The Growth of Warts
By Orthopaedic and Neurology Clinic
Common warts are small, grainy skin growths that occur most often on your fingers or hands. Rough to the touch, these warts also often feature a pattern of tiny black dots, which are small, clotted blood vessels.
Warts are caused by a virus and are transmitted by touch. It can take as long as two to six months to develop after your skin has been exposed to the virus. They are usually harmless and eventually disappear on their own. But many people choose to remove them because they find them bothersome or embarrassing.
What causes Warts?
These are local growths in the skin caused by human papillomavirus (HPV) infection. There are over 100 types of HPV. Some HPV types infect the genital and oral mucosa and produce large masses, which can occasionally become cancerous. Other HPV types are responsible for benign common skin warts that are not associated with cancer. Although they are considered to be contagious, it is not uncommon for just one family member to have them. In addition, they often affect just one part of the body (such as the hands or the feet), but they can be spread to other areas. The form taken by the infection seems to be partially dependent on the genetic type of the wart virus, as well as its anatomical location. For example, the same type of virus can cause common hand warts, as well as plantar warts.
What are some types of Warts?
Common warts, or verruca vulgaris
These common warts have a firm, raised, rough surface and may appear cauliflower-like.
They can occur anywhere, but they are most common on the knuckles, fingers, elbows, knees, and any area with broken skin.
Clotted blood vessels are often visible as small, darkened spots. These are known as seed warts.
Painful verrucae appear on the soles of the feet, heels, and toes.
They usually grow into the skin because the person’s weight pushes onto the sole of the foot. They normally have a small central black dot surrounded by hard, white tissue. Plantar warts are often difficult to clear.
Plane warts, or verruca plana
These are round, flat, and smooth. They can be yellowish, brownish, or skin coloured.
Also known as flat warts, they grow most often on sun-exposed areas.
They tend to grow in larger numbers, possibly between 20 and 100. However, of all wart types, they are most likely to disappear without treatment.
Filiform warts, or verruca filiformis
These are long and thin in shape. They can grow rapidly on the eyelids, neck, and armpits.
These are multiple plantar warts in a large cluster.
Unlike moles, they are often the same colour as the person’s skin. These do not contain pus unless they become infected.
If infection occurs, they may require treatment with antibiotics.
When should I see a doctor?
It is a good idea to see a doctor if the wart:
- causes pain
- bleeds easily
- changes appearance
- spreads easily to other parts of the body
- comes back after prior removal
- appears in an area that leads to constant bumping and bleeding so as to affect daily activities, such as shaving, sports, and so on
Individuals who want the wart removed for cosmetic reasons should see our doctor.
“Each person’s immune system responds differently to the virus, not everyone who comes in contact with HPV will get a wart. And if you cut or damage your skin in some way, it’s easier for the virus to take hold. That’s why people with chronic skin conditions, such as eczema, or who bite their nails or pick at hangnails are prone to getting it.”
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What types of diagnosis?
In most cases, our specialist can diagnose with one or more of these techniques:
- Examining the affected area
- Scraping off the top layer of the growth to check for signs of dark, pinpoint dots — clotted blood vessels
- Removing a small section of the growth (shave biopsy) and sending it to a laboratory for analysis to rule out other types of skin growths
Possible treatment methods?
The goals of treatment are to destroy the wart, stimulate an immune system response to fight the virus, or both. Treatment may take weeks or months. Even with treatment, they tend to recur or spread. Our Specialist generally start with the least painful methods, especially when treating young children.
Our doctor may suggest one of the following approaches, based on the location of your warts, your symptoms and your preferences. These methods are sometimes used in combination with home treatments, such as salicylic acid.
- Stronger peeling medicine. Prescription-strength wart medications work by removing layers a little bit at a time.
Freezing (cryotherapy). Freezing therapy done by involving application of liquid nitrogen to the growth. This works by causing a blister to form under and around it. Then, the dead tissue sloughs off within a week or so. This method may also stimulate your immune system to fight viral warts. You’ll likely need repeat treatments.
Side effects of cryotherapy include pain, blistering and discolored skin in the treated area. Because this technique can be painful, it is usually not used to treat on young children.
- Other acids. If peeling medicine or freezing isn’t working, our doctor may try trichloroacetic acid. With this method, the specialist first shaves the surface of the wart and then applies the acid with a wooden toothpick. It requires repeat treatments every week or so. Side effects are burning and stinging.
- Minor surgery. Our Specialist can cut away the bothersome tissue. It may leave a scar in the treated area.
- Laser treatment. Pulsed-dye laser treatment burns (cauterizes) tiny blood vessels. The infected tissue eventually dies, and the wart falls off. Evidence for the effectiveness of this method is limited, and it can cause pain and scarring.