Warts: symptoms,causes & treatment

Warts: symptoms,causes & treatment

What are warts and what are the right behaviors to prevent them ? Regular swimming is ideal for keeping healthy and in summer it is also pleasant to dive into the pool. But unfortunately the swimming pool is also a very crowded hot-humid place, in which some hygiene rules must be scrupulously respected to prevent possible dermatological infections.

The warts can be caused by viral infections facilitated by the attendance of the common spaces such as swimming pools . They are benign epidermal lesions, small yellow-gray skin growths which appear rough to the touch and which are characterized by a considerable thickening of the horny layer of the skin, the most superficial and hardened. In general, they appear in the areas of the skin most prone to chafing and small traumas and affect children of school age more easily, although they can occur at any age.

There are several types: the most common is represented by common warts . However, in most cases, warts are not dangerous or painful , but they can create a lot of discomfort and produce an unpleasant aesthetic impact. In addition, they have a viral origin: the pathogen responsible for transmission is the human papilloma virus .

In some cases they regress and disappear on their own , in others they can be treated with drugs intended for local application or with medical procedures such as cryotherapy or surgical, with traditional techniques or lasers. Treatment is not complex in itself, but is complicated by the tendency of these formations to reappear after being removed.

What are warts

The term verruca derives from the Latin verrūca , which means protrusion.

These are benign epidermal lesions, small gray-yellow protuberances rough to the touch and hemispherical in shape, which appear mainly on the hands and feet . Generally they are less than a centimeter in diameter. They can occur individually or in large numbers in the same individual.

They are caused by a viral infection , caused by one of about 120 papillomavirus serotypes that infect humans ( HPV , from the English Human Papilloma Virus ). The infection can be promoted by certain conditions, which make it easier for the virus to take root in the skin, the risk factors , which will be discussed in detail in the following paragraphs.

Warts or corns?

To distinguish plantar warts from calluses , it is possible to resort to methods such as superficial scraping performed by the doctor through scalpels: plantar warts tend to bleed at the level of small point areas, which appear as many pinpricks.

Can warts be tumors?

In most cases, warts are not dangerous, but they can be very annoying. In some particular cases, they can represent a serious health risk, as in the case of some types of genital warts that are associated with HPV serotype infection capable of causing tumors , in particular in the oral cavity ( tongue, mouth, tonsils and oro-pharynx ) or genitals (serotypes HPV16 and HPV18 are related to the development of carcinoma of the uterine cervix ).

The most common type of wart, the so-called common wart , is mainly located in areas of skin areas subject to rubbing and small traumas , such as the knees, face, fingers, soles of the feet and elbows. This is because the imperceptible skin lacerations favor the entry of the virus into the skin.

Warts and children

These formations can develop at any age, even if the share of the population most affected is that of school-age children: the peak incidence is reached in the age group between 10 and 15 years . “Warts can contract at any time, even if in some phases of life we ​​are more predisposed, such as in childhood, old age or in cases of immunosuppression”, explains pediatritions

Children suffers from it more frequently , due to their weaker immune system.

The infection can be contracted when you use public toilets , common showers or go to the swimming pool : it is precisely the situations of promiscuity that trigger the transmission of bacteria. Incubation is very slow, ranging from 2 months to 9 months. During this period, a slow increase in the epidermis is seen, almost as if it were slowly swelling.

The classification of warts

They are subject to different classifications, which are based both on the localization at the level of the skin and on the shape.

At a first observation it is possible to distinguish in:

1 – Common warts (also called vulgar warts or leeks)

It is the most common type of warts, which represents about 70% of the total. They are formations of irregular surface, variable size and rounded shape, hard and rough to the touch and occur mainly on the back of the hands and fingers and on the edge of the nail.

More rarely they occur on the palms of the hands, on the elbows and on the knees.

Common warts are caused by human papillomaviruses of serotype HPV1, 2, 4, and 7 . Serotypes 75 to 77 may occasionally be involved in their appearance , but only in patients immunocompromised by HIV infection or due to specific therapies.

At the skin level it is possible to observe nodules with a diameter of 2-10 mm, clearly delimited, roughly rounded or with irregular morphology and of a color that varies between light gray, yellow, brown and gray-black. They can have a shape similar to a cauliflower .

2 – Flat or flat or juvenile warts

They are smaller formations than the common ones and appear in groups as smooth spots, with flat surface, yellow-brown, pink or flesh-colored.

They occur especially on the backs of the hands and on the face.

They can also develop along the scratches that may be present on the skin. The beard area in men and the legs in women are also frequent locations of flat warts , where they can be spread by shaving or epilation . They are asymptomatic and can be difficult to recognize and treat.

Juvenile warts are termed because they are more common in children and young adults. They are caused by human papillomavirus of serotype HPV3 and HPV10 (occasionally from 26, 27, 28, 29 and 41 ).

3 – Filiform wart

They are long and thin neoformations that can appear in specific points of the face such as the eyelids, the face, the neck or the lips . They generally do not cause symptoms and are quite easy to treat.

Warts: location

From the point of view of localization it is possible to distinguish:

Plantar wart

It occurs on the sole of the foot, has a flattened shape due to the pressure exerted by walking, is surrounded by thickened skin and contains a small central black area. If it occurs at the level of the back of the foot or toes, it is generally raised.


They appear on the palm of the hand and are gray or brown in color, with a small central black area.

Periungual warts

They are thickened neoformations, which generally have a cauliflower shape and appear around the nails.

In this case, the risk is that the nail will lose its cuticle, which physiologically has protective functions. So, this phenomenon can increase the risk of other skin infections, such as paronychia , the infection of the tissue surrounding the nail, which appears with:

  • reddening
  • swelling
  • ache
  • local collection of pus.

It is a condition better known as a fingertip . Periungual warts are most common formations among people who bite their nails or perform professions that involve keeping their hands in the water.

Warts or venereal warts

They are relatively rarer formations, which occur on the skin of the genital district and around the anus.

They can have a flat, smooth and velvety appearance or be more irregular and prominent. Warts around the anus can trigger itching . Infection due to high-risk human Papillomavirus subtypes (mainly HPV16 and HPV18 but also types 31, 33, 35 and 39 ) is the main cause of carcinoma of the uterine cervix ( cervical cancer ).

In Italy every year there are about 2,300 new cases of this pathology and 430 deaths.

When this tumor is diagnosed at an advanced stage, its mortality is high, while early diagnosis makes it more curable. The most effective system for its diagnosis is represented by the Pap-Test , a simple and cheap exam that saves the lives of many women every year.

As for the ways of development, warts can:

  • grow in groups of small plantar warts that converge: in this case they are called mosaic (or cluster ) warts
  • develop as isolated, single growths.

How warts manifest

They are skin lesions with specific characteristics:

  • are protruding (apart from the exception of flat warts)
  • benign
  • yellowish-gray color ; sometimes they have some black dots , particularly if they are shaved
  • hemispherical in shape
  • rough to the touch.

Where are they formed? They appear mainly in areas subject to rubbing and small traumas, such as the hands, the soles of the feet and the knees: the imperceptible skin lacerations favor the entry of the virus into the skin.

Why do some hurt? Most warts are not associated with pain , but these formations can cause pain when subjected to pressure. This occurs mainly in the case of plantar warts, in an upright position or during walking.

Are they dangerous? In most cases, warts are not dangerous, but they can be very annoying and generate an unpleasant aesthetic impact. So, the latter aspect is the reason that most often drives them to be removed. Certain types of genital warts are an exception to this general observation, which are due to types of HPV that can cause cancer of the mouth, throat or genitals.

How the infection occurs

Are Warts Contagious? Contagion occurs by direct contact with the skin of another subject covered by one or more warts or by indirect transmission through the exchange of personal objects. The most common form of transmission is that by direct contact with your warts and is called autoinoculation : in this way they are transmitted from one part of the body to another.

The incubation period is very long and varies from 2 months to 9 months: during this period it is possible to feel a burning sensation and observe the formation of a slight swelling.


What is the specialist who takes care of them? For the diagnosis of warts it is necessary to undergo a dermatological examination . In general, the dermatologist is able to make the diagnosis by simply observing the growth. Furthermore, in doubtful cases, it can take a small sample of local skin to be analyzed in order to exclude other pathologies ( biopsy ).

Why do some warts turn black? Among the fundamental signs of warts: the absence of skin lines transversal to the surface, the presence of black points at the apical end (black points are residues of thrombosed capillaries), the bleeding that takes place when the warts are cut. In fact, these signs can be used to differentiate warts, in the diagnostic area, from other skin formations.

How to cure warts

How to cure warts

There are numerous ways of treating warts , which depend on the type of formation, the position, the depth with which they enter the skin, their number and the extent of the affected skin area.

What does it mean that warts are relapsing

They are not difficult to treat, but they are difficult to eliminate definitively : they have a high risk of recurrence. The virus can remain in the skin even after the eradication treatment and give rise to other growths after some time.

The most complicated to treat are plantar warts , which can reappear in the same locations or in different locations, even after treatment. Factors affecting the recurrence of warts are not known, but are likely to include the integrity of the immune system and the patient’s overall health. Regular use of drugs, in the event that chemical aggression is used, increases the probability of success of the therapy.

If you notice the formation of a wart, it is good to intervene quickly. On the one hand it is true that in many cases, they spontaneously regress and disappear on their own without leaving scars. On the other hand, however, they can grow (making treatment more complicated) and spread to other parts of the body (autoinoculation).

Drug treatment

To remove them, it is possible to apply locally irritating and keratolytic chemicals (i.e. they tend to flake the surface layer of the skin).

For this purpose, solutions based on salicylic acid concentrated in elastic collodion are used to be applied directly on the wart. Salicylic acid is also commercially available in other formulations. For example, for plantar warts , patches soaked in 40% active ingredient can be used , to be left in place overnight; in some cases the patch must be kept for even longer intervals.

Salicylic acid treatment, which is the first choice in most cases, should be continued for several weeks.

But other substances are also used, including trichloroacetic acid (30-70%) and 5-fluorouracil .

The cantharidin is applied alone or in combination (1%) with salicylic acid (at 30%) and podophyllin (5%) in a colloidal base.

Natural remedies

Despite the spread of large quantities of content posted on the web on alleged natural remedies for warts, none of them are scientifically validated.

Applying toothpaste , apple cider vinegar , fig milk and garlic can produce irritation and inflammation reactions in the surrounding healthy skin.

Hence, it is recommended that you always seek medical attention for therapy .

Types of warts and effective treatments

The treatment of flat warts

Flat warts are difficult to treat ; they are often more resistant than warts common to the action of drugs. In addition, they are often located in aesthetically impacting areas (primarily the face) and this represents a deterrent to the use of aggressive methods.

Therefore, the first-line treatment is represented by tretinoin, formulated in cream based on retinoic acid (0.05%) and applied every day. On the other hand, if the exfoliation produced with tretinoin is not sufficient to eliminate it, another irritant can be used, such as benzoyl peroxide (5%) or 5% salicylic acid .

Before the application of keratolytics, the part must be superficially abraded to eliminate the surface necrotic tissue and then immersed in hot water to soften the hard and rough surface layer and facilitate the penetration of the drugs.

Since most of these chemicals can also burn healthy skin, it is essential to carefully follow the instructions and apply the drug only to the wart. Some of these products are sold with special protective patches for the skin surrounding the wart.

How to cure periungual warts

Warts that form at the edge of the nail should be treated with a combined approach. Generally cryotherapy is carried out followed by application of cream based on imiquimod (5%), tretinoin or salicylic acid . The use of liquid nitrogen in the periungual area can cause permanent deformities of the nail and, rarely, also nerve injuries: it is therefore a procedure that requires a lot of attention.

How genital warts are treated

Genital warts can be destroyed with a procedure called electrocoagulation , which involves the use of a needle inside which an electric current flows in order to remove the damaged tissue. The treatment also includes local application of products based on anti-mitotic substances (that block cell replication, such as podophyllin, the podophyllotoxin and 5-fluorouracil), immuno-modulating ( imiquimod ) or caustic (as l ‘ trichloroacetic acid ) .

However, no treatment is entirely satisfactory and relapses are frequent.

Apart from the general considerations, the approach to ano-genital warts must proceed, in agreement between the doctor and the patient, according to personalized criteria, such as the size of the wart, the number of lesions, the anatomical site, the economic impact and the reactions adverse.


The cryotherapy consists in freezing of warts by implementing liquid nitrogen and is used to treat plantar warts, filiform sottoungueali and those of the hands. Liquid nitrogen is applied by spraying or with a cotton ball, in order to whiten up to 2 millimeters of skin around the wart. Sudden freezing produces necrotization of the skin, a phenomenon that leads to death of the cells that make up the wart.

Generally there is no need to anesthetize the affected area, but exceptions are usually made in the case of child patients, who may be less and worse able to resist the pain caused by the procedure. Numerous treatments are often needed at monthly intervals, especially for large growths.

The laser treatment

Laser warts surgery involves the vaporization of the skin tissue at these formations. The procedure requires the administration of a local anesthesia and produces wounds that can take a long time to heal and that must be scrupulously medicated. Laser treatment of warts leaves permanent scars.

However, the laser has a selective action, which has minimal impact on the surrounding tissue and minimizes the size of the residual scars.

Surgical removal

Isolated warts can be removed using a special surgical instrument similar to a sharp spoon, the Curette spoon , which detaches the wart from the rest of the skin.


Is it possible to prevent the formation of other warts in an already affected person? Firstly, it is possible to prevent their spread in areas of healthy skin, the process known as autoinoculation .

However, to achieve this it is necessary to use differentiated towels to dry the different areas of the body and avoid scratching the lesions, an operation that facilitates the spread of the infection.

Furthermore, it is possible to improve the treatment result by intervening early. Early diagnosis . In fact, it is also worth noting that a greater stay on the skin of the body increases the probability of contagion of the areas of healthy skin.

Early intervention is also very important to prevent their spread to other areas of the body . To avoid upstream HPV infection underlying the formation of warts, avoid the preventable risk factors:

  • use breathable shoes and store them in the evening in an airy place
  • use antiseptic sprays for footwear in case of predisposition to microbial contamination of the feet
  • wear shoes or slippers while attending swimming pools, gyms and sports centers
  • do not exchange personal items such as towels, sponges, bathrobes, slippers, nail scissors and other utensils for the care of hands and feet
  • avoid risky sexual contacts to prevent genital warts.


In addition, a vaccine is available to protect against HPV infection: effective and safe vaccination can prevent about 90 percent of neoplasms caused by Papillomavirus . For the immunization it is required two doses of inoculum, if the vaccination is carried out before 15 ° birthday. Afterwards, 3 doses are needed.

HPV vaccination is recommended for all adolescents, both male and female, aged 11-14 years.

Know the risk factors to prevent

The incubation period is very long and varies from 2 months to 9 months: during this period it is possible to feel a burning sensation and observe the formation of a slight swelling.

The warts are caused by a viral infection. It is therefore possible to prevent the infection underlying the appearance of warts by identifying risk factors and trying to prevent them whenever possible.

Weakening of the immune defenses

It can occur due to diseases such as HIV infection or due to therapies that have the purpose of suppressing or modulating the action of the immune system and that are administered for the treatment of chronic inflammatory diseases (such as rheumatoid arthritis, the Crohn’s disease and others) or after an organ transplant (to prevent rejection). However, this condition clearly cannot be prevented.

Pre-existing skin lesions

They open a breach for the entry of the virus into the skin; since it can be scarifications, even imperceptible to the eye, this is also a condition that cannot be prevented. This phenomenon makes athletes and people exposed to frequent trauma to the hands and feet more prone to the development of warts.

Use of non-breathable footwear

In fact, they prevent the skin from transpiring properly and create favorable heat and humidity conditions for the development of the virus. Therefore, the choice of suitable shoes , to be left in an airy environment after use, helps to reduce the risk of HPV infection. Specialist sprays are also available in the pharmacy to be sprayed in the shoes to prevent the development of microorganisms.

Mixed use of personal accessories

Towels, bathrobes, slippers and nail care items; protection from warts infection also passes through the prevention of the exchange of personal items.

Public places such as swimming pools or changing rooms of gyms and sports centers
To protect yourself from the risk of warts, you should always wear shoes or slippers, even in the shower. In addition, for small children it is possible to use special mats where they can rest their feet while changing, to be rolled up and stored in the bag after use.

Exposure to sunlight

The role of the sun’s rays in the warts formation process is unclear; one of the hypotheses in this regard is that they can act as promoters for their training.

Genetic factors

The tendency to form from scratch and relapse that is observed in some subjects suggests that there may be a genetic predisposition to the development of warts.

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