“Wart” (verruca) is a collective term for a variety of (almost always) benign skin changes that can be caused by many different pathogens. By far the most common trigger for warts, however, are the so-called human papilloma viruses (HPV), with which one can be infected by a contact or smear infection. It is assumed that every second person suffers from a wart at least once in their lifetime.
In principle, warts can develop at any age, although children are affected significantly more often than adults. Warts can look very different from type to type. Normally, however, they are either flat or at least only slightly raised, relatively small and sharply defined.
As a rule, warts can be treated well, but since the risk of infection and relapse is relatively high, warts can recur again and again in the course of life. Apart from the so-called age warts, which are actually not warts in the true sense, all warts are an expression of a viral infection. In the meantime, over 60 viruses are known to cause warts.
Among the most common are the human papilloma viruses (HPV), which are responsible for vulgar warts (common warts), genital warts, flat warts and brush warts, among others, and the Molluscum Contagiosum Virus (MCV). First of all, one must come into contact with a triggering virus. This happens, especially with warts, often in public places such as swimming pools, saunas or hotels, where many people walk around barefoot and share towels or the like if necessary.
For a virus to actually cause a wart, several factors must coincide. On the one hand, there must be a defect in the skin through which the virus can enter, as the intact skin provides sufficient protection against these viruses. However, these defects are usually so minimal that they are not even noticed by those affected.
Whether or not an infection occurs depends largely on the immune status of a person, i.e. how well the body’s own defense system works. This is, in addition to the not yet so pronounced hygiene behavior of children, another reason why this age group in particular frequently develops warts: in small children, the immune system is simply not yet fully developed. Because of the limited body’s own defense system, people with certain underlying diseases or after taking certain immunosuppressive drugs (for example cortisol) also suffer more frequently from warts.
It also plays a role whether the immune system has already come into contact with the specific pathogen before. If so, it is possible that special cells already exist that are specialized in killing this one pathogen, which can then fight the invading virus so quickly that the warts cannot even develop. The characteristic appearances of different, frequently occurring warts are to be described here briefly more exactly.
There are also flesh warts, flat warts and brush warts.
- Plantar warts (plantar warts, mosaic warts, plantar verrucae) are also caused by papilloma viruses. After an infection, however, it can take up to several months for a wart to become visible on the sole of the foot.
A distinction is made in this type between plantar warts and mosaic warts. Thorn warts grow very deeply into the skin, can sometimes be very cornified on the surface (horny callosity) and contain several black dots. Because deeper skin layers are also affected, this type of wart can cause considerable pain, especially when pressure is applied to the corresponding area, i.e. often when walking.
This pain can be intensified by the fact that spiny nipples can sometimes even grow up to the bone and irritate the sensitive periosteum. Mosaic warts, on the other hand, do not grow in depth, but in width. They are extremely flat, but can occur in large numbers and in the shape of a beet.
Mosaic warts do not usually cause pain. A differential diagnosis is important in the case of plantar warts, since the common warts also occur regularly in the area of the soles of the feet.
- Age warts (senile warts, Verrucae seborrhoicae) The cause for this form of warts is not known so far, it is only known that their development is favored by increased sun or UV radiation. Age warts develop mainly from the age of 50.
They are light brown to black, mostly small, but can sometimes reach bean size, often with a fissured surface and they can affect the skin over a very large area.Some of these skin changes itch, but are otherwise harmless and not contagious, malignant degenerations have only been described in a few exceptional cases.
- Vulgar warts (verrucae vulgaris) This type of warts is by far the most common with about 70% of all warts. Typically vulgar warts form on the face, on the fingers and under the nail plate. At first they are about pinhead to pea size, but as they progress they can grow in size and practically proliferate.
These growths are often described as “cauliflower-like” due to their appearance. The nodes are whitish, hard, rough and often scaly. Sometimes several small “daughter warts” develop around the original wart.
The pathogen of these warts are the human papilloma viruses 1, 2, 4 and 7.
- Genital warts (condylomata acuminata) These warts are also caused by HPV, but mainly by HPV 6 and 11, and are usually transmitted through unprotected sexual intercourse.
They develop either in the area of the genital organs (i.e. the vagina, the external female genital or the penis) or in the anal region. Genital warts are initially only a few millimeters in size and are very bright, whitish or flesh-colored, which is why they are not easily recognized at first. Sometimes, however, they increase in size considerably over time and form so-called wart beds.
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Due to its characteristic appearance, the doctor can usually easily make the diagnosis in the form of a gaze diagnosis.
Often, especially if they have had frequent experience with warts, patients can even make the diagnosis themselves. However, since some types of skin cancer can sometimes look very similar to some wart forms, it is advisable to consult a doctor in the case of newly discovered skin changes in order to obtain a reliable diagnosis. In case of doubt, the doctor can take a tissue sample to rule out malignant tissue growth.
The therapy removal of warts depends on their As age warts are harmless and not contagious, they are usually not treated at all. For all other warts, there are various options for therapeutic removal. Also for these other types of warts, the first option is to simply wait and see.
In many cases warts disappear on their own, sometimes even after several weeks or even months. However, since they often itch, hurt and/or represent a cosmetic problem, patients usually want a therapy. Which of the many options is most sensible in a special case is best discussed with a doctor.
In principle, warts can be treated with the help of 1. cyto- or virustatics: In the beginning, warts are usually treated with a less invasive and less painful method. For this purpose, certain creams, ointments, solutions and varnishes with active ingredients that directly combat certain viruses (virustatics such as cidofovir) or cytostatic agents that inhibit cell growth or cell division (for example fluoruracil or podophyllin or the more potent podophyllotoxin) are suitable. 2. in cryotherapy (freezing), a cooling agent (usually liquid nitrogen) is applied to the wart with the help of a so-called applicator.
This coolant remains on the wart for a few seconds. This process of freezing is repeated several times. The aim is to kill the cells of the uppermost skin layer and then remove them so that the wart practically “grows out” with the newly growing lower skin layers.
A frequent side effect of icing is the formation of an icing blister. 3. surgical removal of warts is only used when other, less invasive procedures have not been successful. There are again several options available in the context of surgical therapy.
- Pathogen
- Degree of expression and
- Localization.
- Cyto- or virustatics
- Icing (cryotherapy) or a
- Treat surgical removal.
- “Sharp spoon”: The most common way to remove warts is with a so-called “sharp spoon”. This procedure is particularly suitable for warts that have grown relatively deep, such as thorn warts. Under local anesthesia the wart can then be practically scraped out.
Depending on the extent of the wart, the condition and the healing potential of the tissue, the subsequent healing phase can take different lengths of time. Unfortunately, this type of removal is often accompanied by a not negligible loss of blood and sometimes strong postoperative pain.
- Electrocoagulation: In another variant, the wart is removed by means of electrocoagulation, i.e. by thermally destroying the skin at the affected area. This method can be accompanied by massive scarring, especially on the soles of the feet.
- Removal with laser: Finally, it is an option to use a laser to remove the wart.
Either the laser is used like a “sharp spoon” and cuts out the wart or a dye laser is used, which can close the blood vessels and dry out the wart from the inside, so to speak. Disadvantages: – Painfulness and the need for many sessionsAdvantages: only rarely relapses (recurrences) described.
Warts patches are available without a prescription and have a relatively simple mode of operation. The patches contain salicylic acid or lactic acid.
These acids attack the uppermost skin layers of the wart. This causes the wart to soften on the surface and the keratinized areas come off by themselves or can be removed with a file. The wart plaster should not be removed from the wart for about 3 days and should be stuck on as water- and airtight as possible so that an ideal effect can be guaranteed.
Furthermore, care should be taken to ensure that the patch does not come off with friction (e.g. on the sole of the foot). The plaster can be removed after an exposure time of 3 days. In the next step, the softened and possibly already slightly dissolved skin should be removed with a file, plane or pumice stone.
Here it is important to remove as much skin as possible until the softened upper layers are no longer visible. In general, only as much as does not cause pain should be planed off. In the following days, after warm water baths (a few minutes) you can try to file off more skin.
If the wart is not yet gone or returns after this time, a wart plaster can be applied again and the process can be repeated. Since the wart plaster does not kill the trigger of the warts – the viruses – but only the cells in which these are present, it must be ensured that the treatment is carried out until the wart has really disappeared completely, otherwise the viruses from the remaining cells can lead to a renewed proliferation of the wart. If the wart does not disappear even after several sessions, you should consider using another treatment and consulting a doctor to rule out other reasons for the increased growth of the wart.
Besides the application of plasters, a very common form of therapy is the application of tinctures. Comparable to the patch, the function of these tinctures is based on acids. Salicylic, lactic or formic acid are often contained.
As with plasters, the acids dissolve the superficial keratinized skin areas and make them easier to remove. In addition to these acids, other tinctures contain other highly corrosive acids or bases such as trichloroacetic acid or potassium hydroxide solution. Here, care must be taken to ensure that the tinctures do not get into the eyes and that the surrounding skin is protected by oily creams if necessary.
Another possibility is the one-time freezing of the wart. In this case, two gases are mixed in a small “plastic bottle” (applicator) by pressing a button and a mixture with a temperature below -50°C is created. This plastic bottle is then pressed on the wart for about 20 – 60 seconds.
This can be a very painful process. However, the application is only effective if the wart is completely frozen. If the wart does not heal or the wart returns, the procedure must be repeated.
In order to prevent the development of warts, it is almost only helpful to maintain good personal hygiene. This includes always using your own towels, washcloths and clothes, not walking barefoot in public places if possible and cleaning the skin regularly. However, because the pathogens that cause warts are so widespread, it is difficult to consistently avoid the risk of infection.
Only against genital warts (HPV) an effective vaccine exists since 2006. The freezing of warts, also known as cryotherapy, describes the removal of superficial warts through the use of cold. This treatment usually uses liquid nitrogen, which is applied to the wart as a spray or solution.
The cold damages the affected tissue and causes it to die. This method is especially suitable for warts that grow on insensitive parts of the body, regardless of the type of wart and is therefore unsuitable for use in sensitive areas such as the eyes or on mucous membranes.The procedure of icing is simple and can be done either by yourself or by the doctor. After cleaning the affected area of the body before the freezing process begins, the doctor places the cold exactly on the wart using a probe.
In pain-sensitive patients, the wart can be anaesthetized slightly before the application of the freezing substance. The cold is caused by the use of liquid nitrogen, nitrous oxide or dry ice. After freezing, the wart dies with the formation of small ice crystals inside the cell and it is possible that a bubble develops in the area of the frozen wart, which disappears in the following days.
New, healthy skin cells will then emerge from under the blister. In most cases the therapy is successful after one application and the wart disappears. If this is not the case, the wart can be frozen again after two to three weeks, so that it does not form again, but disappears completely.
Sprays, which are available in pharmacies, are often used for the independent freezing of warts. This approach should be carefully planned and it should be ensured that the growth in question is actually a wart. When buying the icing agent, one should seek advice in the pharmacy.
In some situations, however, independent action is strongly advised against. For example with diabetics, as the wound healing is impaired in these patients. Furthermore, the icing should be carried out by a doctor for children under four years of age, as well as for warts that are located on sensitive parts of the body. It is advisable to consult a physician, as warts can be frozen and removed more effectively and safely.
