Warts (Verruca): Causes and Treatment

What are warts?

Warts are benign skin lesions that result from viruses in the human papillomavirus (HPV) group infecting the surface cells of the skin.

It most commonly appears on the hands, fingers, soles of the feet, and areas such as the knees and elbows. It can also appear around the face or along the edges of the nails.

Warts can be contagious; however, not everyone who comes into contact with the virus will necessarily develop warts. The immune system's response to HPV plays a significant role in the onset and spontaneous resolution of the disease. (OUP Academic)

Briefly, what you need to know

Warts are associated with HPV.

Skin warts and genital warts do not present the same clinical picture.

Some warts, especially in children, may disappear on their own.

Plantar warts can be mistaken for calluses.

A wart does not have a true "root" that extends beneath the skin.

Salicylic acid and cryotherapy are among the most established treatments.

Plantar warts can be more resistant to treatment.

Different treatment methods may be considered for recurrent or resistant warts. (OUP Academic)

What causes warts?

Warts develop when different types of HPV infect keratinocytes in the skin.

The virus can enter the skin particularly through minor traumas or barrier breaches.

However, we will make an important distinction here:

Having warts on your hands or feet does not necessarily mean you have a sexually transmitted HPV infection.

HPV is a very large family of viruses, and different types prefer different anatomical regions.

That's why we discuss genital warts on our separate Genital Warts page.

What are the different types of warts?

Verruca vulgaris — common warts

It is one of the most common types.

Generally:

in hands,

on the fingers,

on the knees,

elbows

It appears as rough and hard-surfaced raised bumps.

Plantar warts — warts on the soles of the feet

It develops on the sole of the foot.

Due to the pressure created by body weight, instead of growing outwards, it may appear flatter under the skin.

It can cause pain while walking, especially in areas subjected to pressure.

Multiple small plantar warts can merge to form larger areas of mosaic warts.

Verruca plana — flat wart

They are smaller, flatter in surface, and often appear as numerous lesions.

Especially:

face,

backs of hands,

legs

It can be seen in areas such as these.

Aggressive destructive treatments on the face should be used cautiously due to the risk of scarring and pigmentation. The BAD guidelines particularly emphasize this risk in flat and facial warts. (OUP Academic)

Periungual warts

These are warts that develop around the fingernails.

Treatment can be more difficult, and both the disease itself and aggressive treatment can damage the nail unit.

Therefore, treatment plans for warts around the nails should be made more carefully.

Does a wart have a root?

No.

Warts do not have an anatomical root extending under the skin like a tree root.

Warts form as a result of the proliferation of HPV-infected cells in the epidermis. Plantar warts, in particular, can appear to be pushed inward into the skin due to pressure:

“"We need to eradicate it completely."”

This belief may emerge.

The goal of treatment is not to "pull out the root".

What are the black dots on a wart?

Small black dots may be visible, especially in plantar or common warts.

These are not the roots of the wart.

It is usually associated with small, thrombosed capillaries.

This finding can be helpful in dermatological examination when differentiating plantar warts from calluses.

How to distinguish between plantar warts and calluses?

The two can be quite similar.

Calluses are essentially hyperkeratosis caused by chronic pressure and friction.

Plantar warts are caused by an HPV infection.

In warts:

The structure of skin lines may be disrupted.,

Thrombosed capillary points may be seen.,

The characteristic surface features of the lesion may be found.

However, we would not recommend that the patient diagnose themselves at home by scraping with a razor blade.

Dermatological evaluation is a more reliable method, especially for persistent or painful plantar lesions.

Are warts contagious?

Yes.

HPV:

through direct skin contact,

from one area to another on a person's own body,

through virus-contaminated surfaces

It can spread.

However, the transmission mechanism cannot always be determined.

Picking at, cutting, or repeatedly traumatizing warts can facilitate their spread to surrounding skin.

In the case of warts in the beard area, shaving can also contribute to the spread of the virus to neighboring areas. (OUP Academic)

Can warts be transmitted through swimming pools?

HPV can be transmitted through surfaces in moist, shared areas; however, it is often impossible to determine precisely where a single plantar wart was contracted.

Because:

“"You definitely caught it from the pool."”

Avoiding walking barefoot in areas like shared showers and pool areas can help reduce the risk of infection.

Do warts go away on their own?

Yes, it can pass.

The immune system can control HPV infection over time.

A significant number of warts, especially in children, may disappear over time without treatment. The BAD guidelines state that spontaneous clearance in children often occurs within one to two years. (OUP Academic)

Therefore, not every small wart necessarily requires aggressive treatment.

In making treatment decisions:

age + location + pain + spread + cosmetic discomfort + duration of illness

They should be evaluated together.

How are warts treated?

The important message is this:

Siğiller için herkeste %100 etkili tek bir tedavi yoktur.

The location, thickness, and number of warts, the patient's age, and previous treatments all influence the choice of treatment method. Current comparative data, particularly for plantar warts, show significant differences in effectiveness and heterogeneity among treatments.

Salicylic acid

Salicylic acid is one of the most established topical methods for treating warts.

It facilitates the removal of keratinized tissue, and the treatment usually requires regular and long-term application.

According to the BAD guidelines, it is one of the treatments with the strongest evidence level for cutaneous warts. (OUP Academic)

However, high concentrations can cause irritation or chemical burns on normal skin.

Especially:

face,

sensitive areas,

feet with circulatory or sensory problems

Treatment should not be done with indiscriminately high concentrations of acid. (OUP Academic)

Cryotherapy

Cryotherapy is the controlled freezing of wart tissue, usually using liquid nitrogen.

It is one of the most frequently used methods in dermatology practice.

It is not expected to disappear completely with a single session; repeated sessions may be necessary.

After the procedure:

pain,

redness,

fluid accumulation,

crusting,

temporary or permanent pigment change

visible.

While more aggressive freezing may be more effective, it can also increase the risk of pain, blisters, and scarring. (OUP Academic)

Which is better, cryotherapy or salicylic acid?

Cryotherapy is not superior in every case.

For example, classic randomized trials in plantar warts have not shown a clear superiority between salicylic acid and cryotherapy. More recent network meta-analysis also shows that no single method is reliably superior in all patients with plantar/palmoplantar warts. (OUP Academic)

Because:

“"If we freeze it, it will definitely go away."”

What can be done about resistant warts?

For warts that have been present for a long time, are numerous, or resistant to standard treatments, different options may be considered.

These include patients in selected groups:

contact immunotherapy,

Intralesional treatments,

some laser methods,

other destructive or immunological approaches

It can be found.

A recent meta-analysis of palmoplantar warts has shown promising results with needling and some intralesional immunotherapy approaches; however, due to the heterogeneity of the studies, it is not accurate to present them as the “definite best treatment” in place of salicylic acid or cryotherapy.

Does laser treatment completely remove warts?

No.

PDL and some other lasers can be used on resistant warts; however, current evidence does not suggest that laser is the standard first-line treatment for all cutaneous warts.

Even in the old BAD guidelines, the level of evidence for lasers is lower than for salicylic acid. (OUP Academic)

Therefore, just because we have a technology in our clinic doesn't mean we'll position it as the "best wart treatment.".

Is it okay to cut or remove a wart?

No.

At home:

cutting with a razor,

piercing with a needle,

snatch,

trying to burn

It can increase the risk of bleeding, infection, scarring, and spread to surrounding skin.

Also, a growth that someone thinks is a wart might be another type of skin lesion.

Will the warts recur?

Yes.

Even after the visible lesion is removed, warts can develop again in the same or nearby area.

This is always the case:

“"The doctor left the root."”

That doesn't mean anything.

Recurrence is possible due to the biology of HPV infection and the individual's immune response.

Does it have any relation to the immune system?

Yes.

The cellular response of the immune system to HPV plays a crucial role in clearing warts.

Warts in immunocompromised individuals:

more numerous,

larger,

more resistant

It's possible. (OUP Academic)

However, in a healthy person with just a few ordinary warts:

“"Your immune system has collapsed."”

We will not reach a conclusion.

Is wart treatment different in children?

Yes.

Because spontaneous recovery is possible in children, the potential consequences of treatment include:

pain,

fear,

bullet,

scar

The problem caused by the wart itself and the wart should be considered together.

Freezing a small, harmless wart aggressively isn't always the best option. (OUP Academic)

When should you consult a dermatologist?

Especially:

If you are not sure that the diagnosis is actually a wart,

if it is multiplying rapidly,

if it is bleeding,

if it is painful,

If it is around the nail,

If it is in the facial area,

if it hasn't gone away for a long time,

if it is resistant to the treatments applied,

if there is a disease or treatment that suppresses the immune system

Dermatological evaluation is appropriate.

Frequently Asked Questions

Does a wart have a root? No. A wart doesn't have a true root that extends beneath the skin.

Are the black dots inside the wart the root? No. They are usually small thrombosed capillaries.

Are warts contagious? Yes. HPV can spread through skin contact and some contaminated surfaces.

Are warts cancerous? Ordinary cutaneous warts are benign. However, not every raised or bumpy lesion is a wart; in suspicious lesions, the diagnosis should be confirmed with a dermatological examination.

Does the cryotherapy procedure resolve in a single session? Not always. Multiple applications may be required. (OUP Academic)

Why are plantar warts so difficult to treat? A thick keratin layer can reduce the effectiveness of treatments, and plantar warts are generally more resistant. (OUP Academic)

Will the HPV vaccine cure existing hand or foot warts? The primary purpose of HPV vaccines is to prevent diseases caused by the HPV types covered by the vaccine; they are not used as a standard treatment for ordinary cutaneous warts. While the therapeutic use of the vaccine in resistant cutaneous warts has been investigated, it is not accurate to present it as a routine treatment.

Which is better, wart medication or cryotherapy? It depends on the type and location of the lesion. Salicylic acid and cryotherapy are established options; however, no single method has been proven superior to all cases, particularly with plantar warts. (OUP Academic)