wart reappears in the same place, often within a few weeks of the site healing. A single freezing is also rarely enough on its own: a hand wart usually needs three to six sittings two to three weeks apart, and a thick verruca on the sole needs the hard surface pared down before each one so the cold reaches the living tissue. If it has come back after a proper course, your dermatologist will change approach, usually to cautery or laser. A wart in an adult that keeps returning at exactly the same spot despite all of this is also worth a second look, because a few skin cancers begin by looking like one.
Do the acid paints and plasters from the chemist work?
For an ordinary wart on a hand or foot in a healthy person, salicylic acid does work, and it works about as well as freezing for hand warts. What it needs is persistence: daily application for eight to twelve weeks, with the surface filed down with an emery board before each one, and the surrounding skin protected with petroleum jelly. Most failures are courses stopped at three weeks. Do not use it on the face, the genitals or on a lesion you are not sure about. And if you have diabetes, numbness in the feet or poor circulation, have foot lesions treated by a doctor, because acid on skin that cannot feel a burn causes ulcers.
Other dermatology & cosmetology treatments
Treatment of acne and acne-related marks based on skin type, severity and recurrence
Day CareEvaluation and treatment of uneven skin tone, dark spots and other pigmentation concerns
Day CareTalk to a care coordinator about warts
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one