Warts

Warts are an abnormal skin growth caused by the human papillomavirus that, in most cases, are benign in nature. These lesions may appear anywhere on the body, although they are more common on the soles of the feet and the hands.

The different types of warts are classified according to their location and appearance:

• Common warts or verruca vulgaris: these are the most common type. They have a rounded appearance and a rough surface. They may occur in clusters or appear individually. They mainly develop on the hands, scalp, fingers, knees, and elbows.
• Plantar warts: they appear on the soles of the feet and may therefore be painful due to the pressure exerted on them while walking or standing. They have a rough surface and are sometimes covered by calluses (hardened skin).
• Flat warts: these are common in children and adolescents. They are small in size, barely raised above the skin surface, and similar in color to the surrounding skin. They usually appear in clusters. They commonly develop on the face, hands, and lower limbs.
• Filiform warts: these are long and thin in shape and have a soft texture. They are attached to the skin by only a small area. They are common on the face, neck, and eyelids.
• Periungual warts: these appear around the nails and therefore have an irregular appearance. They resemble cauliflower, are rough, and may sometimes be painful.
• Subungual warts: these form underneath the nails and therefore often cause pain due to pressure. Some patients report difficulty handling objects. The nails become yellowish or brownish and may appear thickened and slightly raised.
• Condylomas or anogenital warts: these affect the genital, anal, and perianal areas. They are characterized by being flat and raised or by having a cauliflower-like appearance. They are associated with low-risk HPV subtypes; however, although rare, there is still a possibility that they may develop into cancerous tumors.

As a general rule, warts are benign and disappear on their own, although this may take several months or even years. However, they may also be a sign of a more serious condition, such as cancer, and require specific medical treatment as soon as possible.

Symptoms

The main symptom of warts is the appearance of an abnormal lump on the skin surface. These growths usually have the following characteristics:

• Rough texture.
• Granular appearance.
• Occasionally, black dots corresponding to coagulated skin blood vessels.
• Color varies depending on the type of wart and the area where it appears:
  • Common warts: gray, yellow, brown, or skin-colored.
  • Plantar warts: white, yellow, gray, or brown.
  • Flat warts: whitish, brown, yellow, pink, or skin-colored.
  • Filiform warts: usually the same color as the patient’s skin, although they may also become whitish, yellowish, grayish, or light brown.
  • Periungual and subungual warts: similar in color to the skin, although slightly grayer, yellower, or browner.
  • Condylomas: pink, whitish, or flesh-colored.

It is important to consult a specialist as soon as possible if any of the following warning signs are present:

• Bleeding.
• Itching or burning sensation.
• Pain.
• Discomfort interfering with daily activities.
• Appearance of numerous growths.
• Warts on the face, feet, or genitals.
• Weakened immune system.

Causes

Warts are caused by infection with the human papillomavirus. Each HPV type causes different kinds of warts:

• Common, plantar, periungual, or subungual warts: associated with low-risk HPV subtypes 1, 2, 4, and 7. They are transmitted through direct skin-to-skin contact with an infected person or through contaminated objects.
• Flat warts: usually associated with subtype 3, although in some cases they are caused by other low-risk types. Transmission also occurs through direct skin-to-skin contact or contaminated objects.
• Filiform warts: caused by HPV subtypes 1, 2, 4, 27, and 29, which are predominantly benign. Transmission occurs through direct contact.
• Condylomas: usually associated with subtypes 6 and 11 which, although they may progress to cancer, carry a very low risk. They are transmitted through skin-to-skin contact during sexual intercourse.

Risk factors

The risk of developing warts increases in the following cases:

• Age: they are more common in children and adolescents.
• Weakened immune system.
• Nail biting.
• Walking barefoot (increases the risk of plantar warts in communal showers and locker rooms).
• Sharing personal items such as nail files, towels, or socks.
• High-risk sexual behavior: more than one sexual partner, partner with unknown sexual history, lack of protection.
• Warm and humid environments.

Complications

Warts are benign conditions with a very low risk of leading to serious health problems. Some of the most common complications include:

• Spread to other areas of the body.
• Severe pain; plantar warts may be painful while walking or standing.
• If scratched, bitten, or cut, they may bleed or lead to bacterial infections.
• Low self-esteem.
• Social isolation.
• In rare cases, uterine, vulvar, anal, or penile cancer.

What specialist treats warts?

Warts are diagnosed and treated within the specialty of Medical-surgical dermatology and Venereology. In cases of plantar warts, Podiatry may also be involved.