Warts (verrucae) are common benign skin growths caused by infection with certain strains of the human papillomavirus (HPV); they can appear on the skin or mucous membranes and vary in appearance depending on location.
What are warts?
Warts are benign skin growths caused by infection with certain strains of the human papillomavirus (HPV); the virus induces localized hyperproliferation of the epidermis, producing small, rough, or smooth papules or plaques that differ in appearance by site—common warts on the hands are usually rough and papillomatous, plantar warts on the soles are often flat and painful from inward growth, and flat warts are smoother and more numerous on the face or shins. More than a hundred HPV types exist, but only specific cutaneous types are responsible for non‑genital warts, and individual susceptibility varies with immune response, skin breaks, and exposure risk in communal wet environments. Transmission occurs through direct skin‑to‑skin contact or indirectly via contaminated surfaces, with children and young adults most frequently affected; immunosuppression increases risk and persistence. Most warts are asymptomatic and self‑limited, resolving spontaneously within months to years, but they can be cosmetically bothersome, uncomfortable when on weight‑bearing areas, or refractory to treatment. Diagnosis is typically clinical, sometimes aided by dermoscopy or biopsy for atypical lesions, and management options range from topical keratolytics such as salicylic acid to cryotherapy, immunomodulatory approaches, or procedural removal for persistent or problematic lesions.
What are the types of warts?
Warts are diverse benign epidermal proliferations caused by specific human papillomavirus (HPV) types and are classified largely by their clinical appearance and anatomic location: common warts (verruca vulgaris) are firm, rough, papillomatous papules often found on hands and periungual skin; plantar warts appear on weight‑bearing surfaces of the feet, may be painful, and sometimes show black thrombosed capillaries; mosaic warts are clusters of plantar warts that coalesce into a plaque; flat warts (verruca plana) are smoother, smaller, and often numerous on the face, forehead, or shins; filiform warts are long, narrow, and projection‑like, frequently arising on the face and neck; genital warts (condylomata acuminata) affect anogenital mucosa and are caused by mucosal HPV types with implications for sexual transmission; butcher’s warts are large hyperkeratotic lesions seen in meat and fish handlers from occupational exposure; and focal epithelial hyperplasia (Heck’s disease) presents as multiple soft papules on the oral mucosa, linked to specific HPV subtypes and seen more commonly in certain populations. Recognizing these types guides management choices, infection control, and when to pursue diagnostic biopsy or specialist referral.
How are warts diagnosed?
Warts are usually diagnosed clinically by their characteristic appearance—firm, hyperkeratotic papules or plaques with a rough or papillomatous surface on the hands, flat smooth lesions on the face, or endophytic painful lesions on weight‑bearing areas of the feet—and by a history of gradual onset and exposure risks; physical signs such as pinpoint black dots (thrombosed capillaries) in plantar and common warts are helpful clues. Dermoscopy provides noninvasive confirmation, revealing patterns such as interrupted skin lines, thrombosed capillaries, and specific vascular structures that increase diagnostic confidence and help distinguish warts from molluscum, callus, or neoplasms. In atypical, treatment‑resistant, or mucosal lesions, biopsy and histopathology can confirm the diagnosis by showing papillomatosis, hyperkeratosis, koilocytosis, and viral cytopathic changes. In certain contexts—especially anogenital disease—HPV typing or referral for sexual health assessment may be appropriate, whereas for routine cutaneous warts laboratory testing is rarely necessary. Overall, a combination of clinical assessment, dermoscopy when available, and selective histologic sampling ensures accurate diagnosis and guides appropriate therapy.
What is the treatment for warts?
Warts are treated with a range of approaches that aim to remove the lesion, destroy infected tissue, or stimulate a host immune response, and choice depends on wart type, location, symptoms, patient age, and preference.
First-line therapies for common cutaneous warts often include topical keratolytics such as salicylic acid applied regularly to soften and exfoliate hyperkeratotic tissue and in‑office cryotherapy with liquid nitrogen to induce localized tissue destruction; repeated treatments over weeks to months are frequently required.
Other office options include cantharidin application, topical or intralesional immunotherapies (e.g., imiquimod, intralesional antigens) to promote immune clearance, and minor surgical removal or curettage for recalcitrant lesions. For plantar and mosaic warts, debridement and combination strategies improve outcomes; lasers or photodynamic therapy may be considered for persistent cases but carry higher cost and variable evidence.
Genital warts are managed with patient‑applied topical agents (imiquimod, podofilox), provider‑applied therapies (cryotherapy, trichloroacetic acid), or excision, with attention to sexual health and HPV prevention via vaccination.
Many warts resolve spontaneously, so treatment balances symptom relief and cosmetic concerns against discomfort, cost, and recurrence risk; counseling about transmission prevention and realistic timelines is important for all patients.
Can warts go away on their own?
Warts often resolve spontaneously because the immune system can recognize and clear human papillomavirus‑infected cells, particularly in children and young adults; many cutaneous warts disappear without treatment over months to a few years, so a watchful waiting approach is reasonable for asymptomatic lesions and when cosmetic or functional concerns are minor. The likelihood and speed of resolution vary with age, immune status, wart type, and location: children have higher spontaneous clearance rates than adults, immunocompetent people clear warts more readily than immunosuppressed individuals, and plantar or mosaic warts may persist longer because of constant pressure and thicker keratin layers. When warts cause pain, spreading, cosmetic distress, or are long‑standing, active therapies (topical salicylic acid, cryotherapy, or other clinician‑directed options) are appropriate, while prevention advice—avoiding direct contact, protecting skin in communal areas, and treating breaks in the skin—helps reduce transmission during the observation period.
Conclusion
Warts are common, benign skin growths caused by specific HPV strains that often resolve on their own but can persist, spread, or cause pain and cosmetic concern; diagnosis is usually clinical, treatments range from topical therapies and cryotherapy to immune‑based or procedural options, and management should be individualized based on wart type, location, patient age, and immune status, with prevention, patient education, and realistic expectations guiding care.
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