Wart Removal

What are Warts?

Warts are small, non-cancerous skin growths caused by infection with certain types of the human papillomavirus (HPV). They are very common. There are many different types of HPV, but only some cause the skin growths we recognise as warts.

What Do Warts Look Like?

Warts can vary considerably in appearance depending on their type and location. They may be rough or smooth, flat or raised, and some have a bumpy, cauliflower-like surface. Others may appear thread-like or finger-like.

They are usually skin-coloured, but may also appear pink, brown or grey. Some warts contain tiny black or brown dots, which represent small clotted blood vessels within the wart.

How Big Are Warts?

Warts range from a few millimetres to a few centimetres in size. They may occur as a single growth or develop in clusters.

Where Do Warts Appear?

Warts can develop almost anywhere on the body, but are particularly common on the hands, fingers, feet and face. Different types of warts tend to occur at different sites. For example, plantar warts develop on the soles of the feet, while genital warts affect the genital or surrounding areas.

Are Warts Harmful?

Most warts are harmless and may eventually disappear without treatment as the immune system clears the infection. However, this can take months or even years.

Warts can become bothersome, unsightly or painful, particularly when they occur on pressure-bearing areas such as the soles of the feet. They are also contagious and can spread to other parts of the body or to other people through direct contact or contaminated surfaces.

What Causes Warts?

Warts are caused by infection with certain types of the human papillomavirus (HPV). The virus can enter the skin through tiny cuts, scratches or other breaks in the skin barrier and stimulates the skin cells to grow, producing a wart.

Warts are contagious and can spread in several ways:

• Direct contact: Touching a wart on another person.
• Self-spread: Touching, scratching, shaving or picking a wart and then touching another area of your skin.
• Shared objects: Using contaminated items such as towels, razors or nail-care instruments.
• Communal surfaces: Walking barefoot on damp communal surfaces, such as around swimming pools and changing rooms, can increase the risk of plantar warts.

Not everyone exposed to HPV develops warts. Individual susceptibility and the body's immune response also play a role.

All warts are caused by HPV, but not all HPV types cause warts. The HPV family contains many different types. The HPV types that commonly cause warts on the hands and feet are generally different from the high-risk HPV types associated with cancers such as cervical cancer.

What are the Types of Warts?

There are several types of warts, each with characteristic appearances and locations. A dermatologist can usually identify the type by examining the skin and recommend treatment based on the type, location, size and number of warts.

1. Common Warts (Verruca Vulgaris)

Appearance: Firm, raised growths with a rough or grainy surface. They may contain tiny black or dark-red dots, which are small blood vessels.

Location: Most commonly found on the hands and fingers, although they can develop elsewhere on the body.

2. Plantar Warts (Verruca Plantaris)

Appearance: Rough, thickened growths on the soles of the feet. Because of pressure from walking, they often grow inwards rather than outwards and may resemble a callus. Small black dots due to thrombosed blood vessels may be visible within the wart.

Location: Usually occur on the soles of the feet, particularly pressure-bearing areas such as the heels and balls of the feet. They can be painful when standing or walking.

3. Mosaic Warts

Appearance: Multiple small plantar warts that grow closely together to form a larger, flatter cluster or patch.

Location: Usually found on the soles of the feet, particularly the balls of the feet and beneath the toes.

4. Flat Warts (Verruca Plana)

Appearance: Small, smooth, slightly raised, flat-topped growths. They may be skin-coloured, pink or light brown and often occur in large numbers.

Location: Commonly occur on the face, forehead, hands and legs. They may spread along areas that are shaved or scratched.

5. Filiform Warts (Digitate Warts)

Appearance: Narrow, elongated growths with finger-like projections extending from the skin.

Location: Most commonly occur on the face, particularly around the eyelids, nose, mouth and lips.

6. Periungual Warts

Appearance: Rough, thickened growths that develop around or underneath the nails. Larger warts can distort the nail or interfere with normal nail growth.

Location: Found around the fingernails and toenails. Nail biting and picking at the skin around the nails can facilitate their development and spread.

Sometimes, warts, especially those on the feet, can be mistaken for corns or calluses. It is important to know the difference, as they require different treatments.

What are the Differences Between a Wart and a Corn?

Warts on the feet are sometimes mistaken for corns or calluses because both can appear as areas of thickened skin. However, they have different causes and characteristic features. Warts are caused by HPV infection, while corns develop in response to repeated pressure or friction.

How to Prevent Warts?

Warts are caused by HPV, which is widespread and can be difficult to avoid completely. However, several simple measures can reduce the risk of developing warts and prevent existing warts from spreading:

• Avoid direct contact: Avoid touching or picking at another person's warts. If you already have a wart, avoid scratching, picking or biting it, as this can spread the virus to other areas of your skin.
• Protect your feet: Wear slippers or footwear in communal showers, changing rooms and around swimming pools, where the warm, moist environment may facilitate transmission of the virus that causes plantar warts.
• Keep your skin intact: HPV can enter through small cuts and breaks in the skin. Take care when shaving and avoid biting your nails or picking at the skin around them.
• Practise good hygiene: Wash your hands regularly, particularly after touching or treating a wart, and keep affected areas clean and dry.
• Avoid sharing personal items: Do not share towels, razors, nail clippers, socks, shoes or other personal items that may have been in contact with a wart.

Although exposure to HPV is common, not everyone who encounters the virus develops warts. The body's immune response plays an important role in controlling HPV infection. Protecting the skin from injury and taking sensible precautions to reduce exposure can help lower the risk of developing and spreading warts.

How to Prevent Warts from Spreading?

Warts are contagious and can spread to other areas of your body or to other people. If you have a wart, the following measures can help reduce the risk of spreading the virus:

• Cover the wart: Keep the wart covered with a clean bandage, particularly during activities where it may come into contact with other people or shared surfaces.
• Avoid picking or scratching: Do not scratch, cut or pick at warts, as this can spread the virus to the surrounding skin.
• Wash your hands: Wash your hands after touching or treating a wart.
• Keep hands and feet dry: Dry your skin thoroughly after washing, particularly between the toes, as warts are more easily transmitted in warm, moist environments.
• Wear footwear in communal areas: Wear slippers or flip-flops around swimming pools, communal showers and changing rooms to reduce exposure and transmission.
• Avoid shaving over warts: Shaving can cause tiny skin injuries and spread the virus to nearby areas.
• Do not share personal items: Avoid sharing towels, razors, nail clippers, socks, shoes or other items that may have been in contact with a wart.

If you are treating a wart at home, do not use the same nail file, pumice stone or other instrument on healthy skin, as this may spread the virus.

When to See a Doctor?

Most warts are harmless and may eventually disappear without treatment. However, you should consider seeing a dermatologist if:

• You are unsure of the diagnosis: Some skin conditions, including certain skin cancers, can occasionally resemble a wart.
• The wart is in a sensitive area: Warts on the face, eyelids or around the nails may require more careful treatment to minimise the risk of scarring or damage to surrounding structures.
• You have multiple or spreading warts: Numerous warts or warts that continue to spread may benefit from medical treatment.
• The wart causes symptoms: Seek advice if a wart becomes painful, persistently itchy, bleeds easily or interferes with daily activities.
• The wart changes: A growth that changes rapidly in size, shape or colour, ulcerates or repeatedly bleeds should be assessed.
• You have a weakened immune system: Warts may be more extensive, persistent and difficult to treat in people who are immunocompromised.

A dermatologist can confirm the diagnosis and recommend the most appropriate treatment based on the type, size and location of the wart.

How are Warts Removed?

The most appropriate treatment depends on the type, size, number and location of the warts, as well as the patient's age and treatment preferences. A dermatologist will first examine the wart to confirm the diagnosis and recommend the most suitable treatment.

At Stephanie Ho Dermatology, treatment options include:

Cryotherapy

Cryotherapy uses liquid nitrogen to freeze and destroy the wart tissue. It is commonly used for warts on the hands, feet and other areas. As warts can be persistent, several treatment sessions may be required.

Shave Excision and Electrocautery

Warts that protrude from the surface of the skin can be carefully shaved, followed by electrocautery to treat the base of the wart and control bleeding. This method allows suitable warts to be removed immediately.

CO₂ Laser

A CO₂ laser precisely removes or vaporises wart tissue. It may be considered for larger, persistent or difficult-to-treat warts, including selected warts on the soles of the feet and around the fingers, toes or nails.

MMR Immunotherapy

For persistent or multiple warts, MMR (measles, mumps and rubella) vaccine can be injected directly into a selected wart. This aims to stimulate the body's immune system to recognise and fight the HPV infection.

An advantage of immunotherapy is that the immune response may help clear not only the injected wart but also untreated warts elsewhere on the body.

MMR immunotherapy can also be combined with cryotherapy, which may improve the treatment response in persistent or difficult-to-treat warts. Treatment is usually performed at approximately 3-week intervals, with around 3–5 sessions often required, depending on the response.

Topical Treatment

For children or patients who prefer to avoid procedures, topical treatments may be considered. Depending on the type and location of the wart, these treatments may gradually remove the wart or stimulate the immune system to recognise and clear HPV-infected cells.

Will Wart Removal Be Painful?

We aim to make wart treatment as comfortable as possible. Depending on the procedure and location of the wart, numbing cream can be applied beforehand wherever appropriate. For treatments that require stronger anaesthesia, such as shave excision, electrocautery or CO₂ laser, a local anaesthetic injection can be given to completely numb the treatment area.

You may feel a brief sting from the anaesthetic injection, but the area should then remain comfortably numb during the procedure.

Which Treatment Is Best?

For patients who prefer rapid removal, shave excision with electrocautery or CO₂ laser may allow suitable warts to be treated in a single session. For multiple or persistent warts, cryotherapy, MMR immunotherapy or a combination of the two may be recommended.

No treatment can guarantee that a wart will not recur, and some warts require several treatment sessions before they clear completely.

Where appropriate, wart treatments can be performed on the same day following consultation, using our on-site treatment facilities.

Post-Treatment Care for Warts

Proper aftercare can help the treated area heal well and reduce the risk of infection, scarring and pigmentation changes. Your dermatologist will provide specific instructions depending on the treatment performed.

• Keep the area clean: Gently clean the treated area as advised by your dermatologist and pat it dry. Avoid rubbing or scrubbing the area while it is healing.
• Keep the wound covered: Depending on the treatment, you may be advised to apply a thin layer of antibiotic ointment and/or cover the area with a clean dressing until the skin has healed.
• Do not pick or scratch: Cryotherapy may cause a blister, while laser or electrocautery treatment may result in a scab. Allow these to heal naturally and avoid picking, scratching or deliberately breaking blisters.
• Avoid prolonged soaking: Avoid swimming, hot tubs and prolonged soaking of the treated area until the skin has healed. Showering and gentle washing are generally fine unless your dermatologist advises otherwise.
• Reduce friction and pressure: Protect the treated area from rubbing and repeated pressure while it heals. This is particularly important for plantar warts on the soles of the feet.
• Watch for infection: Mild redness, swelling, tenderness or blistering can be expected after some wart treatments. Contact your dermatologist if you develop increasing pain, spreading redness, warmth, significant swelling, pus or discharge, or fever.
• Follow your treatment plan: Warts can be persistent and may require several sessions. Attend any scheduled follow-up treatments even if the wart has become smaller.

For exposed areas, once the skin has healed, sun protection can also help reduce post-inflammatory pigmentation, particularly in darker skin types.

Summary

Warts are common, non-cancerous skin growths caused by HPV. Although generally harmless, they can be contagious, persistent and sometimes uncomfortable, and may spread to other areas of the body or to other people.

At Stephanie Ho Dermatology, we offer a range of wart treatments, including cryotherapy, shave excision and electrocautery, CO₂ laser and MMR immunotherapy. Treatment is tailored to the type, size, number and location of the warts, as well as the patient's age and individual needs.

Where appropriate, numbing cream or local anaesthetic injections can be used to make treatment as comfortable as possible. Some warts can be removed in a single session, while others may require several treatments for optimal clearance.

If you have persistent, spreading or troublesome warts, book an appointment with our dermatologist for an assessment and personalised treatment plan.