How to identify a wart: common types and treatments

How to identify a wart

Illustrated guide outlines how to identify a wart, different types of warts, medical and home remedy options for treatment and removal.

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Warts (verrucae) are benign growths on the skin that are caused by viruses. Children in particular often have a wart on their finger or in other places on their hands – often in plural. Warts on the face and feet are also common, so it is useful to know how to identify a wart. 

How to identify a wart: Brief overview

  • Warts types: Common warts, brush warts, plantar warts, flat warts , “fake” warts ( molluscum, senile warts , stem warts ) and factors for how to identify a wart type.
  • Causes: Real warts are usually caused by the human papilloma virus ( HPV ). The molluscum contagiosum virus is responsible for warts. The exact cause of the age and pedunculate warts is unknown.
  • Risk factors: including skin wounds, weakened immune system, circulatory disorders, tendency to allergies (atopy) or existing atopic disease (such as neurodermatitis ), emotional conflicts and stress
  • Treatment options: including freezing ( cryotherapy ), acid treatment (e.g. as a plaster or ointment containing active substances), “burning” with electric current (electrocoagulation), laser treatment, ablation with a medical instrument (curette, sharp spoon, scalpel, etc.)
  • Prognosis: Warts are usually harmless and often go away on their own (but often only after months or years). However, the relapse rate is high, whether with or without treatment.

How to identify a wart: Types of warts

Warts (verrucae) are small, sharply defined growths (tumors) on the epidermis. They are caused by viruses, in the vast majority of cases by human papillomavirus (HPV). Warts occur particularly often in children and adolescents. In principle, you can get verrucae at any age.

There are different types of HPV. Depending on which virus type is responsible for the infection and where it settles, different types of warts develop morphologically. There are also some skin lesions that look like warts but are of different origins. To guide you in how to identify a wart, below is a description of the most important real and fake warts and treatment options (general information about wart treatment can be found below):

Common warts (Verrucae vulgares)

How to identify a wart

Common or common warts are the most common form of viral warts. Other names are vulgar wart, skin wart or spiked wart. These skin nodules can form anywhere on the body. Most commonly, such warts are found on the hand or foot. In many cases, a wart on the finger is located near the edge of the nail (periungual).

How to identify warts (common)

Common warts are usually the size of a pinhead to a pea. Its initially smooth surface becomes fissured and horny as it grows . In addition, the skin growths that are initially skin-colored gradually take on a dirty yellow color . They sometimes appear individually (solitary). However, they are often observed in larger numbers.

Usually cause common warts no tenderness and no itching . If you don’t want to wait for the skin nodules to heal on their own, you can try various options for treating warts. These include above all freezing (with liquid nitrogen) and acid treatment ( e.g. with salicylic acid). Sometimes other methods are used, such as laser therapy.

Brush warts (Verrucae filiformes)

It is a special form of the common warts with a long, thread-like stem . They form on the face (on the eyelids, lips, nose ) or neck , especially in older people . Occasionally they itch. In addition, brush warts can be irritated or injured when washing, drying or shaving. Above all, however, the thread-like or prickly-looking warts on the face are often perceived as cosmetically disturbing. That is why many sufferers have them removed by the doctor, for example by freezing (cryotherapy), acid treatment or laser treatment.

Plantar warts (Verrucae plantares)

In contrast to common warts, plantar warts are not raised, hemispherical skin growths. Instead, plantar warts are pressed inwards. This is because they usually form on the soles of the feet: the weight of the body on them pushes the warts inward into the subcutaneous tissue. In addition, plantar warts, in contrast to common warts, are usually quite painful . Every step can be uncomfortable for those affected.

You can get plantar warts if you become infected with the causative virus (HPV) while walking barefoot in the swimming pool, gym or communal shower. To get rid of them, you can stick a plaster containing salicylic acid . It softens the horny layer so that it can be easily abraded in a warm foot bath. Another therapy option is to freeze the plantar warts (cryotherapy). It can also be “burned” with electricity (electrocoagulation) or removed with a special medical instrument.

Flat warts (Verrucae planae juveniles)

How to identify a wart

If the warts on the face or hands are not raised, they are probably so-called flat warts or planar warts. Occasionally this type of wart forms on other parts of the body. Flat warts are most commonly seen in children and adolescents. They are therefore also called juvenile warts.

As with other real warts, this form of warts is triggered by human papilloma viruses. A weakened immune system can encourage infection with these viruses. Children in particular often scratch their flat warts. Then new flat warts can form along the scratch track because the viruses are distributed with the nails.

Flat warts are harmless and often go away on their own. If you don’t want to wait for it or if you have severe and flat warts, you should talk to your doctor about treatment options. For example, flat warts can be dissolved with vitamin A acid or salicylic acid (possibly in combination with UV radiation). They can also be frozen (cryotherapy) or “burned” with electricity (electrocoagulation). Sometimes they are also removed with a special surgical instrument ( curette ) or removed with laser therapy .

Dellar warts (Mollusca contagiosa)

How to identify a wart

Dellar warts aren’t real warts – despite their name and similar appearance. This is because they are not caused by human papilloma viruses. Instead, the molluscum contagiosum virus is what causes these wart-like, harmless skin nodules.

Mostly dellar warts appear in groups on one or two areas of the skin. In some people, however, they are also found loosely over the body. In adults, the genital region is most often affected by dellar warts. In contrast, other parts of the body are often affected in children, such as the face, neck or armpits .

Inside, dellar warts contain an infectious secretion . If you come into contact with it, you can get infected quite easily ( smear infection ). This is especially true if your own skin is softened (for example when going to the swimming pool or sauna). Then the triggering viruses can penetrate the skin more easily. Wounds, fungal infections of the skin and neurodermatitis also encourage infection with the wart pathogens.

Usually dellar warts go away on their own. But they can also last for years. Similar to flat warts, they can be eliminated with salicylic acid or vitamin A acid . However, it can also be removed with a surgical instrument . There is also the option of treating irritation : applying an irritating liquid inflames the skin in the area of ​​the dellar warts. This should help them heal faster.

Age warts (seborrheic keratosis)

How to identify a wart

Age warts (senile warts) are also not real warts , even if they are similar to these. Its cause is unknown. We know, however, that they are not caused by viruses – neither HPV nor other types of viruses. Age warts are therefore not contagious .

The name of these wart-like skin nodules comes from the fact that they mainly appear in old age . They tend to form on the face, chest and back, on the back of the hand and the front of the arms and legs. Their appearance is very variable. That is why doctors differentiate between different forms of old age warts , for example pedunculated old warts and stucco keratoses.

Because age warts are harmless and usually do not cause any discomfort, they usually do not necessarily have to be removed. If you still want to get rid of them, you should contact a doctor (as with other warts): Age warts can be removed with a surgical instrument (curette, sharp spoon, scalpel) or removed with a laser

Pedunculate warts (fibroids)

(See our main image) Pedunculate warts aren’t real warts either. Rather, they are soft, benign growths of certain skin cells. Their medically correct name is soft fibroids .

Pretty much everyone gets the small, stalked, skin-colored skin appendages sooner or later. We don’t know why this is so. Since pedunculate warts occur more frequently in some families, experts suspect a genetic predisposition.

Like age warts, stem warts are harmless and not contagious . But they can be cosmetically disruptive. Sometimes they are also mechanically disruptive. With stem warts in the neck area, for example, thin necklaces or fine silk scarves can get caught on them. In such cases, those affected can have their pedunculate warts removed by a doctor – using a laserelectric current (electrocoagulation), or using surgical scissors.

Warts: causes and risk factors

In most cases, real warts are caused by human papilloma viruses (HPV): The pathogens penetrate skin cells through small injuries and cracks and trigger uncontrolled cell reproduction. The intruders force the human host cells to produce more viruses.

The pathogens are different types of HPV. For example, common (vulgar) warts are usually caused by HPV types 1, 2, 4 and 7. Mainly HPV types 1, 2 and 4 can also be detected in plantar warts. In contrast, flat warts (Verrucae planae juveniles) are generally caused by HPV type 3.

By the way: Certain types of human papilloma viruses are involved in the development of several cancers (such as cervical cancer and penile cancer). However, these are not the types of virus that are responsible for conventional verrucae. Caution is only required with so-called genital or genital warts (condylomata).

Faux warts are not caused by HPV: Molluscum contagiosum viruses are responsible for dellar warts . At age warts , the cause is unknown. The same applies to stem warts .

Risk factors for warts

Various factors can promote the formation of verrucae – especially the most common form, verrucae vulgares. These risk factors include increased sweating (hyperhidrosis), impaired blood circulation in the fingers and toes (acrocyanosis) and a weakened immune system . People with a tendency to allergies (atopy) or an already existing atopic disease (such as neurodermatitis) are particularly susceptible.

Emotional conflicts and stress also seem to increase the risk of illness. Affected adults are also often smokers .

Are warts contagious?

Viral warts are contagious (infectious): The viruses are transmitted directly from person to person, sometimes indirectly via towels or razors. Four weeks to eight months can pass between the infection and the appearance of the first verrucae (incubation period).

It is particularly easy to get infected with wart viruses if the skin is injured . Damp or softened skin also has a beneficial effect . This is why it is particularly easy to get infected in the swimming pool, sauna and communal showers, for example. Also at risk are people who have frequent contact with the causative virus or affected people (such as children).

Someone who already has the small skin growths can further infect themselves ( autoinoculation ). This is how the verrucae can spread on the body: The viruses are transmitted to neighboring or more distant parts of the body, for example by scratching the skin nodules, where they can also settle.

“Fake” warts that are not caused by viruses (age warts and pedunculate warts) are not contagious.

How to identify a wart: examinations and diagnosis

Verrucae are usually harmless. A doctor’s visit is only necessary if the small skin tumors are cosmetically disturbing and should be removed or if they occur in the genital area. You should definitely go to the doctor if

  • a wart is bleeding or inflamed,
  • Warts on other skin diseases (such as neurodermatitis) develop or
  • Dell warts spread quickly.

Age warts may be confused with skin cancer . So if you are not sure that wart-like skin nodules are actually harmless old age warts, you should also see a doctor.

Diagnosis is usually simple

Diagnosing verrucae is generally not difficult for a doctor. He can usually recognize the small, benign skin tumors by their appearance. In addition, the shape, structure and location of the growths in most cases also provide information for how to identify a wart and about the type of wart.

If the doctor is not entirely sure, however, he can take a tissue sample from the skin nodules and have it examined in the laboratory for a histological examination. In individual cases, attempts are also made to detect the pathogen (human papilloma viruses) in the sample.

How to identify a wart: treatment

Most warts are uncomfortable and will go away on their own sooner or later. There is then no medical reason why the warts should be removed.

However, if you find the small skin growths cosmetically disturbing, you should discuss with a doctor how your warts can be removed. The same applies to warts that cause discomfort, such as plantar warts on the soles of the feet, which make walking very painful.

How can you remove warts?

“What helps against warts?” Many sufferers turn to their pharmacist or doctor with this question. The answer is, there are different methods and remedies for warts. Which strategy makes the most sense in individual cases depends, for example, on the type and number of warts and their location.

How to remove warts easily

Dissolving the hard layer

Various acids can remove warts by dissolving their horny layer. Usually salicylic acid is used for this, sometimes another acid such as lactic acid . If you want to remove flat warts on the face, vitamin A acid is usually used. The acids are available in the pharmacy as a solution, cream or plaster – usually without a prescription.

Read the package insert before using for the first time. There is exactly how the product in question is to be used. Generally, a solution or cream needs to be applied to the warts several times a day for several weeks. A patch is worn for a few days (possibly with repetition).

The cornified skin layers dissolve under the action of acid. You must remove them carefully on a regular basis, such as with a file or a callous plane . Make sure that the surrounding areas of skin are not injured and that the wart viruses are not transmitted there. Otherwise new warts will appear on these injuries.

Freeze warts (cryotherapy)

The doctor can freeze warts by gently applying liquid nitrogen . When it evaporates, extreme cold occurs, which destroys the top layer of skin. The icing must be repeated several times, this is the only way to finally remove the warts. At least one week must pass between the individual sessions .

Applying the liquid nitrogen can trigger short, sharp pain from the cold. As a result, the skin usually reddens and swells a little. A blister can also form. It usually takes several days for the crusted warts to heal. If cryotherapy is performed with caution, no scar will be left behind.

Removing warts by means of icing is not permitted in all cases . The method is not suitable, for example, for people with a diabetic foot or with “intermittent claudication” (peripheral arterial occlusive disease, PAD). The freezing of warts on the foot can additionally disturb the already poor blood circulation, damage the nerves and cause wounds that do not heal well. Cryotherapy is also unsuitable for removing a wart in Raynaud’s syndrome (reduced blood flow to fingers and toes due to the disease).

You don’t have to go to a doctor to use cold to remove warts. Pharmacies now offer over-the-counter icing pens for self-treatment at home. But these are less cold than the liquid nitrogen that the doctor can apply. In addition, the effectiveness of such icing pens has not yet been scientifically proven.

Removing warts: other methods

There are other remedies for warts. So far, however, there is no clear evidence that they really help or work better than acids or freezing.

So are special ointments and solutions with agents that cell growth (5-fluorouracil) or the viruses inhibit ( acyclovir , etc.), also can remove warts. Sometimes different drugs than are syringe verabreich directly into the warts, such as 5-fluorouracil or substances that affect the immune system (interferons).

Warts can also be removed with the help of curettage : the skin nodules are scraped off with a special medical instrument (curette). Before that, they are often pretreated with acid.

Some people have their warts lasered, that is, heat them up with a laser and destroy them.

In photodynamic therapy , a special gel is applied to the wart. It is left on for about three hours and then the wart is irradiated with light. Certain ingredients in the gel are activated and destroy the skin tumor.

The old method of cutting out warts is rarely used today. This can lead to infections and cosmetically annoying scarring.  

Home remedies for warts

Various medicinal plants are said to be very helpful if you want to remove warts. The milky sap of the celandine , for example, is supposed to remove the small skin tumors if you dab them with it several times a day. In the same way, you can treat warts with the milky sap of the dandelion or a solution from the foot-leaf root. This should also be able to remove the small skin nodules.

In many cases, naturopaths also rely on the anti-viral power of tea tree oil when treating warts. It is applied to the wart in a diluted form several times a day. Garlic could also be effective against wart viruses: with the intake of a high-dose garlic preparation, warts can also be removed.

Warts: course and prognosis

Warts are generally harmless . As soon as the body successfully combats the virus that caused it, it disappears on its own. However, this can take weeks to months. Studies on affected schoolchildren and adolescents showed that about fifty percent were wart-free after one year and about seventy percent after two years. There are no comparable studies in adults.

How quickly the small skin growths disappear in individual cases depends on various factors. The type of virus and wart, for example, and the state of the immune system play a role. Verrucae can be very persistent in people with weakened body defenses.

If warts have healed at some point – with or without treatment – you will not be immune to it in the future. On the contrary: the relapse rate (recurrence rate) is high. 

Tips for prevention

Some measures can possibly prevent you from becoming infected with affected people or, in turn, from transmitting the virus to other people:

  • Do not share towels, shoes, and socks with other people.
  • Do not walk barefoot in swimming pools, communal showers, gyms, and changing rooms.
  • Cover existing warts with a waterproof patch before swimming.
  • Do not touch the verrucae.

Also, you should avoid scratching warts . Otherwise you can transmit the viruses contained in it to other parts of your body or to other people.