Warts are extremely common skin growths that can appear on any part of the body, though they are most often found on the hands and feet. Several types of warts exist, including the common wart, the flat wart, the filiform wart, the plantar wart, the periungual wart and genital warts. Among these, the common wart is, like the term suggests, the most common. Among the general population, up to 13 percent of people are affected by warts, and they present in people of all ages. In the vast majority of cases, warts are not a medical concern, but they are usually considered a cosmetic issue, especially if they are densely packed or located on the face. Whether a patient has one wart or a cluster of them, a primary care physician can safely and reliably remove the warts.

What is a wart and what causes them?

Warts are benign skin growths that are not cancerous and do not predict future development of cancers. They are, in most cases, an annoyance, though they can become irritated if scratched or bumped continuously. Warts come in many varieties, and here’s a more in-depth look at each:

  1. Common warts – Common warts present as a raised growth that may be rough to the touch. They are found in people of all ages (but are much more common in children) and usually grow on the hands, though they can spread to other parts of the body.
  2. Flat warts – Flat warts are, unsurprisingly, flat growths that are smooth and smaller than common warts. They can present in larger numbers and can be quite ubiquitous, appearing on the hands, feet, face, knees, wrists and neck.
  3. Filiform warts – Filiform warts look like a tiny finger or thread, and are smaller than common warts. They are almost always found on the face, and around the lips or eyelids in particular.
  4. Plantar warts – Plantar warts are only found on the feet, usually close to pressure points. These warts are harder than other warts and are dotted with black specks in the center. Plantar warts may be painful to touch.
  5. Periungual warts – Periungual warts are always found around the fingernails and present as a clump of growths that look like cauliflower.
  6. Genital warts – Genital warts are about as common as common warts, and extremely prevalent among sexually active people. Genital warts spread through sexual contact, and though they usually present with few symptoms, they are often treated due to their appearance.

All warts are caused by the human papillomavirus, or HPV. HPV is everywhere and infects the skin by entering through a small cut or broken area. Once inside, HPV causes the skin to rapidly grow, partly by ramping up keratin production and thickening underlying layers of the dermis. There are more than 170 types of HPV, and most of them pose little threat to a healthy immune system.

However, HPV is highly contagious, so warts can spread with contact or after contacting a surface that was recently touched by a wart. And in people with weakened immune systems, HPV can pose a greater threat, as the virus cannot be easily killed off by the body’s natural defenses. In these patients, dense concentrations of warts can appear and remain for long periods of time, causing significant distress.

How are warts dealt with?

Because they are benign, local growths, there is little difficulty in removing warts. Treatment is the patient’s decision, as warts rarely represent a threat and because they resolve on their own, in most cases. However, warts located on an obvious patch of skin, like on the face or hands, may warrant removal for cosmetic reasons. And warts on the foot can produce pain or irritation, which would also warrant removal. Primary care physicians can perform removal procedures, and have plenty of tools at their disposal. Some of those tools include:

1. Medication – Physicians can prescribe one of several medications, all of them applied directly to the wart. Salicyclic acid is the most frequent choice here, as it is reliable and safe to use by patients. Salicyclic acid works as a kertolytic, which means it forces the skin to shed. This process will break down the wart steadily over time.

Other medications include imiquimod and dinitrochlorobenzene, or DNCB. Imiquimod is a topical cream that targets HPV by encouraging the body to produce more interferon. This helps the body’s immune system signal the virus for other immune system components to destroy. DNCB possesses a cure rate of 80 percent and is also applied to the wart, but it must be used with much more caution. DNCB is extremely reactive, even at room temperature, and can cause genetic damage to other tissues if not applied carefully, so if a physician opts for DNCB, they will usually apply it themselves.

2. Cryotherapy – During cryotherapy, the wart is frozen, allowing a blister to form between the wart and the underlying epidermis. Cryotherapy is usually performed using liquid nitrogen, which is precisely sprayed on the wart. Common warts on thin skin can be removed completely after three or four treatments. It may take dozens of treatments if the wart is located on calloused skin.

3. Curettage – Curettage is more direct, involving the use of a curette to physically scoop the wart off of the underlying tissue. This form of treatment is normally only indicated if medication fails.

4. Laser treatment – Laser treatment is considered more extreme than other forms of wart removal, and as such, it is usually employed only when a patient is suffering from dense clusters of warts. Laser treatment is effective at removing many warts at once and does so immediately. However, laser therapy is more expensive and can be painful, even resulting in minor scarring. But because it completely vaporizes the tissues in the wart, it leaves no trace behind.

Warts may not be a health problem worth worrying about, but they are unsightly, causing many to seek treatment for their removal. Fortunately, they are easily treated and can be eliminated with the help of a primary care physician.