Warts

Warts are a benign growth of skin, caused by human papillomavirus (HPV) infection. Some types of the virus increase the risk of developing malignant tumours, making the treatment of warts crucial.
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Clinic of Aesthetic Dermatology Patient education Encyclopedia Skin diseases Warts

The wart-causing HPV can infect both skin and mucous membrane. Currently, more than 150 types of the virus have been identified. The infection is transmitted by touch, especially if the skin or mucous membrane has been damaged (cuts and minor flesh wounds) and is perceptive to infections. Children and adults with lowered immunity commonly suffer from warts. The appearance of warts may differ.

Common warts

Generally occurring on fingers, hands and knees. Common warts are usually pale or skin-coloured, hard to the touch and slightly elevated. Sometimes warts are formed from multiple clusters of growth, similar to cauliflower. Multiple warts can coalesce.

Flat warts

Characterised by a flat surface, commonly found in clusters. Flat warts tend to develop in linear positioning since the infection is caused by shaving or scratching. As flat warts progress, they can develop similarities with common warts.

Plantar warts

These warts commonly occur on feet, where the skin is noticeably thicker. Usually, plantar warts are not elevated, creating the impression of growing inwardly, and causing discomfort or pain while walking. Same as common warts, plantar warts can develop in clusters and/or coalesce.

Difference between corns and warts

The early stages of plantar warts share visual similarities with corns, but foot corns are not a form of HPV infection – corns are thickened areas of skin that are caused by excessive friction or mechanical pressure. 

Filiform warts

Also known as digitate warts, filiform warts are characterised by protruding, elongated and thread-like shape. Most common on the face.

Seborrheic warts

Also known as seborrheic keratosis. The non-cancerous skin growth that multiplies and becomes larger in size after reaching the age of 30. As many as 9 in 10 people after the age of 60 have at least one seborrheic wart.

Seborrheic warts are skin-coloured, brown or black. Flat to the touch, these warts can develop a knot-like formation. Sometimes seborrheic keratosis can share similarities with malignant skin tumour; in some instances, the only way to identify whether the wart is a form of melanoma is by performing a biopsy (taking skin tissue samples for microscopic examination).

Seborrheic warts are not caused by HPV, but a sudden increase in their count can be a symptom of an internal disease.

Condylomas and warts

Condyloma acuminata or anogenital warts are the most common type of sexually transmitted mucosal warts. Anogenital warts affect genitals and the skin and mucosa around the anus. The virus can also infect the skin around and inside the mouth.

Papillomas and warts

Papillomas are benign, elongated skin growth, typically occurring around the neck and in armpits, commonly affecting middle-aged and elderly people. Their cause is not definitive, but papillomas are often observed with metabolic disorders (i.e. diabetes).

Significance of the colour of warts

Usually, warts are skin-coloured or pale. Sometimes warts can be reddish or black in colour if traumatised. Note that such visual similarities can be observed with malignant epithelial tumours – do not hesitate to make an appointment with your dermatologist in case of uncertainty.

Wart size and rapidly growing warts

Warts can differ in their size – they can be very small, as well as up to few centimetres in diameter, especially when adjacent warts have coalesced.

Rapidly growing and large warts may indicate possible immunity malfunction, but especially large warts may indicate squamous cell carcinoma, which is caused by HPV. Warts may become larger in size and multiply in count if they are not treated.

Warts can grow very fast – a proliferation of 1 cm can form in as little as 2 weeks.

Significance of wart location

Different types of warts tend to form in specific areas of the body, but their location does bear significance.

Bleeding warts

Usually, bleeding warts are not dangerous. If bleeding does not stop after dressing the wound, see a dermatologist immediately.

Prolonged and non-healing open sores may indicate the presence of malignant skin tumour!

Itchy warts

Itchy warts are not a symptom. Itchiness is commonly caused by irritated or dry skin.

Why do warts become fringe-like?

As a result of HPV infection, the virus affects cells, changing their appearance and growth-controlling mechanism. Due to these changes, smooth skin may acquire fringe-like appearance.

How deep are warts?

Deep warts or warts “down to the bone” are a myth. Warts are epidermal proliferation – they develop in the upper layers of epidermis. If a wart forms on feet where the skin is thicker, due to the pressure on the skin it does not grow outwardly, but thickens the skin tissue of the foot, growing in diameter.

Note that squamous cell carcinoma can resemble warts, and it grows inwardly.

Wart diagnostics

Usually, warts have easily identifiable visual characteristics and placement, which does not call for administering additional methods for determining the diagnosis. It is possible, however, to perform dermatoscopy of warts (examining the skin growth with an optical device that digitally zooms in the lower layers of dermis), as well as perform a biopsy (surgical skin cell sample removal for microscopic examination), if it is suspected that the growth may be malignant.

Identifying the presence of HPV is relatively expensive and does not affect the diagnosis and/or determine the treatment course. Such lab tests identify only high-risk types of HPV (i.e. HPV causing cervical cancer); lab tests do not exclude potential presence of other types of HPV.

Warts and tumours

Although warts may disappear without treatment, they can multiply and become a chronic condition for individuals with immunity disorders. Wart removal during the treatment course is highly advised, since their presence may cause the spreading of warts, increasing the risk of the development of malignant tumours.

Certain types of HPV may cause serious conditions, such as laryngeal and respiratory papillomatosis, cervical cancer and squamous cell carcinoma of the anal canal. Note that some types of skin tumours may have visual similarities with warts, making their examination crucial. Nowadays the state funds the HPV vaccine for young women that are yet not sexually active, thus decreasing the prevalence of high-risk HPV and cervical cancer among women.

 

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