Viral Warts Diagnosis and Treatment

Almost everyone will have a wart or two during their lifetime. The growths seemingly come out of nowhere, and are most commonly found on the hands. Warts are caused by the human papillomavirus (HPV) that usually enters through a tiny scratch on the outer layer of skin, with the virus lingering on keyboards, doorknobs, flooring and almost everything else we come into contact with.

There are more than 100 varieties of HPV and although the growths are harmless they can be unsightly, painful and embarrassing for sufferers. Once the virus infection enters the skin, rapid cell growth ensues, creating a wart on the skin’s outer layer. Some HPVs are likely to cause warts on the hands, while others target the soles of feet, genitals, and different areas of the body. It’s difficult to trace the exact source of infection as a viral wart can take months to manifest.

Nevertheless, although everyone encounters human papillomavirus, some people are more prone to develop warts. Dermatologists believe this is due to an individual’s capacity to resist infection. For this reason, warts are more common in children who don’t have a fully developed immune system. People who suffer from eczema are also more likely to become infected due to compromised skin protection. The best way to avoid getting warts is to focus on prevention by avoiding contact with the virus.

Strategies include:

  • wash hands regularly and thoroughly
  • wear flip-flops or other footwear in bathrooms, especially those in public spaces
  • use a clean towel to wipe gym equipment before use
  • ensure you don’t come into direct contact with unclean surfaces
  • keep skin moisturised, clean and free from nicks and scratches
  • shave with a clean, sharp razor that is less likely to nick the skin
  • avoid biting fingernails by using clean nail clippers

Viral Wart features

Although there are many varieties of HPV, most warts are hard and scaly, often with a minute black dot in the centre caused by a clotted blood vessel.

Some well-known wart varieties are listed below:

Common warts: Ranging from 1 millimetre to more than 1-centimetre-wide, common warts have a rough, raised surface. They often appear on the back of fingers and toes or around the nails. Common warts are regularly noticed on the knees of children, probably due to the nature of play. They are sometimes likened to a cauliflower in appearance and are also known as butcher’s warts.

Plantar warts: Often very painful, plantar warts are found on the soles of the feet. Due to their location, pain is associated with walking, standing and any other activity that results in weight carried by the feet.

Plane warts: These warts are distinguished by their flat surface. Distribution is often linear, likely caused by scratching or shaving. Plane warts are most noticeable on the hands, face and shins.

Mucosal warts: Also known as papillomas, mucosal warts are slightly raised papules and plaques appearing on the lips or inside the cheeks. Usually pink in colour, mucosal warts continue to grow for weeks or months, with long-term latency meaning they are prone to persist or reactivate.

Viral Wart diagnosis and treatment

Dermatologists are trained to use any one of several treatment programs. This allows the dermatologist to choose among the various possibilities, depending on the age of the patient and the type of wart that is present. Some of the more common methods are listed in the following paragraphs.

Common warts in young children can be painted on a daily basis with various forms of dilute salicylic acid. This treatment can be carried out at home by the patient or parent. It results in very little discomfort, but does take many weeks of consistent use to obtain satisfactory results.

For adults and older children cryotherapy (freezing treatment) is generally preferred. This approach also is somewhat painful and rarely results in scarring but may cause pigment loss. However, repeat treatments at one to three week intervals are often necessary. For those who are not concerned about the possibility of scarring, electrosurgical destruction (“burning”) represents a good alternative since complete removal can generally be accomplished during a single surgery visit.

Plantar warts are difficult to treat because the bulk of the wart lies below the skin surface. The methods mentioned above may be tried but many dermatologists prefer the use of salicylic acid plasters or cantharidin or curettage (“scooping out”) of the wart under local anaesthesia. Modification of shoes to reduce pressure on the wart or measures to reduce foot sweating may also be recommended.

Flat warts are often too numerous to treat with methods mentioned above. As a result “peeling” methods using daily applications of salicylic acid, retinoic acid, or benzoyl peroxide are often recommended. For some adults repeated surgery treatments with cantharidin, trichloracetic acid, curettage, cryotherapy, or light electrosurgical destruction are sometimes necessary.

Mucosal warts are perhaps the hardest of all to treat.  First, the location of all warts must be determined. This may require inspection of the vagina and cervix in women and the rectum in both sexes. Then repeated surgery treatments with podophyllin, trichloracetic acid or cryotherapy are generally carried out. Unfortunately, many surgery visits often are necessary to eradicate the warts successfully. With very stubborn or very large genital warts, electrosurgical destruction may be necessary. In addition, the patient’s sexual partner should be examined for warts by a doctor.

It should be emphasised that warts may be very difficult to cure.  Often multiple treatments will be needed and even then treatment success cannot be guaranteed.

Aldara (Imiquimod), a relatively expensive cream, can be applied to genital warts and the surrounding skin.  It triggers an immune response that destroys both visible and invisible warts.  Recurrence rates may be less with this product.

A visual examination is usually all that’s required to diagnose viral warts as they are very common and have specific characteristics. Warts rarely cause serious complications and many people tolerate them without undergoing removal procedures. They often recede of their own accord, but if warts become painful or cause embarrassment there are a range of removal methods available.

There is no single treatment that will eradicate all viral wart types, so a consultation at Pymble Dermatology will help determine a treatment path that is appropriate for each individual case. Warts on children usually disappear of their own accord in time. Adults generally experience more persistent warts but they will clear up eventually, especially with the assistance of established treatment methods available at your dermatology clinic.