The vast majority of people have warts or verrucae at some point in their life but without targeted treatment, they can become a longer-term annoyance
Common warts, or verrucae vulgaris, are caused by the human papillomavirus (HPV) infection and while most people get some during their lifetime, they are most common among children and young adults.
Verrucae vulgaris present as elevated, hyperkeratotic, round skin papules, usually with a light-brown or grey-white surface colour. Areas of the body that are more prone to trauma are the sites most likely to manifest warts, such as the knees, elbows or hands. Often, they will resolve spontaneously over time, but sometimes the patient will opt to treat them aggressively.
While this article will focus mainly on common and plantar warts, there are other types of wart, including:
- Filiform warts: These are long and slender in appearance, and are more likely to form on the neck or face.
- Mosaic warts: These grow in clusters, often to form a ‘tile-like’ pattern. They are most likely to appear on the soles of the feet or palms of the hand.
- Periungual warts: These can be painful, have a rough surface, and can sometimes affect the shape of the nail.
- Plane warts: These develop in clusters, which can contain hundreds of plane warts. They are yellowish in colour and sometimes appear on the legs of women because HPV can be spread by shaving, but are most common on the legs of children.
Painful
Verrucae, or planter warts, can be some of the more painful manifestations of warts. They normally develop on the soles of the feet and are white, usually with a black dot in the middle, which is a blood vessel. They are flat rather than raised but are problematic, as they are often on a weight-bearing area of the sole.
Verrucae are also caused by HPV, which relate to different parts of the body. In this case, it is because HPV thrives in moist, damp environments and it is easy to get a verruca from sharing the same floor area as someone else with a verruca, such as communal showers and swimming pool areas. If someone has a small cut or abrasion, that makes them even more vulnerable to contracting verrucae.
Prevention and referral
When offering treatment solutions to patients, it is a good opportunity to advise them of preventative measures to reduce the risk of warts and verrucae returning. Patients should be advised to:
- Wash their hands after touching a wart or verruca.
- Change socks every day if they have a verruca.
- Always cover warts and verrucae with a plaster when swimming.
- Be careful not to cut a wart while shaving.
They should also be advised not to share towels, face cloths or personal clothing, and to avoid walking barefoot in shared areas.
Some warts or verrucae may raise clinical suspicion and prompt a referral to the patient’s GP. If they are worried about a wart, it may be worth suggesting a GP visit to put their mind at ease. They may also benefit from a GP consultation if their wart or verruca keeps coming back, despite treatment, or if the wart becomes very large or painful. Likewise, if a wart bleeds for no obvious reason or changes shape, a referral is warranted. Genital warts are beyond the scope of this article, but they should also be examined by a GP.
Warts that develop among people with a compromised immune system — such as those receiving treatment for cancer — are often more difficult to treat. In people with a healthy immune system, warts may disappear over time, but discomfort, embarrassment or painful verrucae can prompt people to treat them aggressively.
Treatment
Effective treatments for warts and verrucae require patience and strict adherence to the manufacturer’s instructions. Topical treatments containing salicylic acid are recommended for home treatments, although these therapies should not be used on the face.
The length of time it can take for a wart or verruca to disappear varies from person-to-person, and they tend to be more stubborn in adults and older children. Cryotherapy is also useful to freeze the wart and destroy the affected skin cells, and surgery is only recommended in a very limited number of cases.
In some more serious cases or those that raise suspicion, referral to a podiatrist or GP might be warranted, who may then send the patient for an appointment with a dermatologist.
References on request
