Common Wart

Who's At Risk?

Warts can affect people of any age, but they are most common in those aged 12-16 years. It is estimated that 20% of schoolchildren and about 10% of the general population have warts. Warts can affect any race / ethnicity. People with organ transplants or who are on chemotherapy have a higher incidence of warts due to their weakened immune system.

Signs & Symptoms

Warts may occur singly or in groups and often have what appear as multiple small black “dots” at the surface from tiny blood vessels.

• Common warts are rough, thick papules (solid bumps) ranging in size from 1 mm to over 10 mm, often on the hands, face, elbows, and knees.
• Filiform warts are long and narrow, like tufts of thread, and they are usually small at the base (1-3 mm). They often affect the face, eyelids, or nose.
• In lighter skin colors, warts may be pink, skin-colored, or light brown. In darker skin colors, warts may be pink, skin-colored, purple, brown, or gray.
• Warts can be covered with scale, which can be whitish, yellow, brown, or gray.

Self-Care Guidelines

Because warts can resolve on their own, it is not necessary to treat all warts. Additionally, treatment of warts may not always destroy them, nor will it necessarily keep other warts from appearing. Treatment can be painful, cause scars, and might need to be repeated, so it should only be done in cases where the warts are bothersome or interfere with daily life.

• Over-the-counter wart removers (eg, Compound W) have a high percentage of salicylic acid and work by dissolving away the layer of skin infected with the virus. This treatment needs to be used daily and can sometimes be irritating to unaffected skin around the wart.
• Duct tape applied daily to the affected area can help remove warts. The tape should be very sticky and kept on for a few days. Some children may have a reaction to the adhesive on the tape.
• Over-the-counter freezing medications are available but have not been found to be very effective.
• Coupled with the above therapies, the wart should be soaked in warm water, and any loose skin should be removed every few days with a mild abrasive, like a pumice stone.
• Family members should avoid sharing personal items such as towels.

Treatments

• Application of cantharidin (Ycanth), podophyllin (Condylox), tretinoin (Retin-A), or acid (Tri-Chlor).
• Destruction with freezing (cryosurgery), burning (electrocautery), or laser. These treatments are painful, though, and may be avoided in younger children.
• Application of imiquimod (Aldara, Zyclara), an immunotherapy agent, that triggers an immune reaction to destroy the wart.

Visit Urgency

Call a health professional if your child has:

• Painful or bleeding warts.
• Warts on the face or warts interfering with daily life that do not improve with self-care.
• Warts on the genital or anal area.

Trusted Links

• MedlinePlus: Warts
• Clinical Information and Differential Diagnosis of Wart, Common (Verruca Vulgaris, HPV)

References

Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018.

James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2019.

Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill Education; 2019.

Paller A, Mancini A. Paller and Mancini: Hurwitz Clinical Pediatric Dermatology. 6th ed. St. Louis, MO: Elsevier; 2022.