Common Questions

Let’s Talk About Warts

By: Doug Egge, MD

Warts. Many of us likely had them as a child. Many of us still likely have no idea what they are or why they show up on our children’s hands, feet, and everywhere in between.

These undesirable skin growths have been around forever. They are caused by a virus that is very good at survival, and annoyingly, they often take a long time to resolve. Most warts in childhood are not a serious issue and will most likely resolve on their own…eventually. There are several types of warts, and each has a slightly different treatment plan, but most have at least this in common:

Warts are caused by a family of viruses called human papillomavirus that hide from our immune system by surrounding themselves with a person’s own skin cells. That is what creates the bump that you can see, and when your immune system passes the bump, all it can detect are your own cells. The “seeds” that can be seen inside the bump are dried out blood clots, and not the actual virus.

Types of Warts
  • Common warts. These appear on the fingers, toes and hands. Sometimes they can also be found on the arms and legs, usually around the elbow or knee area, but can appear on almost any skin surface. They can look like 3-5 mm firm thickened bumps that may appear to have “seeds”, or dark spots inside them. Often they can enlarge to be twice that size, and can become very bothersome or interfere with normal activities. Common warts are not very infectious with intact skin, but can be passed by people from sharing bedding, towels or when people pick at their warts, bite their nails and do not properly wash their hands.
  • Plantar warts. These appear on the bottom of the feet or toes, and also on the palm of the hand. These are more flat than common warts, and because the skin is so much thicker, they are deeper in the skin layers. Unfortunately, this thick barrier makes them a lot more difficult to treat. Plantars are also often more painful when pressure is applied over the wart.
  • Flat Warts. These appear on the face, body and extremities. Like the name implies, they do not create a bump, but spread along the surface of the skin.
  • Molluscum Contagiosum. This wart is actually caused by a different virus called, you guessed it, molluscum contagiosum virus. Warts from this virus can show up almost anywhere on the body and look like a single or cluster of shiny, smooth, skin-colored (or pink) domes that have a small dimple in the center. These warts will usually go away on their own within 6-18 months.
  • Genital warts. There are several different types of genital warts caused by HPV and other viruses. They each have a different treatment course, so if you believe your child may have genital warts, definitely contact their pediatrician.

As noted, most warts will usually resolve on their own if given enough time. But, why does it take so much time you ask? Well, the wart virus is buried within a person’s skin cells and the immune system has a difficult time “finding” the virus and killing it. Once the immune system does find the wart virus, most of the warts will resolve.

Sometimes they will become tender, or occur in a location that makes them bothersome. Other times they will just be an annoyance to your child because they look a bit gruesome. Either way, if a wart needs to be treated, the following trategies could help in making the wart disappear at a faster rate…

  1. Duct tape. This old trick sounds like a bit of a wives’ tale but it is actually a great treatment— some studies even show this as the most-effective! The goal is to cover the wart 24 hrs/day for several days then pare down the skin over the wart, and repeat the covering for several days. Repeating this pattern will irritate the skin and cause the wart to become smaller over time and then resolve.This treatment is usually best for common warts and plantar warts on fingers/toes/extremeties.
  2. Over the counter wart remover liquids or pads. These usually involve salicylic acid and work by creating irritation to the skin that covers the wart and can melt away some of the superficial layers. Eventually the irritation will draw the immune system to the area and the wart will go away. Patience is important with this treatment option, as it can take weeks to months for the immune system to react and find the virus. This treatment can work for most types of warts caused by the H. papillomavirus.
  3. Cryotherapy. This treatment uses some form of liquid nitrogen to freeze the skin over the wart. There are versions available over the counter, but most are not as thorough as the type that can be used in the doctor’s office. This method can be used alone, or in conjunction with another chemical treatment. Cryotherapy can work for most types of warts caused by the H. papillomavirus, and sometimes is used for other types of warts. As with all wart treatments, it can take several attempts to get the wart to resolve.
  4. “Beetle Juice”, aka cantharidin. This is the oil from a Japanese blister beetle and will literally create a blister over the wart. As you can imagine, this needs to be handled very carefully and is only available in the doctor’s office. That said, it can be very effective. Canthatidin can help speed up the healing process of most warts and molluscum contagiosum.
  5. Surgery. Some dermatologists will burn or cut out warts as part of a treatment plan. This is done in the office and with the use of anesthesia to the area. Although this sounds dramatic and permanent, there is nearly a 50% recurrence rate.
  6. Prescription topical treatments can also be used to treat troublesome warts. Retin-A, prescription strength salicylic acid, or glycolic acid can help the layers of a wart dissolve. Immune modulators like Aldara can help shrink the wart and speed the natural immunity. Topical 5-fluorouracil will stop the growth of the extra cells that make up a wart the same way it can stop tumor cells from growing. All of these options have the chance for significant side effects, so they are not considered unless needed in a particular case.
  7. Injectable medicines, such as Bleomycin are used by dermatologists for several types of warts. This treatment is usually reserved genital warts or for warts that do not respond to other treatments.
Wart Prevention

Warts and the virus that spread them are difficult to avoid entirely. You can reduce your risk by washing your hands frequently, and wearing flip flops at public pools/showers and beaches. You should also try to avoid sharing towels or clothing with others unless they have been washed between uses.

If your child does have a wart, encourage them to not pick at it as this can spread warts to others or to others areas of their own skin. If they do touch or pick at a wart, then we recommend they wash their  hands immediately.

Until next time,

Dr. Doug Egge

Parkside Provider, Medical Director (Reidville Road), and a proud teller of dad jokes

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