Warts & Verrucas

What are warts and verrucas?

Warts and verrucas are tiny rough lumps on the skin that almost everyone has had at least once in their life. These lumps are caused by a virus known as human papillomavirus (HPV). Warts that are present on the soles of the feet are termed verrucas.

Besides being unsightly to some people, warts and verrucas are harmless for the most part and happen to go away on their own; they may, however, take anywhere from months to even years to heal on their own. Warts and verrucas form when human papillomavirus infects the epidermis (outer layer of the skin). Upon infection, it causes the skin cells to grow very quickly, resulting in the formation of a wart. 

Warts are rough and firm to the touch and commonly appear on the knees, palms, knuckles and fingers. They may range in size from 1 mm to more than 1 cm. Based on their appearances, warts are divided into the following categories:

• Common warts: Firm to the touch with rough edges.
• Filiform warts: Finger-like in appearance.
• Plane warts: Round and flat. Yellow in colour.
• Mosaic warts: Multiple warts that coalesce on feet or hands.

What causes warts?

Warts and verrucas are caused by an infection with the human papillomavirus. Upon infection, HPV causes excessive development of keratin protein in the top layer of the skin, known as the epidermis. This excess growth results in warts forming in different body parts, including the palms, soles, knees, hands, and genitals.

In the UK, almost 1 in 10 individuals have warts at any one time. Warts are transmitted by touch — when the virus comes in direct contact with the skin, with the risk of infection being even greater on broken or bruised skin, such as areas nicked by shaving or minor cuts. It can take anywhere from 2-6 months for warts to develop on a person's skin after exposure to the virus.

What are the common symptoms of warts?

Common warts and verrucas mainly occur on the fingers or hands, and be of the following appearance:

• Pink, yellow, white or flesh-coloured
• Tiny grainy bumps
• Itchy
• Have black pinpoints
• Have a rough texture

Although warts appear harmless in most cases, one should get them checked and treated, for they may sometimes cause serious complications.

Warts appearing on the soles (verrucas) can disrupt walking around. Genital warts may sometimes result in urethral obstruction. Wart-like growths on the larynx and vocal cords, known as laryngeal papillomas, may disrupt speaking or breathing.

How to treat warts and verrucas?

You can take specific precautionary measures to prevent warts and verrucas:

• Wear flipflops around communal changing rooms and swimming pools
• Do not touch other people's warts.
• Refrain from sharing socks, towels, and shoes with others.
• Do not scratch or touch your warts or verrucas.
• If you touch your warts or verrucas, make sure to wash your hands properly for at least twenty seconds. Use a hand sanitiser in case washing your hands is not an option.
• Cover your warts with waterproof plaster in case you plan to swim.

There are various treatment options for warts and verrucas, although none of them guarantees 100% effectiveness. These treatment options aim to remove the wart without it scarring or reappearing. The main treatment options include:

Salicylic acid

Although there is limited evidence supporting salicylic acid as the most effective treatment for warts and verrucas, salicylic acid indeed works and clears up warts within 12 weeks of use in most cases.

From creams to gels and plasters, salicylic acid is available in numerous forms that can be acquired over the counter. Salicylic acid is known as a keratolytic agent, which works by gradually peeling layers of the wart. Since it also affects healthy skin, make sure to apply petroleum jelly around the wart or verruca before applying the salicylic acid preparation.

Duct tape

Duct tape is often used for the treatment of warts. This treatment involves placing some duct tape over the wart for a period of 6 days, and in case the duct tape peels or falls off, it must be replaced.

Following the six days period, remove the duct tape and soak the area in water. Any rough skin is removed using an emery board, and the wart is left uncovered overnight. The next day, place a new piece of duct tape over the wart, and the same procedure is to be repeated for up to 2 months.

Cryotherapy

Also known as freezing therapy, cryotherapy involves visiting the doctor's office where liquid nitrogen is applied to warts. The liquid nitrogen causes a sore blister to develop under and around the wart, which falls off within a week.

Cryotherapy only takes up to 15 minutes, but the procedure can be painful. Since this method poses a lesser risk of irritation than salicylic acid, it is considered better for treating warts on the face.

Minor surgery

Your doctor may recommend surgery to remove warts and verrucas in some instances. The surgical procedure is performed under local anaesthesia. It may either involve scraping the tissue, a curettage technique or burning the tissue using electricity, a method referred to as cautery.

Surgery is primarily only preferred in cases of a few large warts.

Laser treatment

This procedure is also performed at the doctor's office. It involves using an intense beam of light (laser) to burn the tiny blood vessels of warts. This causes the infected tissue to die, and the wart eventually falls off. Laser treatment may, however, cause pain and scarring.

Chemical treatments

Chemical agents other than salicylic acid are also used to remove warts and verrucas. These agents are toxic to skin cells and are applied to warts to destroy the tissue. Some of the chemicals used include podophyllin, 5-fluorouracil, and formaldehyde. 

Chemical treatment can cause swelling and brown staining of the skin.

How long does it take to treat warts?

For many people, warts and verrucas are a cosmetic concern, which may be described as unsightly, whereas they may cause mechanical issues for others. For instance, verrucas disrupt movement due to their location. Warts and verrucas may take anywhere from a few months to two years to go away on their own.

With cryotherapy, warts tend to fall off in 5-7 days. Salicylic acid may take anywhere from weeks to months. The treatment time depends on the size and location of warts.