Wart Removal: Should You Treat Them at Home or Wait for Them to Fall Off?

Many people experience warts, which are benign (‘noncancerous’) growths that can be found on the skin or mucous membranes (such as the inside of the mouth). They are caused by human papillomavirus (HPV), which is a virus with over a hundred variants, though only a few might cause warts on certain parts of the body. Warts are generally harmless; however, they can be annoying and occasionally painful.

Symptoms

Warts can look different depending on the type. They may appear as:

• Dome-shaped
• Flat
• Rough
• Bumpy or resembling cauliflower
• Smooth
• Thread-like or finger-like
• Skin-coloured, brown, grey or black
• Featuring small black or brownish dots
• They can range in size from 1 millimetre to a few centimetres, and you might have just one wart or several in the same area.
• While you might be able to recognize a wart on your own, it is always a good idea to consult with a healthcare provider if you are unsure about a new skin growth.

Types

Healthcare providers categorize warts based on their appearance, the specific HPV strain (type) that causes them and the areas of the body they affect.

• Common warts (Verruca vulgaris): These are warts on hand that typically appear as rough bumps and may have black dots that look like seeds, which are actually dead capillaries. These warts can range in size from a pinhead to a pea. HPV types 2 and 4 are the most common causes of warts on the hands, along with types 1, 3, 7, 27, 29 and 57.
• Plantar warts: These are warts on feet that typically develop on the soles and are often flat or grow inward, sometimes featuring black dots. These warts can become quite large and may cause pain when standing or walking. HPV types 1, 2, 4, 27 and 57 are responsible for causing warts on feet.
• Mosaic warts: They are small, white warts about the size of a pinhead. They usually appear on the balls of your feet or under your toes but can spread to cover larger areas. These warts are flatter than plantar warts and typically don’t cause pain when you walk. HPV type 2 is the main cause of mosaic warts.
• Flat warts: They can appear anywhere on your body. They are smaller and smoother than other types of warts and often grow in clusters, with anywhere from 20 to 100 warts appearing at once. HPV types 3, 10 and 28 are the main causes of flat warts.
• Filiform warts: They are long, thread-like growths that stick out. They commonly appear on the face, around the mouth, eyes and nose. HPV types 1, 2, 4, 27 and 29 are responsible for causing filiform warts.
• Genital warts: They affect the genital and anal areas. They are a sexually transmitted infection (STI) passed through skin-to-skin contact. These warts appear as small, firm lumps with a rough surface. HPV types 6 and 11 are responsible for approximately 90% of cases of genital warts.
• Butcher’s warts: They usually appear on the hands of people who handle raw meat, such as butchers, or those who work in cold, moist environments. HPV type 7 is the cause of butcher’s warts.
• Focal epithelial hyperplasia (Heck’s disease): It is a rare condition where warts form inside the mouth on the mucous membranes. These warts are usually soft and appear white or mucosal-coloured. HPV types 13 and 32 are responsible for causing Heck’s disease.

Causes

Certain strains of the human papillomavirus (HPV) cause warts by entering the skin through small cuts, leading to increased cell growth. This causes the outer layer of the skin to become thicker and harder, forming a wart. Warts are more likely to develop on moist, soft or damaged skin.

All warts are caused by HPV, but not all types of HPV lead to warts. The strains of HPV that can cause cancer, such as cervical cancer, do not cause warts.

Can warts spread to others?

Yes, as HPV is contagious, warts can be spread from one person to another. Warts can be transmitted through both direct and indirect contact. Direct contact includes touching someone else’s wart or having skin-to-skin contact, while indirect contact can occur when using items like towels or razors that have been in contact with a wart or HPV.

Diagnosis

In most cases, a healthcare provider can diagnose a common wart using one or more of the following methods:

• Examining the wart
• Scraping off the top layer of the wart to look for dark, pinpoint dots, which are typical in warts
• Taking a small sample of the wart and sending it to a lab to rule out other types of skin growths (also called a shave biopsy)

Treatment

Most common warts will go away on their own, though it can take a year or two, and new warts may appear nearby. Some people opt for treatment from a healthcare professional when home treatments are not effective or if the warts are bothersome, spreading or causing cosmetic concerns.

• Medications: Drugs like salicylic acid dissolve warts one layer at a time. These products are offered in liquid, gel and patch formulations. You may need to apply the medication daily for several months to remove the wart completely.
• Medical topical treatments: Your healthcare provider may apply a liquid containing the chemical cantharidin to the wart. This causes a blister to form underneath the wart, cutting off its blood supply. You will need to return to the healthcare provider in about a week to remove the dead wart.
• Medical freezing: In a procedure known as cryotherapy, your provider applies liquid nitrogen to freeze the wart. Over time, the wart may fall off. Multiple treatments may be required.

If the wart does not improve with conservative treatments, your provider may suggest more invasive options, such as:

• Immunotherapy: Immunotherapy boosts your immune system’s ability to fight the virus that causes warts. One form of this treatment involves applying a topical chemical like diphencyprone (DCP), which triggers a mild allergic reaction that may help the wart disappear.
• Surgical removal: Your provider may surgically cut out the wart to remove it, which could leave a scar.
• Electrosurgery: This treatment uses a heated needle to burn away the wart tissue. Scarring may occur as a result.
• Laser wart removal treatment: In the Laser wart removal procedure, your provider uses laser light to heat and destroy the small blood vessels inside the wart. This cuts off the blood supply, effectively killing the wart. Scarring may occur as a result.

Wart removal at home

Some home remedies, such as covering the wart with duct tape, may help remove warts. However, never attempt to cut or tear off a wart on your own, as this can cause infection and other complications. Only healthcare providers should perform surgical wart removal.

Conclusion

While warts are generally harmless, they can be embarrassing or interfere with your daily life. The good news is that there are several treatment options available, and many warts will eventually go away on their own, though it might take some time. If you have a persistent wart or any other concerns, don’t hesitate to talk to your healthcare provider; they are there to help.