Wart Treatment

Warts are among the most common skin growths that bring patients to a dermatology office, and they can appear almost anywhere on the body, from the soles of the feet to the face, hands, and nail beds. Caused by the human papillomavirus (HPV), warts are contagious skin infections that manifest as benign papillomas and spread through direct skin-to-skin contact. While many over-the-counter, salicylic acid-based products can treat superficial common warts, plantar warts, and flat warts, more stubborn wart types often require a board-certified dermatologist to clear safely and effectively. Whether a wart is new, painful, or resistant to home treatment, an accurate diagnosis and individualized treatment plan from an experienced dermatologist like Dr. Michele Green can make all the difference.

Because warts are highly contagious, prompt treatment helps prevent them from spreading to other parts of the body or to family members and close contacts. Dr. Green offers a full range of in-office wart removal options, from cryotherapy with liquid nitrogen and laser treatment to immunotherapy and prescription topical medications, tailored to each wart’s type, size, and location. With decades of experience treating cutaneous and genital warts alike, Dr. Green helps patients find lasting relief from these common but often frustrating skin growths, always emphasizing the safest, least invasive path to clear skin, a priority reflected in every treatment plan designed by Dr. Michele Green.

What are warts?

Warts are a very prevalent skin condition and one of the most common reasons patients visit a dermatologist in NYC. There are many over-the-counter treatments for plantar and common warts, most of which are salicylic acid-based. However, many types of warts do not respond to over-the-counter products and instead require a dermatologist to remove them. Warts can occur on any area of the body, including flat warts on the face, plantar warts on the soles of the feet, periungual warts under the nails, and genital warts. Each type requires specialized treatment based on its anatomic location. Whether it is cryotherapy, fluorouracil, cidofovir, or cantharidin, Dr. Michele Green will advise you on the best treatment options for your warts. Dr. Green is trained to treat and remove warts safely, painlessly, and effectively in her private NYC dermatology office.

What causes warts?

A common wart is a small, grainy growth that feels rough to the touch. At the base of common warts, small black dots are clotted blood vessels, or capillaries, within the wart. Warts are highly contagious and spread from person to person through direct skin-to-skin contact. The wart virus is highly contagious and is often seen in young children, young adults, and patients with a weakened immune system. After exposure, such as touching someone with a wart, it can take two to six months for a wart to develop. This incubation period can vary in those with a weakened immune system, such as patients with HIV/AIDS or those who have had an organ transplant. Individuals with atopic dermatitis or eczema, in whom the stratum corneum of the epidermis is disrupted, are more prone to warts and their spread. Because warts are so contagious, it is important to treat them promptly to avoid self-spread and transmission to others.

Various types of human papillomavirus (HPV) cause warts. According to the American Academy of Dermatology, of the more than 100 types of HPV, about 10 cause cutaneous skin warts. Different HPV strains cause different types of warts on the skin or mucosa, including rare conditions like focal epithelial hyperplasia (also known as Heck disease) and myrmecia. One HPV type causes plantar warts, while another causes flat warts or Heck disease. A few types of HPV can cause genital warts, and a subset of these strains has been linked to cancers such as cervical cancer in women and penile cancer in men. The types of HPV that cause genital warts are different from those that cause non-genital warts. Everyone reacts differently to the wart virus, and whether you contract warts and how they spread depend largely on your immune system. In immunocompromised patients, wart treatment can be more difficult, so consult a dermatologist as soon as a new wart appears.

How do you diagnose a wart?

A routine dermatological exam can identify a wart. Your dermatologist will look for certain basic characteristics to identify a wart and rule out other skin diseases.

• New growth that feels grainy or rough.
• Later growths appear larger and can grow in groups or clusters, some with a cauliflower appearance.
• Flesh-colored, white, pink, or tan in appearance.
• Clustered black pinpoint dots, with clotted blood vessels at the base of the lesion.

What are the different types of warts?

There are several types of warts, each with distinct features and typically appearing on different parts of the body. The group of warts classified as cutaneous warts includes plantar, common, and flat warts. Depending on the wart’s anatomic location, size, and your underlying immune status, treatment options vary.

Common Warts

Common warts, also called verruca vulgaris, are typically flesh-colored and appear on the extremities. They are round and rough, with a grainy appearance, and usually grow on the knuckles, elbows, fingers, toes, and areas of broken skin, such as those affected by eczema.

Plantar Warts

Plantar warts are usually found on the soles of the feet, heels, and toes. They can be embedded in the skin, surrounded by areas of hyperkeratosis (hardened skin), with black dots in the center. Plantar warts can form clusters on the bottom of the feet, called mosaic warts, and mosaic warts are sometimes confused with corns. These warts can be so painful that even walking becomes difficult. Because we stand on our feet for much of the day, plantar warts are pushed deeper into the bottom of the foot and are often more difficult to remove. Many individuals contract plantar warts from walking barefoot in locker rooms or at the gym.

Flat Warts

Flat warts, or verruca plana, also called plane warts, are small, round, flat, and smooth skin growths. These flat warts are typically found on the face, thighs, or arms and can be mistaken for other skin growths, such as seborrheic keratosis or moles. They are usually flesh-colored and tend to appear in larger numbers, from as many as 20 to 100 at a time.

Filiform warts

Filiform warts are flesh-colored warts that are often mistaken for skin tags because they are small, thin, and raised. They are most commonly found on the neck, eyelids, and armpits.

Periungual warts

Periungual warts tend to develop around the fingernails or toenails. They initially appear as very small lesions that gradually grow into larger, cauliflower-like bumps. Periungual warts can be painful because they grow under the nail bed and can cause cuticle deformity, nail infections, and other secondary skin infections. Nail biting can contribute to the spread of these warts, including to the mouth.

Palmar warts

Palmar warts are warts on the hands and often result from touching or picking at warts on other areas of the body. Palmar warts typically appear in clusters and are also often referred to as mosaic warts. They can vary in color from flesh-colored to pink or brown and are often quite painful.

Genital warts

Genital warts are caused by certain types of HPV and are transmitted through sexual contact, classified as a sexually transmitted infection (STI). They initially appear as small bumps but can grow larger, taking on a cauliflower-like appearance. A subset of human papillomavirus strains causes serious STIs, including cervical cancer in women and penile or anal cancer in men. Genital warts are highly contagious, so if you notice what appears to be a new lesion in the genital area, it is very important to see a dermatologist immediately to identify and treat the new growth and differentiate it from other skin conditions. There are now vaccines for children to help protect against HPV; there are two HPV vaccines, Gardasil and Cervarix. Gardasil protects against four HPV types (6, 11, 16, and 18) and is approved by the FDA for female patients ages 9 to 26 to help prevent genital cancers.

Butcher’s warts

Butcher’s warts result from human papillomavirus type 7. These warts are named for their prevalence among people in the food industry who frequently handled raw meat. One study by the American Academy of Family Physicians found that 34% of retail butchers had warts on their hands.

What Are The Best Treatment Options For Warts?

Many individuals seek wart treatment because warts can be painful, unsightly, and contagious. Warts can spread to other family members or auto-inoculate to other areas of your body. Treating warts can be challenging, as some are unresponsive to conventional treatments and require a more aggressive, targeted approach. Because the immunologic response to HPV can be slow, wart treatment can take time, and some warts are more difficult to treat than others. Consult a dermatologist as soon as you notice a wart — the sooner treatment begins, the better — before the virus takes root.

Salicylic Acid Treatment

Prescription-strength salicylic acid works the same way as lower-strength, over-the-counter versions. Dr. Green may prescribe this medicine for home use, or she may suggest salicylic acid plasters, patches containing 40% salicylic acid. It is recommended that you soak the wart in warm water for 15 to 20 minutes and file down the dead skin with an emery board before applying the patch. The patches should be applied daily, though it can take several months before the wart is gone. Use disposable emery boards to avoid spreading or reinfecting the wart virus.

Trichloroacetic Acid Treatment

Trichloroacetic acid (TCA) is a strong acid used to destroy the wart chemically. The wart is pared down to its base, cauterized, and then TCA is applied. This process may require several treatments to remove the wart completely and is typically used for plantar warts.

Vbeam Pulsed-Dye Laser Treatment for Warts

Vbeam pulsed-dye laser treatment uses light energy to cauterize the tiny blood vessels within a wart. Cauterizing these vessels causes the wart to dry out and fall off. This laser treatment is highly effective for warts, especially flat warts on the face, though it typically requires several sessions.

Electrodessication and Curettage of Warts

Electrodesiccation and curettage for wart removal is a relatively quick and painless surgical procedure. The area is anesthetized with a topical or local anesthetic before treatment, and a hyfrecator (electric needle) is used to burn the wart while a curette scrapes it away. The wart scabs and falls off within a few days. This is a very popular method for treating cutaneous warts.

Cryotherapy

Cryotherapy freezes warts with liquid nitrogen and is a somewhat painful wart-removal treatment. Liquid nitrogen can cause skin blistering and often requires multiple treatments. There is also a risk of scarring or hypopigmentation with cryotherapy.

Surgery

Surgical excision of a wart is usually reserved for warts that are unresponsive to other treatments. A small shave biopsy is taken and sent to a laboratory for review and processing, which can also help determine the histological type of the HPV wart virus involved. The wart is then surgically removed.

Imiquimod for Warts

Imiquimod is dispensed under the brand name Aldara, an immunotherapy agent that enhances cell-mediated immunity. In addition to treating warts, Aldara is FDA-approved to treat skin cancers such as basal cell carcinoma and squamous cell carcinoma. Aldara is a very effective treatment for recalcitrant warts, and studies have shown that after 16 weeks of use, warts are significantly reduced. Aldara is often used to treat genital warts, as is podophyllin.

Bleomycin for Warts

Bleomycin is a chemotherapeutic medication used to stop tumor growth, and it has proven very successful in treating cutaneous warts. Bleomycin is usually reserved as a last resort due to its potential side effects and is used for difficult warts that have been unresponsive to other treatments. Bleomycin is injected directly into the wart to kill the virus, though the injections can be painful and may cause a skin rash or discoloration at the injection site.

Cantharidin for Warts

Cantharidin is a chemical your dermatologist applies to the wart and then covers with a bandage. The solution is painted on and left in place for 24 hours, after which the wart typically blisters, which may cause some pain. Once the bandage is removed, your dermatologist will remove the dead skin on top of the wart. If the wart is still present, another application of cantharidin may be necessary.

Fluorouracil for Warts

Fluorouracil, sold under the brand name Efudex, is an antineoplastic, or chemotherapeutic, drug that inhibits thymidylate synthase, preventing DNA synthesis. Eliminating thymidylate triphosphate prevents the wart from surviving and ultimately causes cell death. For warts, Efudex can be combined with salicylic acid for a more aggressive treatment approach.

Candida Immunotherapy for Warts

Candida antigen is an immunotherapy treatment for recalcitrant plantar warts. This treatment involves multiple injections into the wart every three to four weeks.

Home Remedies For Warts

Warts are viral and can disappear on their own; however, because they are viral, they can also spread. Dr. Green may recommend home treatments for removing warts, but take special care to avoid inadvertently spreading them to other parts of your body. A few topical treatments, such as salicylic acid plasters or liquid compounds, can be used at home. You should never, however, attempt to remove a wart on your face, as doing so can cause scarring, inflammation, or infection. If you are diabetic or immunocompromised, you should consult your dermatologist for any wart removal and avoid attempting to treat or remove warts on your own.

Duct Tape for Warts

Duct tape for warts is an age-old, inexpensive wart treatment, and many people have reported success treating warts this way. This treatment involves soaking the wart in water, then covering it with duct tape for several days, and using a pumice stone to remove the dead layers of skin. The concept behind this remedy is that the wart needs oxygen to grow, and duct tape blocks the wart from the oxygen it needs.

At Home Freezing Treatments

You can purchase an over-the-counter freezing spray that contains liquid butane. These sprays produce an extremely cold chemical that is applied directly to the wart, freezing it and destroying the tissue. Freezing warts at home can remove some superficial warts, but it cannot reach deeper parts of the wart, making it ineffective for deeper warts. Additionally, these freezing methods can cause blisters, burns, irritation, or infections.

Apple Cider Vinegar

Apply apple cider vinegar (ACV) directly to the wart to help eliminate the HPV virus. To use apple cider vinegar, some reports describe mixing two parts ACV with water and soaking the wart with gauze or a cotton ball; you can also apply the solution to a bandage placed over the wart, which may help reduce its size. Using apple cider vinegar is a tedious process that can take a long time before results are seen.

Garlic Extract

Garlic is also known for its antiviral properties due to the compound allicin. To treat a wart, crush the garlic and cover the wart with a bandage, repeating this process daily until the wart’s skin cells dry out and the wart shrinks. This treatment can also take a long time, and not all types of warts respond to it.

Frequently Asked Questions (FAQs) About Wart Treatment

What virus causes warts?

Warts are caused by the human papillomavirus (HPV), a family of more than 100 related viruses. About 10 types of HPV cause the cutaneous warts commonly seen on the skin, while other distinct strains cause genital warts. The specific HPV type a person is exposed to largely determines the type of wart that develops, whether it is a common wart, a plantar wart, or a flat wart.

Does HPV cause all warts?

Yes, all warts are caused by some strain of human papillomavirus. However, not every strain of HPV behaves the same way; some cause common or plantar warts on the skin, others cause flat warts, and a distinct group of strains causes genital warts and is linked to cancers such as cervical cancer. This is why the same virus family can produce such a wide range of wart types and appearances.

How do you get warts?

Warts are typically contracted through direct skin-to-skin contact with a wart or a surface that harbors the virus, such as a locker room floor or a shared towel. The virus enters the body through small breaks or cuts in the epidermis, and it can take anywhere from two to six months after exposure for a visible wart to develop. People with weakened immune systems or skin conditions like eczema, where the skin barrier is already disrupted, tend to be more susceptible.

Are warts contagious?

Yes, warts are highly contagious. They spread through direct skin-to-skin contact and can also spread indirectly via contaminated surfaces. Because warts are contagious, patients can spread them to other parts of their own body by scratching or picking, or transmit them to family members and close contacts, which is why prompt treatment matters.

How do warts spread?

Warts spread primarily through direct contact with the wart itself, but the virus can also survive on surfaces such as pool decks, gym mats, and shower floors, allowing indirect transmission. Once infected, the virus can also spread to other areas of the same person’s skin through scratching, shaving, or nail biting, a process known as auto-inoculation.

What causes warts on hands?

Warts on the hands, often called common warts or verruca vulgaris, develop when HPV enters the skin through small cuts, hangnails, or other breaks in the skin. Frequent hand-to-hand contact, nail biting, and occupations involving handling raw meat, as with butcher’s warts, can all increase the risk of developing warts on the hands and fingers.

What causes plantar warts?

Plantar warts are caused by specific strains of HPV that infect the thick skin on the soles of the feet. The virus typically enters through small cracks or cuts in the skin. Because the warts are pushed upward into the foot by the pressure of walking and standing, they can become surrounded by thickened, callused skin known as hyperkeratosis.

How do you get plantar warts?

Plantar warts are most often contracted by walking barefoot in warm, moist communal environments such as locker rooms, public showers, and swimming pool decks, where the virus can survive on surfaces and enter through small breaks in the skin of the feet. Once contracted, plantar warts can multiply and form clusters known as mosaic warts.

Are plantar warts contagious?

Yes, plantar warts are contagious and can spread to other parts of your feet and to other people through shared surfaces or direct contact. Because the soles of the feet bear significant pressure throughout the day, plantar warts are often pushed deeper into the skin, which can make them more resistant to treatment and more likely to spread if left untreated.

What do warts look like?

Warts generally appear as small, rough, grainy growths that are flesh colored, white, pink, or tan. Many warts have tiny black dots at their base, which are clotted capillaries, and larger or older warts can grow in clusters with a cauliflower-like appearance. The exact appearance of a wart can vary depending on its type and location, from the smooth, flat surface of a flat wart to the thickened, callused appearance of a plantar wart.

Do warts hurt?

Warts can be painful, particularly plantar and palmar warts, which grow on weight-bearing or frequently used areas of the hands and feet and are pushed deeper into the skin by everyday pressure. Periungual warts around the nails can also be painful as they grow under the nail bed. Many other warts, such as flat warts or common warts on the arms and legs, are not painful, though they may be sensitive to touch or irritation.

Do warts itch?

Warts themselves are not typically itchy, though the surrounding skin can become irritated, dry, or itchy, especially in patients with eczema or in areas where the wart rubs against clothing or shoes. Persistent itching around a new growth should be evaluated by a dermatologist to confirm the diagnosis.

Are warts dangerous?

Most plantar and flat warts are benign and not dangerous, though they can be painful, unsightly, and highly contagious. Genital warts are the exception and should be watched closely, as some HPV strains that cause them are also linked to cervical cancer in women and to penile or anal cancer in men. For this reason, a dermatologist should evaluate any new genital lesion right away.

Do warts go away on their own?

Warts can sometimes resolve on their own as the immune system eventually clears the HPV virus, but this process can take months or even years, during which the wart may spread to other areas or to other people. Because of this unpredictability and the risk of contagion, most dermatologists recommend treating warts rather than waiting for them to disappear on their own.

How do you get rid of warts?

Getting rid of warts typically requires a combination of in-office and, in some cases, at-home treatments tailored to the wart’s type, size, and location. Dr. Green offers several options, including cryotherapy, laser treatment, cantharidin, bleomycin, imiquimod, and surgical excision. Dr. Green will recommend the most effective approach based on a thorough skin examination.

How does salicylic acid work on warts?

Salicylic acid gradually breaks down and exfoliates the thickened, infected layers of skin that make up the wart, helping the body’s immune system recognize and clear the underlying virus over time. Over-the-counter salicylic acid products are often effective for smaller common or plantar warts, but more resistant warts typically require prescription-strength formulations and salicylic acid plasters, used with regular filing with an emery board.

When should I see a dermatologist for wart removal?

You should see a dermatologist as soon as you notice a new wart, especially if it is painful, spreading, located on the face, or hasn’t responded to over-the-counter treatment. Patients who are diabetic or immunocompromised should also see a dermatologist promptly, as should anyone unsure whether a new growth is a wart. Early treatment from a board-certified dermatologist like Dr. Green can help prevent warts from spreading and reduce scarring risk.

Schedule Your Wart Treatment Consultation with Dr. Michele Green Today

Warts are a common, highly contagious skin condition that can appear anywhere on the body. While some respond to over-the-counter salicylic acid-based products, many types of warts, from plantar and periungual warts to genital warts, require the expertise of a dermatologist for safe and effective removal. With treatment options ranging from cryotherapy and laser treatment to immunotherapy, bleomycin, and surgical excision, Dr. Green tailors each treatment plan to the specific type, size, and location of a patient’s warts, helping patients avoid self-spread, transmission to others, and unnecessary scarring, all under the care of Dr. Michele Green.

If you’re concerned about the appearance of warts and home remedies haven’t provided the relief you hoped for, Dr. Michele Green can help. Dr. Green is an internationally recognized, board-certified dermatologist with a private practice on the Upper East Side of New York City, offering safe, effective, and minimally invasive wart removal for patients of all ages. To schedule your wart treatment consultation, contact us online or call Dr. Green’s NYC office at 212-535-3088 today.