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Causes

Warts are caused by a virus called HPV. They are spread through direct contact. HPV infects the top layer of skin and usually enters through an area of broken skin. Once the skin has been in contact with the virus, it can take many months of slow growth beneath the skin before a wart forms. 

The virus causes the top layer of skin to grow rapidly, forming a wart. Most warts go away without medical treatment within a few months or years.

Warts occur most commonly in children and young adults. If you have eczema or any condition that affects the immune system, like AIDS or an organ transplant, you are more likely to acquire warts.

It is very unlikely that you will get a wart every time you come in contact with HPV. Some people are more likely to get warts than others, although we do not really know why.

Symptoms and Diagnosis

Warts come in a wide variety of sizes and shapes. Warts can be smooth and small or rough and large. Tiny blood vessels grow into the core of the wart to supply it with blood. These blood vessels may look like dark spots in the wart's center. In most cases, the skin lines and creases over the wart look distorted.

Warts are usually painless. But a wart that grows in a spot where you put pressure, such as on the palm of the hand or on the bottom of the foot, can be painful.

We usually can tell if a skin growth is a wart just by looking at it. If we aren't sure what the growth is, we may do a biopsy.

Types

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There are many different types of warts. Here are the types we see most often:

Common warts are most likely to grow on the hands and fingers, but they can grow anywhere on the body. They usually feel rough, are a gray-brown color, and are shaped like a small dome. They may look like a tiny cauliflower and may occur alone or in groups.

Plantar warts can grow on the bottom of the feet. They grow inward and look like hard, thick patches of skin with dark spots. Sometimes a callus grows over them. They are sometimes called mosaic warts. Because of the weight you put on your feet as you walk, plantar warts may cause pain. They can grow alone or in clusters.

Flat or plane warts are more common in children and adolescents than in adults. They can grow on the arms or legs but are most common on the face. They are small (usually smaller than a pencil eraser) and have flat tops, and they can be pink, light brown, or light yellow in color. They often appear in a string or several strings near each other and are often introduced to the skin when adolescents start shaving.

Genital warts usually appear as cauliflower-like bumps or flat pink, red, or flesh-colored patches around the anus, or occasionally on the belly or thighs. In women, they may occur inside the vagina or on the lips around the vagina. In men, they may occur on the penis or scrotum.

Treatments

Home Treatment

Treatment for warts usually starts with home treatment. Aside from the convenience, home treatment is usually less painful than surgical treatment. Check with us if you are not sure whether to start home treatment.

Salicylic acid

You can buy this medication at our pharmacy or at a drugstore without a prescription. It is effective and introduces little risk or pain. Salicylic acid is available as a paint, cream, plaster, tape, or patch that you put on the wart. Be sure to read and follow the specific instructions that are supplied with the medicine. Salicylic acid treatment usually takes from 2 to 12 months to cure a wart.

For best results, soak the wart in water to loosen and soften the skin before applying the salicylic acid. This helps the medicine get into the skin more easily. It is best to apply salicylic acid to the wart before you go to bed. Touch only the wart with the medicine. Cover the area with a bandage and wash it off in the morning.

As you continue to apply the salicylic acid, the wart becomes soft. You can then remove dead tissue daily or once or twice a week with careful use of a file or pumice stone or as instructed on the medicine package. Since dead tissue contains live wart virus, dispose of it carefully. The pumice stone or file will also have living wart virus on it, so don't use it for any other purpose, or you may spread the virus.

If treatment makes the area too tender, stop using the medicine for 2 to 3 days until your skin heals.

Nonprescription cryotherapy (freezing)

Although cryotherapy can be performed in our office, you can also buy an over-the-counter freezing treatment for common warts on the hands and feet. You will spray a combination of two chemicals into a foam applicator and then hold the applicator to the wart for a few seconds. This home treatment should not be used for children younger than 4 years old or by women who are pregnant or breastfeeding.

If you are uncertain that a skin growth is a wart, or if you have diabetes or other major illnesses that may affect your treatment, it is best to come and see us. Do not use home treatment methods to remove genital warts.

Medical Treatment

In most cases, warts on the skin are harmless and can sometimes disappear without treatment. Some types of HPV have been linked to cervical cancer. Therefore, it is very important that women with genital warts get yearly pap smears.

None of the available treatments can cure HPV. The virus can remain in the skin even after all the visible warts have been treated.

Warts can recur after treatment, and we may need to try other types of treatment. Although we try to clear warts quickly, most methods require multiple treatments. Treatments may include: 

Freezing (cryotherapy) with liquid nitrogen. In this treatment, we will use liquid nitrogen to freeze a wart. A blister forms around the wart, and the dead tissue dries up and falls off within a few weeks. The blister may be clear or filled with a dark fluid. Try not to touch it while it dries out. If it is painful, you can prick the blister with a sterilized needle. If the blister breaks, clean the area with water and apply a thin layer of an over-the-counter antibiotic cream. We may need to repeat this procedure until the wart is gone.

Cantharidin. This medication is applied to the skin and forms a blister around the wart. After application, the area is covered with a bandage. The blister lifts the wart off the skin so we can remove the dead portion of the wart.

Other medications. These include bleomycin, which is injected into a wart to kill the virus. Aldara is a prescription cream that works on the immune system. Although developed for genital warts, it is can be effective on all types of warts.

Minor surgery. When treating warts with other methods does not work, we may use surgery.

Prevention

The following strategies can help to prevent warts from occurring:

• Avoid touching warts on your own or another person's skin.
• Wear flip-flops or slippers in public places, especially if your skin is broken.
• Don't share tools for paring down warts and be sure to clean your tools thoroughly after using them.
• Don't share razors or towels.
• Use condoms correctly and consistently during sex.
• Get the Gardasil HPV vaccine, that protects against 4 HPV types, which together cause 70 percent of cervical cancers and 90 percent of genital warts. Currently, the vaccine is recommended for girls 11 to 26.
  

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might contact me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we may discuss your medical and family history and I will examine your skin. Usually, no special tests are needed, but, occasionally, we do a skin biopsy. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.