Warts

Overview

Warts are rough skin growths that feel like tiny grains. They usually grow on the fingers, legs, and hands. Warts also feature small black dots, which are basically clotted blood vessels.

Common warts are caused by human papillomavirus, or HPV, which spreads via human touch. The HPV virus triggers excessive cell growth, which causes the skin to become stiff and thick in a particular spot.

If your skin is exposed to the virus, it may take 2-6 months to develop. Generally, these are non-cancerous and harmless and disappear independently after a while.

That said, not everyone exposed to the virus is prone to warts. Only individuals with weakened immune systems usually become the victims of warts. If someone has skin damage or cuts, the virus might attack him/her easily. Perhaps this is why people with chronic skin conditions like eczema are at higher risk of warts.

Types of Warts:

There are several types of warts, each with distinct characteristics commonly found on different body parts. Here are the main types:

Common warts: Often appear on fingers, toes, knees, or elbows. They’re rough, skin-coloured, and may have black dots.
Plantar warts: Found on the soles of the feet, these can be painful and look like thick, calloused skin with black specks.
Flat warts: Smaller and smoother, these can be found on the face, thighs, or arms and are usually light brown.
Filiform warts: These are characterized by long, thin projections and are typically found around the eyes, nose, or mouth.
Periungual warts: Grow around the nails and can affect nail growth.
Genital warts: A sexually transmitted infection that appears in the genital area.
Each type of wart may require specific treatments, such as topical medications, cryotherapy, or surgical removal. If you suspect you have warts, it’s best to consult a healthcare provider for proper diagnosis and treatment.

Symptoms:

Common symptoms of warts include:

Small, fleshy, grainy bumps
Rough to the touch
Sprinkled with small black pinpoints, clotted blood vessels
Warts are generally harmless and often disappear independently, but they can be bothersome or embarrassing for some people. If you have warts that are painful, change in appearance or colour, or persist despite treatment, it’s advisable to see a doctor for further evaluation

Causes:

HPV viruses cause warts. Warts form when one of these viruses infects the top layer of the skin. According to the American Academy of Dermatology, warts are more likely to develop after a small cut or other skin damage. Warts spread more easily on moist skin. Warts are contagious and can spread from person to person via direct skin contact or by touching an object, such as a towel, that has been touched by another person's warts.

Genital warts are transmitted through sexual contact with someone who has them, either orally, vaginally, or anal.

According to the AAD, the people most at risk of developing warts are:
children
Teenagers who bite their nails or pull hangnails.
Individuals with a weakened immune system

Risk factors:

The risk factors for developing warts include:

Age: Children and teenagers will likely develop warts due to their less mature immune systems.
Weakened immune system: People with compromised immunity, such as those with HIV/AIDS or organ transplant recipients, are at higher risk.
Skin trauma: Cuts, scrapes, or conditions like eczema can make skin more susceptible to HPV infection.
Personal habits: Nail biting or cuticle picking can create openings for the virus.
Public spaces: Walking barefoot in public showers or pools can increase the risk of plantar warts.
Direct contact: Touching warts on another person or using shared items like towels or razors can spread the virus.
To reduce the risk of warts, it’s important to maintain good skin care, avoid direct contact with them, and keep the immune system healthy. If you have concerns about warts or risk factors, consult a healthcare provider for personalized advice.

Possible Complications:

Most warts get resolved on their own with time. But if it doesn’t and the individual fails to avail proper treatment for the same, it may lead to the following issues:

• Infection: If an individual cuts or picks on the wart, it may cause the wart to break open. This will allow bacteria to enter the wart and cause further infection, irritation and pain.

• Pain: Most warts are not painful. That said, if one develops plantar warts, they might cause pain because they begin to grow inwards in the foot. So, walking will become troublesome, as the person will start feeling like there is a pebble under his/her foot.

• Disfigurement: People with weak immunity may get unappealing wart clusters on their face, hands or body.

• Cancer: Genital warts and HPV are closely linked to anal, throat, and cervical cancers. Always use precaution while indulging in sexual activities and get the HPV vaccine to minimise the risk of genital warts.

Prevention:

Preventing warts involves a combination of good hygiene practices and caution to avoid spreading the human papillomavirus (HPV) that causes them. Here are some effective prevention strategies:

Wash your hands regularly: This helps remove the virus from your skin.
Keep your skin healthy and intact: Moisturize to prevent dry, cracked skin, which can be an entry point for HPV.
Avoid direct contact with warts: This includes your own or someone else’s.
Don’t share personal items, such as towels, razors, or nail clippers, with others.
Cover cuts and scrapes: Use a bandage to protect breaks in the skin.
Wear protective footwear: In communal showers or locker rooms to prevent plantar warts.
Avoid biting nails or picking at hangnails: These habits can create openings for the virus to enter.
Keep feet clean and dry: To reduce the risk of plantar warts.
Remember, while it’s difficult to prevent warts completely due to the prevalence of HPV, these measures can significantly reduce your risk. Consult a healthcare provider if you have concerns about warts or notice new skin growths.

When to consult a doctor?

An individual must see a dermatologist for common warts situations if:

• Several warts begin to show up on the skin, which might serve as an indication of poor functioning of the immune system

• One is unsure whether the skin growths are warts or not

• An individual has skin growth or warts on his/her face or other sensitive body parts like genitals, nostrils or mouth

• An individual observes any pus or scabbing, or signs of bleeding around the wart

• The warts are hampering a person’s day-to-day life and general activities

• Home remedies are not helping at all

• Even after managing and treating warts, these continue to persist and recur

• An individual has diabetes or any other autoimmune diseases that would point to a weak immune system

• The warts are painful and keep changing their colour and appearance

Diagnosis:

• Physical examination: A dermatologist or general physician will conduct a quick physical exam to diagnose warts. The doctor will distinguish warts from other conditions like calluses, moles, skin tags, corns or cancer.

• Tests:

1. Lab tests: Women with genital warts should go for a pap smear or pap test. The sample of cells is collected from the cervix with a small brush. It's then sent for a lab examination to determine any abnormalities. The doctor may also recommend an HPV test. A small sample is taken from a relevant site and undergoes a PCR method to confirm whether it's a particularly low-risk or high-risk virus. A DNA test is also helpful in recognising if a person has strains of the high-risk HPV virus, which may lead to genital cancer. For men, a wart sample is taken from the anus, urethra or any other visible wart site.

2. Advanced tests: Sometimes, for proper diagnosis, the doctor might also conduct a biopsy, wherein a tiny tissue sample is taken to determine whether the genital wart has an infection that may turn cancerous. 

Treatment:

• Home treatment: Warts generally get better with time, although it might take a few weeks or months. If a person doesn't want to spend money on expensive and conventional treatments, he/she can first try home remedies.

1. Take a cotton ball soaked with apple cider vinegar and water and put it on the wart for 3-4 hours.

2. Tape a piece of banana peel over the wart and leave it overnight

3. Apply aloe vera gel on the wart

4. A layer of clear nail polish over the wart may help prevent the virus from spreading.

5. Stick duct tape on the wart for 3-6 days, then soak it in warm water and scrub it with a pumice stone.

6. Rub orange peel against the wart every day for 2-3 weeks

7. Give a rub down on the warts with crushed garlic

• Medications: The medications for warts are directly applied over the lesion, and it is still advisable to apply a handful of medications before they work. Here are some valuable medicines:

1. Trichloroacetic acid helps burn off warts on the soles, palms, and genitals. However, it can cause some skin irritation.

2. Imiquimod is a cream that may boost the immune system's ability to fight against HPV. It may cause some swelling and redness at the site of application.

3. Podofilox is a topical prescription that destroys the tissues that cause genital warts. When applied, it can cause some itching and burning.

4. Salicylic acid removes the wart layers one by one. It can cause irritation and shouldn't be used on the face.

• Surgical treatment: If the prescribed medication fails to improve the condition, doctors may suggest one of the following surgical methods to remove warts:

1. Excision: The doctor might cut the wart out by making a small incision at the site.

2. Laser treatment: A dermatologist might opt for laser treatment if no other therapies are helpful. The doctor will first inject a shot of anaesthesia to numb the wart before eradicating it.

3. Electrosurgery and curettage: Electrosurgery or burning is one of the best treatments for foot warts, common warts and filiform warts. Before electrosurgery, the doctor will scrape away the wart with a small, sharp knife or spoon. This is called curettage.

• Alternative management: Besides all the medications, home remedies and surgical procedures, there are some alternative therapies to cure warts:

1. Cryotherapy: This method is also known as the freezing treatment. It's not too painful and is quite a popular method for treating warts. However, it can cause some dark spots. You may need the therapy on a repeated basis.

2. Cantharidin: In this method, a dermatologist paints the wart with cantharidin. This causes blisters under the wart, and within a week, the doctor clips off the dead wart.

3. Chemical peels: If an individual has many flat warts, dermatologists may suggest a peeling method and prescribe medications like tretinoin, salicylic acid, and glycolic acid to help remove them.

Additional information

• What are the symptoms of warts in young children?

Let’s take a look at how different kinds of warts can present different symptoms in young children:

1. Plantar warts: A group of plantar warts is known as mosaic and grows in the palms or the soles of the feet. These are sometimes really painful.

2. Common warts: These warts have rough exteriors and look brown or greyish-yellow in colour. These may develop on the elbows, face, knees and fingers.

3. Filiform warts: These warts look long and small with narrow growths and usually occur on lips, eyelids, neck or face.

4. Flat warts: Flat warts are tiny and smooth and usually appear on the kids' faces.

5. Periungual warts: A kid with thickened skin around his/her nails could be a periungual wart. It can lead to painful fissures or splits in the child’s skin.