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Viral Warts/Verrucae

Viral warts: Treatment, symptoms, advice and help

About viral warts

Warts are tumours or growths of the skin caused by infection with Human Papillomavirus (HPV).

Signs and symptoms of viral warts: Diagnosis

Common warts appear initially as smooth, skin-coloured papules. As they enlarge, their surface becomes irregular and hyperkeratotic, producing the typical warty appearance. They are most common on the hands but may also be seen on the face, genitalia and sun-exposed surfaces of the arm and leg.

Causes and prevention of viral warts

Viral warts are extremely common and are result of infection with the DNA human papillomavirus (HPV). Transmission is by direct contact with the virus, in either living skin or fragments of shed skin, and is encouraged by trauma and moisture (e.g. in swimming pools, fishmongers etc) Genital warts usually due to specific HPV subtype, are spread by sexual activity.

Viral warts: Complications

Some types of HPV have been found to cause cancer of the cervix and vulva.

Viral warts: Treatment

Viral warts will, in the vast majority of normal individuals resolve spontaneously. However, this may take several years. Most practitioners try to avoid treating warts that are not causing distress.

Initial treatment should be with salicylic acid or salicylic and lactic acid combinations, together with frequent and regular paring of the hyperkeratotic skin. Such treatment needs to continue for at least several months before convincing effects will be appear. If it fails, or as an alternative, warts can be treated by cryotherapy using liquid nitrogen. Such therapy needs to be repeated at intervals of 2 – 4 weeks.

Viral warts can be a particular problem in inviduals who are immunosuppressed following organ transplantation. Other treatments systemic retinoids, intralesional injection of bleomycin or interferon, and the application of contact sensitizers such as diphencyprone or dinitrochlorobenzene to the warts. The immunomodulator, imiquimod, is useful in treating stubborn anogenital warts.

The viral warts/verrucae information advice that you find here is written for the benefit of non-medical laypersons by a viral warts/verrucae specialist who is part of a team of 100 practising UK consultants and GPs. The content is in keeping with UK guidelines and based on current best practice for the management and treatment of viral warts/verrucae.

Viral Warts/Verrucae: Definition

Viral warts are an infection of the surface layer of the skin (epidermis) caused by a virus. The virus which causes warts (verrucae) in humans is called the human papilloma virus of which there are many different variants.

Viral Warts/Verrucae: Incidence/Age/Sex

Viral warts (verrucae) occur more commonly in children than in adults. The majority of adults have been exposed to the virus responsible for warts (verrucae) as a child and as a result may have formed their own immunity (antibodies) to the virus without necessarily having clinically visible apparent warts (verrucae) at any stage on their skin. In practice 95% of adults develop immunity to the wart virus.

Viral Warts/Verrucae: Causes and Preventions

Viral warts (verrucae) are caused by external contact occurring with the human papilloma virus. As an electron microscope is required to visualize the human papilloma virus it is therefore not visible to the naked eye. Therefore in practice where the wart virus is acquired from usually remains a mystery. It takes time for the virus to multiply within the skin, for it to enter the skin cells, and for a visible wart (verruca) to become apparent. The virus is acquired from external contact and does not pass internally, and is not passed through the blood stream. In practice therefore it can be passed from hand to hand contact or be acquired from communal changing facilities, for example swimming baths where the risks of verrucae are increased.

As it may take several months for a visible wart (verruca) to become apparent, restrictions on that individual from coming in contact with other people are worthless. This is because when the virus enters the skin cells, the virus becomes locked up within the individual cells causing an increased rate of cell turnover in the surface of the skin with the typical wart (verruca) appearing above the surface.

The virus at this stage is locked up within the cells and at a deeper level and therefore poses very little risk to any individuals coming in contact with them. Before the wart (verruca) becomes apparent then some shedding of virus may occur resulting in the potential for infection to occur to other individuals but this is at the stage when the skin looks normal. Therefore no restriction should ever be placed upon an individual with warts or verrucae from engaging in any communal activities which include swimming.

Viral Warts/Verrucae: Signs and Symptoms

A common wart is usually easily recognizable from its raised up craggy appearance above the skin. These commonly occur on the hands but can occur at other sites. When they occur on the face they may have a long stringy appearance (called a filiform wart). When verrucae occur on the feet they may be obvious or sometimes appear as a hard callus. These may be painful when they are on the feet because of pressure through the hard skin impinges on the underlying nerves.

Warts on the hands tend not to have any associated discomfort unless the skin heats up, becomes dry and then splits and cracks which can result in subsequent discomfort.

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