Warts

Warts: 

Warts are benign (noncancerous) growths that can develop on your skin and mucosa (like inside your mouth). The human papillomavirus (HPV) causes warts. There are over 100 subtypes (strains) of HPV, but only a few types can cause warts on certain parts of your body.

Warts are generally harmless, but they can be bothersome and sometimes painful.

They’re more common in school-aged children, affecting 10% to 20% of this age group. Warts are also more likely to affect people who are immunocompromised and people who handle raw meat regularly (like butchers).

Warts can spread through direct or indirect contact. Direct contact would be touching someone else’s wart or skin-to-skin contact. An example of indirect contact is using objects like towels or razors that have come into contact with a wart or HPV.

Warts vary in appearance based on the type. They may look:

• Dome-shaped.
• Flat.
• Rough.
• Bumpy or cauliflower-like.
• Smooth.
• Thread- or finger-like.
• Skin-colored, brown, grey or black.
• Like they have small black or brownish dots.

< p style="margin:3rem 0rem;">They range in size from 1 millimeter to a couple of centimeters. You may have just one wart or several in the same area.

Types of warts: 

Common warts (Verrucca vulgaris): 

Common warts are small, grainy skin growths that occur most often on your fingers or hands. Rough to the touch, common warts also often feature a pattern of tiny black dots, which are small, clotted blood vessels.
Common warts are caused by a virus and are transmitted by touch. It can take a wart as long as two to six months to develop after your skin has been exposed to the virus. Common warts are usually harmless and eventually disappear on their own. But many people choose to remove them because they find them bothersome or embarrassing.

Common warts usually occur on your fingers or hands and may be:

• Small, fleshy, grainy bumps
• Rough to the touch
• Sprinkled with black pinpoints, which are small, clotted blood vessels

Common warts are caused by the human papillomavirus (HPV). The virus is quite common and has more than 150 types, but only a few cause warts on your hands. Some strains of HPV are acquired through sexual contact. Most forms, however, are spread by casual skin contact or through shared objects, such as towels or washcloths. The virus usually spreads through breaks in your skin, such as a hangnail or a scrape. Biting your nails also can cause warts to spread on your fingertips and around your nails.

To reduce your risk of common warts:

• Avoid direct contact with warts. This includes your own warts.
• Don’t pick at warts. Picking may spread the virus.
• Don’t use the same emery board, pumice stone or nail clipper on your warts as you use on your healthy skin and nails. Use a disposable emery board.
• Don’t bite your fingernails. Warts occur more often in skin that has been broken. Nibbling the skin around your fingernails opens the door for the virus.
• Groom with care. And avoid brushing, clipping or shaving areas that have warts. If you must shave, use an electric razor.

Plantar warts: Plantar warts are small, rough growths on the feet. They usually show up on the balls and heels of the feet, the areas that bear the most pressure. This pressure may also cause a wart to grow inward beneath a hard, thick layer of skin (callus). Plantar warts are caused by HPV. This virus enters through tiny cuts or breaks on the bottom of the feet. HPV types 1, 2, 4, 27 and 57 cause plantar warts.

Plantar wart signs and symptoms include:

• A small, rough growth on the bottom of your foot, usually at the base of the toes or on the ball or heel
• On brown and Black skin, the growth may be lighter than unaffected skin
• Hard, thickened skin (callus) over a spot on the skin, where a wart has grown inward
• Black pinpoints, which are small clotted blood vessels commonly called wart seeds
• A cluster of growths on the sole of the foot (mosaic warts)
• A growth that interrupts the normal lines and ridges in the skin of your foot
• Pain or tenderness when walking or standing
• HPV is very common, and more than 100 kinds of the virus exist. But only a few of them cause warts on the feet. Other types of HPV are more likely to cause warts on other areas of your skin or on mucous membranes.

To help prevent plantar warts:

• Avoid direct contact with warts. This includes your own warts. Wash your hands carefully after touching a wart.
• Keep your feet clean and dry.
• Wear sandals or other foot protection when walking around swimming pools, in locker rooms or in gym showers.
• Don’t pick at or scratch warts.
• When using an emery board, pumice stone or nail clipper on your warts, choose one that you don’t use on your healthy skin and nails.

Mosaic warts: These warts are white and about the size of a pinhead. They typically form on the balls of your feet or under your toes. But they can spread and cover larger areas of your foot. Mosaic warts are flatter than plantar warts, and they only rarely hurt when you walk. HPV type 2 causes mosaic warts.

When the warts on the bottom of the foot appear in a cluster, they are mosaic warts. Other signs and symptoms include:

• Thicker skin. Sometimes you may mistake your mosaic wart for a callus on the bottom of the foot.
• Pain, especially when walking and standing.
• Small black dots that appear on the warts. These are tiny blood vessels that have burst on the underside of the foot.
•  Mosaic warts prevention:
• Wearing comfortable shoes that have padding in the sole.
• Purchasing special pads designed for plantar warts (usually available at a drugstore) that reduce pressure on the feet.
• Refraining from sharing shoes, socks, or other footwear-related items with other people.
• Covering mosaic warts with special waterproof bandages to keep from transmitting the virus that spreads the warts to other people.
• Filing the wart using an emery board or pumice stone, usually after soaking the skin in the bath or shower. Always carefully dispose of any skin filings in the trash. 
• Never share your emery boards or pumice stones.

Flat warts: These warts can develop anywhere on your body. They’re smaller and smoother than other warts and tend to grow in large numbers, like 20 to 100 at a time. HPV types 3, 10 and 28 cause flat warts.

These flat types of warts are most common on your face and the top of your hands. They may also spread by shaving. For this reason, they may appear on the beard area in people assigned male at birth (AMAB) and on the legs of people assigned female at birth (AFAB). A flat wart doesn’t usually cause any pain, but it can be difficult to treat.

Prevention: 

• Avoid rubbing, picking or scratching any flat warts.
• Wash your hands after touching warts.
• Keep your hands clean and dry.
• Avoid skin-to-skin contact with someone with flat warts.
• Don’t share clothing, towels or other personal items with other people.
• Wear flip-flops at swimming pools and in public showers and locker rooms.
• Clean your children’s toys frequently.

Filiform warts: Filiform warts are made up of long, thin projections of skin, giving them a distinctive appearance. These warts look like long threads that stick out. They often grow on your face — around your mouth, eyes and nose. These warts are also called digitate or facial warts. They are harmless and usually disappear without treatment. However, many people prefer to remove them.  HPV types 1, 2, 4, 27 and 29 cause filiform warts.

HPV usually spreads through skin-to-skin contact. Clothing or objects that have touched warts can also spread the virus.

A person is more likely to develop filiform warts if they have:

• a cut on the skin, through which the virus can enter
• a weakened immune system
• warm, moist skin
• been repeatedly exposed to HPV

Prevention: 

An individual with HPV can lower the risk of infecting others by:

• Washing their hands thoroughly and often, particularly after touching warts
• Refraining from picking at warts
• keeping the skin around warts clean and dry
• keeping any affected area covered with a bandage

Genital warts: These warts affect your genitals and rectum (anal warts). It’s a sexually transmitted infection (STI) that gets passed through skin-to-skin contact. Genital warts are small, hard nodules with rough surfaces. HPV types 6 and 11 cause about 90% of genital warts.

Genital warts affect the moist tissues of the genital area. They can look like small, skin-colored bumps. The bumps may resemble cauliflower. Often, the warts are too small to be seen with your eyes. Some strains of genital HPV can cause genital warts. Others can cause cancer. Vaccines can help protect against certain strains of genital HPV.

The human papillomavirus (HPV) causes warts. There are more than 40 strains of HPV that affect the genital area. Genital warts almost always are spread through sexual contact. Even if your warts are too small to be seen, you could spread the infection to your sexual partner.

Risk factors:

 Most people who are sexually active get infected with genital HPV at some time. Factors that can raise your risk of infection include:

• Not getting the HPV vaccine.
• Having sex without a condom or with more than one partner.
• Having had another sexually transmitted infection.
• Having sex with a partner whose sexual history you don’t know.
• Becoming sexually active at a young age.
• Having a weakened immune system, such as from HIV or medicines from an organ transplant.

Prevention

Get the HPV vaccine to help prevent genital warts. And if you have sex, limit your number of partners. It’s safest to have sex with just one partner who only has sex with you. It’s also a good idea to use a condom every time you have sex. But this won’t fully protect you from genital warts. That’s because HPV can infect parts of the body that the condom doesn’t cover.

Butcher’s warts: These warts tend to develop on the hands of people who handle raw meat (like butchers) and those whose occupation involves frequent exposure to a cold, moist environment. HPV type 7 causes Butcher’s warts.

Focal epithelial hyperplasia (Heck’s disease): This is a rare condition in which warts develop inside your mouth (on the mucosa). The warts are generally soft and whiteish to mucosal-colored. HPV types 13 and 32 cause Heck’s disease.

The household transmission of FEH is believed to be through saliva.
Focal epithelial hyperplasia may be suspected clinically, particularly in high-risk populations.

A biopsy from a lesion in the mouth will show diagnostic pathology – the epithelium is very thickened and raised above the surrounding mucosa with typical ‘mitosoid’ cells. The diagnosis can be confirmed by the detection of HPV 13 or 32 DNA following PCR on a scraping taken from a lesion, or by in situ hybridization of biopsy specimens. In some cases, particularly in children, a mucosal scraping to confirm the specific HPV types, rather than a more invasive biopsy, is all that is required to confirm the diagnosis. The identification of the specific HPV type may be important in cases of suspected child sexual abuse as HPV 13 and 32 have only ever been detected in the oral mucosa.
You may be able to identify a wart by yourself. But if you’re unsure about a new skin growth, you should see your healthcare provider.
All warts come from HPV, but not all forms of HPV cause warts. The type of HPV that can progress to cancer (like cervical cancer) doesn’t cause warts.