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How to manage warts

Warts are caused by DNA-containing human papillomavirus (HPV). These viruses are found in the upper epidermis and cause squamous epithelial cell proliferation. At least 70 types of HPV exist,1 but some types tend to be more common in certain body areas. Common warts (on hands) are due mainly to HPV2 but also to types 1 and 4. Plantar warts also involve HPV 1, 2, or 4 with mosaic warts commonly caused by HPV2. Flat warts are mainly due to HPV types 3 and 10. The incubation period is probably many months.

Viral warts are extremely common in children, particularly in those over 3 years old. Incidence peaks between the ages of 12 and 16 years.

Warts over the fingers (fig 1) are the most common presentation but plantar warts (verrucae vulgaris) and knee warts are also commonplace. It should be noted that gentle paring of plantar warts reveals small capillaries which will be absent if pared skin is simply hard skin (callus). When considering best management, it should be remembered that up to 30% of warts disappear spontaneously within six months and most disappear spontaneously within three years; this really does happen. It seems that the soil (that is, the skin) ceases to allow virus replication and the wart disappears. I should mention here that warts are often rough to touch unlike another common self limiting virus …