Verruca Vulgaris (Common Warts)

• Symptoms
• Causes
• Proper diagnosis
• What can I do
• Should I seek medical care?
• Treatment

Verruca vulgaris (common warts) is a benign growth caused by viral infection. Warts are very common among children of school age, but anyone can be infected. It is one of the most common complaints encountered by dermatologists in routine practice.3 They are contagious through skin contact and by damp towels or wet floors in showers and changing rooms

The infection is localized and is with one of the many types of human papillomavirus (HPV). HPV-2 and HPV-4 are the most common type to cause verruca vulgaris; other subtypes that may cause the warts include HPV-1, HPV-3, HPV-27 and HPV-57.

Symptoms

Close-up of a Verruca Vulgaris wart on the side of a hand finger, showing the rough, raised texture of the wart [ICD – B07.9]

Verruca vulgaris has a rough surface and usually appears on the hands or feet. They can occur on the back of fingers or toes and on the knees. The warts are small blisters that appear usually on the hands or under the feet (so called verrucas). You may see them in groups or a linear pattern. Warts are likely to appear in large numbers and bigger sizes during pregnancy and in immune suppressed patients.

They are often slightly raised, excessively keratinized, have hard edges and softer centers. They may be either lighter or darker than the surrounding skin. There may be small black dots in the warts as well. Warts on the hands are usually more visible and larger in size. They may look like tiny cauliflowers.

According to the place where the warts appear, they are given distinctive names. Warts in the soles of feet are called plantar warts. Those that appear on mucus membranes such as tongue are tongue warts, and they do not get keratinized so remain soft. Warts near the genital area are called condyloma (genital warts). If they appear near nail beds, it can be hard to identify as a wart, so the diagnosis should be made very carefully.

Causes

Common warts are the result of human papillomavirus infection. There are several ways you can catch this virus. Most common is, coming to direct skin to skin contact with an infected person.

Also, there is evidence to believe in sexual transmission and direct mother to fetus transmission.⁵ There is no significant difference between mother to fetus transmission in vaginal and caesarean deliveries. Both are shown to have 27.66% probability.⁵

You can get the virus during some treatment methods as well. Especially high temperature evaporation treatment methods like CO₂ laser treatment produce a vapor that contains HPV from the destroyed skin lesion, which has the ability to give you new warts in the surrounding skin or on a totally different body part.

Proper diagnosis

A healthcare professional can usually diagnose a wart based on your medical history and the wart’s appearance. One key sign is the disruption of normal skin lines—warts often obscure these natural lines.

Your doctor may gently pare down the thickened surface of the wart with a sterile blade to reveal tiny black dots. These are small clotted blood vessels, a common feature of warts. This helps distinguish them from other skin conditions, as the surface underneath typically shows a mosaic-like pattern.

If the lesion has unusual or suspicious features, further investigation may be recommended to rule out a precancerous or cancerous condition. In such cases, a small tissue sample (biopsy) may be taken for histological examination. Laboratory tests can confirm the presence of human papillomavirus (HPV), particularly in atypical or persistent lesions.

What can I do?

For warts under the sole of the foot, which often become hard because of the pressure, there are also relieving patches available in pharmacies.

To speed up the healing process, you can soften the wart in water and then file it down as much as possible without bleeding. Then, you may put on topical cream. You should treat the wart as such every day for at least 5 to 10 sessions.

You can also get a spray at the pharmacy to freeze the wart. However, you should not use the spray on children under the age of four, if you have diabetes or if you are pregnant or breastfeeding.

Should I seek medical care?

You should consider seeing a healthcare professional if you have:

• warts that are extensive, spreading, or causing discomfort

• warts that have persisted for more than 2 years

• pain, bleeding, or partial detachment (avulsion) of a wart

• concerns about the appearance or location of the wart (e.g. on the face or genitals)

Warts are generally harmless, but if they become bothersome—either physically or cosmetically—treatment options are available. It’s also important to rule out other skin conditions if a wart looks unusual or changes over time.

Treatment

Warts are not harmful and usually clear on their own, although it may take months or even years. Treatment is not always necessary, but many people choose to remove warts for cosmetic reasons, to stop them spreading, or if they are painful.

There are a variety of treatment options available. Some work quickly but may cause more discomfort, while others are slower but gentler. Despite advances in dermatology, there is still no guaranteed way to permanently remove warts or prevent recurrence, as most treatments do not eradicate the human papillomavirus (HPV), which causes them.

Over-the-counter treatment – Salicylic Acid

Salicylic acid is a commonly used treatment. It works by breaking down the thickened skin of the wart. Available in gels, liquids, pads, and plasters, it should be applied daily, often for several weeks.

• Always follow the product instructions carefully.

• Skin irritation is common – speak to a pharmacist if unsure.

• Avoid use on the face or genitals.

• Not suitable for people with diabetes, poor circulation, or weakened immune systems.

Cryotherapy – Freezing with Liquid Nitrogen

Cryotherapy is one of the most effective medical treatments, offered by some GPs or private dermatologists. It involves freezing the wart using liquid nitrogen, which causes it to blister and eventually fall off.

• May require multiple sessions.

• Can be painful and may leave temporary skin discolouration or, rarely, scarring.

• Should only be carried out by a trained medical professional.

Other Options

• Topical treatments: Stronger topical agents may be prescribed for stubborn warts.

• Laser treatment or electrosurgery: Useful for persistent or resistant warts.

• Immunotherapy (e.g., imiquimod cream): Stimulates the immune system to fight the virus.

• Thermotherapy: Uses heat (around 44°C) to destroy wart tissue, typically used for patients with low pain tolerance. Side effects like blistering or post-inflammatory pigmentation can occur.

Complementary and Traditional Approaches

Some people try alternative or traditional remedies such as taping a banana peel or garlic clove to the wart. There is limited evidence for their effectiveness, but they are often harmless if done with good hygiene and care.

Interestingly, suggestive therapy – a psychological technique involving positive reinforcement – has been found to help children, especially those under 10. The method relies on the belief that suggestion may enhance the body’s natural healing process.

Source:

1. MedicineNet, Inc. Viral Skin Diseases – Picture of Verruca Vulgaris. Disponible en: http://www.medicinenet.com/image-collection/verruca_vulgaris_picture/picture.htm
2. Wart (Plantar, Verruca Vulgaris, Verrucae). Ahmad M, et al. https://www.ncbi.nlm.nih.gov/books/NBK431047/
3. Muršić I, Včev A, Kotrulja L, Kuric I, Milavić T, Šustić N, Tolušić Levak M. TREATMENT OF VERRUCA VULGARIS IN TRADITIONAL MEDICINE. Acta Clin Croat. 2020 Dec;59(4):745-750. doi: 10.20471/acc.2020.59.04.22. PMID: 34285446; PMCID: PMC8253083.
4. Philip Buttaravoli, M. F. (2007). Minor Emergencies. Splinters to Fractures (2nd ed., Vol. 1). Mosby, Inc. an affiliate of Elsevier Inc.
5. Zhu, P., Qi, R. Q., Yang, Y., Huo, W., Zhang, Y., He, L., Wang, G., Xu, J., Zhang, F., Yang, R., Tu, P., Ma, L., Liu, Q., Li, Y., Gu, H., Cheng, B., Chen, X., Chen, A., Xiao, S., … Gao, X. H. (2022). Clinical guideline for the diagnosis and treatment of cutaneous warts (2022). Journal of Evidence-Based Medicine, 15(3), 284. https://doi.org/10.1111/JEBM.12494