Warts
Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
More about the experts All content is checked by medical journalists.
Warts (verrucae) are benign growths on the skin that are caused by viruses. Children in particular often have a wart on their finger or in other places on their hands - often in plural. Warts on the face and feet are also common. Read everything you need to know about the topic: How do warts develop? Are you contagious? How can you prevent warts?
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B07
Brief overview
- Types of warts: common warts, brush warts, plantar warts, flat warts, "false" warts (dellized warts, age warts, pedunculate warts)
- Causes: Real warts are usually caused by the human papilloma virus (HPV). The molluscum contagiosum virus is responsible for warts. The exact cause of the age and stem warts is unknown.
- Risk factors: including skin wounds, weakened immune system, circulatory disorders, tendency to allergies (atopy) or existing atopic disease (such as neurodermatitis), emotional conflicts and stress
- Treatment options: including freezing (cryotherapy), acid treatment (e.g. as a plaster or ointment containing active substances), "burning" with electric current (electrocoagulation), laser treatment, ablation with a medical instrument (curette, sharp spoon, scalpel, etc.)
- Prognosis: Warts are usually harmless and often go away on their own (but often only after months or years). However, the relapse rate is high, whether with or without treatment.
Types of warts
Warts (verrucae) are small, sharply defined growths (tumors) on the epidermis. They are caused by viruses, in the vast majority of cases by human papillomavirus (HPV). Warts occur particularly often in children and adolescents. In principle, however, you can get verrucae at any age.
This is how most warts develop
There are different types of HPV. Depending on which virus type is responsible for the infection and where it settles, different types of warts develop morphologically. There are also some skin lesions that look like warts but are of different origins. Below is a description of the most important real and fake warts and treatment options (general information about wart treatment can be found below):
Common warts (Verrucae vulgares)
Common or common warts are the most common form of viral warts. Other names are vulgar wart, skin wart or spiked wart. These skin nodules can form anywhere on the body. The most common warts of this kind are found on the hand or foot. In many cases, a wart on the finger is located near the edge of the nail (periungual).
Usually common warts are the size of a pinhead to a pea. Its initially smooth surface becomes fissured and horny as it grows. In addition, the initially skin-colored skin growths gradually turn a dirty yellow color. They sometimes appear individually (solitary). However, they are often observed in larger numbers.
As a rule, Verrucae vulgares do not cause tenderness or itching. If you don't want to wait for the skin nodules to heal on their own, you can try various options for treating warts. These include above all freezing (with liquid nitrogen) and acid treatment (e.g. with salicylic acid). Other methods, such as laser therapy, are sometimes used.
Brush warts (Verrucae filiformes)
It is a special form of the common warts with a long, thread-like stem. They form on the face (on the eyelids, lips, nose) or on the neck, especially in older people. Occasionally they itch. In addition, brush warts can be irritated or injured when washing, drying or shaving. Above all, however, the thread-like or prickly-looking warts on the face are often perceived as cosmetically annoying. That is why many sufferers have them removed by the doctor, for example by means of freezing (cryotherapy), acid treatment or laser treatment.
Plantar warts (Verrucae plantares)
In contrast to common warts, plantar warts are not raised, hemispherical skin growths. Instead, plantar warts are pressed inwards. This is because they usually form on the soles of the feet: The weight of the body on them pushes the warts inward into the subcutaneous tissue. In addition, plantar warts, in contrast to common warts, are usually quite painful. Every step can be uncomfortable for those affected.
You can get plantar warts if you become infected with the causative virus (HPV) while walking barefoot in a swimming pool, gym or communal shower. To get rid of them, you can stick a plaster containing salicylic acid. It softens the horny layer so that it can be easily abraded in a warm foot bath. Another therapy option is to freeze the plantar warts (cryotherapy). It can also be "burned" with electricity (electrocoagulation) or removed with a special medical instrument ("sharp spoon").
Read more about the appearance and treatment of painful plantar warts in the article Plantar warts.
Flat warts (Verrucae planae juveniles)
If the warts on the face or hands are not raised, they are probably so-called flat warts or planar warts. Occasionally, this type of wart forms on other parts of the body. Flat warts are most commonly seen in children and adolescents. They are therefore also called juvenile warts.
As with other real warts, this type of wart is triggered by human papilloma viruses. A weakened immune system can encourage infection with these viruses. Children in particular often scratch their flat warts. Then new flat warts can form along the scratch track because the viruses are distributed with the nails.
Flat warts are harmless and often go away on their own. If you don't want to wait for it or if you have severe and flat warts, you should talk to your doctor about treatment options. For example, flat warts can be dissolved with vitamin A acid or salicylic acid (possibly in combination with UV radiation). They can also be frozen (cryotherapy) or "burned" with electric current (electrocoagulation). Sometimes they are also removed with a special surgical instrument (curette) or removed using laser therapy.
You can read more about this in the article Flat warts.
Dellular warts (Mollusca contagiosa)
Dell warts aren't real warts - despite their name and similar appearance. This is because they are not caused by human papilloma viruses. Instead, the molluscum contagiosum virus is what causes these wart-like, harmless skin nodules.
Usually dellar warts appear in groups on one or two areas of the skin. In some people, however, they are also found loosely over the body. In adults, the genital region is most frequently affected by pelvic warts. In contrast, other parts of the body are often affected in children, such as the face, neck or armpits.
Inside, dellar warts contain an infectious secretion. If you come into contact with it, you can get infected quite easily (smear infection). This is especially true if your own skin is softened (for example when going to a swimming pool or sauna). Then the triggering viruses can penetrate the skin more easily. Wounds, fungal infections of the skin and neurodermatitis also favor infection with the wart pathogens.
Most of the time, dellar warts go away on their own. But they can also last for years. Similar to flat warts, they can be eliminated with salicylic acid or vitamin A acid. However, it can also be removed with a surgical instrument. There is also the option of treating irritation: Applying an irritating liquid inflames the skin in the area of the dellar warts. This should help them heal faster.
You can read more about this in the article Dell warts.
Age warts (seborrheic keratosis)
Age warts (senile warts) are also not real warts, even if they are similar to these. Its cause is unknown. We do know, however, that they are not caused by viruses - neither HPV nor any other type of virus. Age warts are therefore not contagious.
The name of these wart-like skin nodules comes from the fact that they mainly occur in old age. They tend to form on the face, chest and back, on the back of the hands and the front of the arms and legs. Their appearance is very variable. That is why doctors differentiate between different forms of old age warts, for example pedunculated old warts and stucco keratoses.
Because age warts are harmless and usually do not cause any discomfort, they usually do not necessarily have to be removed. If you still want to get rid of them, you should consult a doctor (as with other warts): Age warts can be removed with a surgical instrument (curette, sharp spoon, scalpel) or removed with a laser. Pedunculated warts can be removed with an electric snare.
You can read everything you need to know about these widespread, harmless skin growths in the post age warts.
Pedunculate warts (fibroids)
Pedunculate warts aren't real warts either. Rather, they are soft, benign growths of certain skin cells. Their medically correct name is soft fibroids.
Pretty much everyone gets the small, stalked, skin-colored skin appendages sooner or later. We do not know why this is so. However, since pedunculate warts occur more frequently in some families, experts suspect a genetic predisposition.
Like age warts, pedunculate warts are harmless and not contagious. But they can be cosmetically disruptive. Sometimes they are also mechanically disruptive. With stem warts in the neck area, for example, thin necklaces or fine silk scarves can get caught on them. In such cases, those affected can have their pedunculate warts removed by a doctor - using a laser, electric current (electrocoagulation) or using surgical scissors.
You can find out more about these stalked skin appendages in the article pedunculate warts.
Warts: causes and risk factors
In most cases, real warts are caused by human papilloma viruses (HPV): The pathogens penetrate skin cells through small injuries and cracks and trigger an uncontrolled multiplication of cells there. The intruders force the human host cells to produce more viruses.
The pathogens are different types of HPV. Common (vulgar) warts, for example, are mostly caused by HPV types 1, 2, 4 and 7. Mainly HPV types 1, 2 and 4 can also be detected in plantar warts. In contrast, flat warts (Verrucae planae juveniles) are generally caused by HPV type 3.
By the way: Certain types of human papilloma viruses are involved in the development of several cancers (such as cervical cancer and penile cancer). However, these are not the types of virus that are responsible for conventional verrucae. Caution is only advised with the so-called genital or genital warts (condylomata).
Faux warts are not caused by HPV: Molluscum contagiosum viruses are responsible for dellar warts. The cause of age warts is unknown. The same applies to stem warts.
Risk factors for warts
Various factors can promote the formation of verrucae - especially the most common form, verrucae vulgares. These risk factors include increased sweating (hyperhidrosis), impaired blood circulation in the fingers and toes (acrocyanosis) and a weakened immune system. People with a tendency to allergies (atopy) or an already existing atopic disease (such as neurodermatitis) are particularly susceptible.
Emotional conflicts and stress also seem to increase the risk of illness. Affected adults are also often smokers.
Are Warts Contagious?
Viral warts are contagious (infectious): The viruses are transmitted directly from person to person, sometimes indirectly via towels or razors. Four weeks to eight months can pass between the infection and the appearance of the first verrucae (incubation period).
It is particularly easy to get infected with wart viruses if the skin is injured. Damp or softened skin also has a beneficial effect. This is why it is particularly easy to get infected in the swimming pool, sauna and communal showers, for example. Also at risk are people who have frequent contact with the causative virus or affected people (such as children).
Someone who already has the small skin growths can further infect themselves (autoinoculation). This is how the verrucae can spread on the body: The viruses are transmitted to neighboring or more distant parts of the body, for example by scratching the skin nodules, where they can also settle.
"Fake" warts that are not caused by viruses (age warts and pedunculate warts) are not contagious.
Warts: examinations and diagnosis
Verrucae are usually harmless. A visit to the doctor is only necessary if the small skin tumors are cosmetically annoying and need to be removed or if they occur in the genital area. You should definitely go to the doctor, if
- a wart is bleeding or inflamed,
- Warts or warts develop on other skin diseases (such as neurodermatitis)
- Dell warts spread quickly.
Age warts may be confused with skin cancer. So if you are not sure that wart-like skin nodules are actually harmless old age warts, you should also see a doctor.
Diagnosis is usually simple
Diagnosing verrucae is generally not difficult for a doctor. He can usually recognize the small, benign skin tumors by their appearance. In addition, the shape, structure and location of the growths in most cases also provide information about the type of wart.
However, if the doctor is not entirely sure, he can take a tissue sample from the skin nodules and have it examined in the laboratory for a histological examination. In individual cases, attempts are also made to detect the pathogen (human papilloma viruses) in the sample.
Warts: treatment
Most warts are uncomfortable and will go away on their own sooner or later. There is then no medical reason why the warts should be removed.
However, if you find the small skin growths cosmetically annoying, you should discuss with a doctor how your warts can be removed. The same applies to warts that cause discomfort, such as plantar warts on the soles of the feet, which make walking very painful.
How can you remove warts?
“What helps against warts?” Many sufferers turn to their pharmacist or doctor with this question. The answer is, there are different methods and remedies for warts. Which strategy makes the most sense in individual cases depends, for example, on the type and number of warts and their location.
Dissolving the horny layer
Various acids can remove warts by dissolving their horny layer. Mostly salicylic acid is used for this, sometimes another acid such as lactic acid. If you want to remove flat warts on the face, vitamin A acid is usually used. The acids are available in the pharmacy as a solution, cream or plaster - usually without a prescription.
Read the leaflet before using for the first time. There is exactly how the product in question is to be used. Generally, a solution or cream needs to be applied to the warts several times a day for several weeks. A patch is worn for a few days (possibly with repetition).
The cornified skin layers dissolve under the action of acid. You will need to remove them carefully on a regular basis, such as with a file or a callous plane. Make sure that the surrounding areas of skin are not injured and that the wart viruses are not transmitted there. Otherwise new warts will appear on these injuries.
Freezing warts (cryotherapy)
The doctor can freeze warts by gently applying liquid nitrogen. When it evaporates, extreme cold occurs, which destroys the top layer of skin. The icing has to be repeated several times, this is the only way to finally remove the warts. At least one week must pass between the individual sessions.
Applying the liquid nitrogen can trigger brief, sharp pain from the cold. As a result, the skin usually turns red and swells a little. A blister can also form. It usually takes several days for the crusted warts to heal. If cryotherapy is performed with caution, no scar will be left behind.
Removing warts by means of icing is not permitted in all cases. The method is not suitable, for example, for people with a diabetic foot or with intermittent claudication (peripheral arterial occlusive disease, PAD). The freezing of warts on the foot can additionally disturb the already poor blood circulation, damage the nerves and cause wounds that do not heal well. Cryotherapy is also unsuitable for removing a wart in Raynaud's syndrome (reduced blood flow to fingers and toes due to the disease).
You don't have to go to a doctor to use cold to remove warts. Pharmacies now offer over-the-counter icing pens for self-treatment at home. However, these are less cold than the liquid nitrogen that the doctor can apply. In addition, the effectiveness of such icing pens has not yet been scientifically proven.
Remove warts: other methods
There are other remedies for warts. So far, however, there has been no clear evidence that they really help or work better than acids or freezing.
Special ointments and solutions with active ingredients that inhibit cell growth (5-fluorouracil) or the viruses (acyclovir etc.) should also be able to remove warts. Sometimes different drugs are injected directly into the warts, for example 5-fluorouracil or substances that affect the immune system (interferons).
In addition, warts can be removed with the help of curettage: The skin nodules are scraped off with a special medical instrument (curette). Before that, they are often pretreated with acid.
Some people have their warts lasered, that is, heat them up with a laser and destroy them.
In photodynamic therapy, a special gel is applied to the wart. Leave it on for about three hours and then irradiate the wart with light. This activates certain ingredients in the gel and destroys the skin tumor.
The old method of cutting out warts is rarely used today. This can lead to infections and cosmetically annoying scarring.
Home remedies for warts
Various medicinal plants are said to be very helpful if you want to remove warts. The milky sap of the celandine, for example, is supposed to remove the small skin tumors if you dab them with it several times a day. In the same way, you can treat warts with the milky sap of the dandelion or a solution from the foot of the foot. This should also be able to remove the small skin nodules.
In many cases, naturopaths also rely on the anti-viral power of tea tree oil in the treatment of warts. It is applied to the wart in a diluted form several times a day. Garlic could also be effective against wart viruses: With the intake of a high-dose garlic preparation, warts can also be removed.
Warts: course and prognosis
Warts are generally harmless. As soon as the body successfully combats the virus that caused it, it disappears on its own. However, this can take weeks to months. Studies on affected schoolchildren and adolescents showed that about fifty percent were wart-free again after one year and about seventy percent after two years. There are no comparable studies in adults.
How quickly the small skin growths disappear in individual cases depends on various factors. For example, the virus and wart type and the state of the immune system play a role. Verrucae can be very persistent in people with weakened body defenses.
If warts have healed at some point - with or without treatment - you will not be immune to it in the future. On the contrary: the relapse rate (recurrence rate) is high.
Prevention tips
Some measures can possibly prevent you from becoming infected with affected people or, in turn, from transmitting the virus to other people:
- Do not share towels, shoes, and socks with other people.
- Do not walk barefoot in swimming pools, communal showers, gyms, and locker rooms.
- Cover existing warts with a waterproof patch before swimming.
- Do not touch the verrucae.
Also, you should avoid scratching warts. Otherwise you can transmit the viruses contained in it to other parts of your body or to other people.
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