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Common Warts

What are Warts

Warts are small benign tumors that can grow on human skin and mucous membranes. A family of viruses called “papilloma viruses” causes all human warts. Because of their viral cause, warts can spread from one part of a child’s body to another, or to other children. There are four major kinds of warts.

Common warts appear alone or in small groups, most often on the hands, fingers, feet and toes. They are skin colored or sometimes slightly darker. They may have a rough surface, and they can sometimes bleed, especially if they get bumped or scratched. Common warts can sometimes occur in or around the mouth as well, especially if the child develops a habit of biting or picking at warts in other body areas.

Plantar warts are large warts that usually appear alone, and on the bottom surface of the foot. Plantar warts can be very uncomfortable because they commonly occur on the ball or heel of the foot, where there is a lot of pressure from walking.

Flat warts appear on the tops of the hands and feet. They are usually dark brown or yellow in color, and may have a rough or scaly surface.

Genital warts occur in the genital areas, around the vagina or on the shaft or base of the penis. Genital warts are a sexually transmitted infection with human papilloma virus (HPV). Women with genital warts have increased risk of cervical cancer later in life.

What is the biggest concern?

With the exception of genital warts, most warts are not dangerous. Warts are bothersome and many people feel they are ugly. Children and teens are usually very concerned about their appearance. When doctors treat warts, they are concerned not only about destroying the wart, but also to prevent the virus that causes them from spreading to other parts of the body or to other people. Treatment may also help to minimize the emotional damage that warts can cause in children and teens.

Wart Treatment

Medical experts disagree on how important it is to treat simple or common warts. They go away on their own over a space of about 4 years in more than 90% of cases. For this reason, some doctors do not recommend treating a single wart that is in an inconspicuous location and does not bother the child. Larger numbers of warts, or warts in places that cause physical or emotional discomfort, are usually worth treating.

There are many different treatments for warts, though the scientific evidence for them is limited. The goal in all forms of treatment is to destroy the wart without damaging the adjacent skin, and to kill the virus that is causing the wart. No one therapy is 100% successful at doing all of this. For this reason, doctors often think of treating warts in a series of stages. The “first line” treatment options are those that are the safest and most likely to work. Doctors will use “second line” treatments only if the first line treatments fail. If the second line treatments also fail, doctors use third-line treatments. These are the treatments that have the most side effects, or are the least well-studied.

The most effective and safest treatment so far seems to be a chemical called “salicylic acid,” which is related closely to aspirin. Many doctors recommend salicylic acid for single or few warts, and warts that are less than one year old. Salicylic acid comes as a liquid which you can apply directly to the wart. It is a very mild acid, but it will kill the virally-infected skin cells. It will also kill healthy skin cells, so it is important to try to apply it directly to the wart itself and avoid the healthy skin near its edges. Your doctor or dermatologist will guide you in how long to treat a wart. It often takes about 3 weeks of regular treatments. Please remember to put the child-proof cap back on the bottle and keep it safely out of reach of any children in the house.

“Occlusive taping” is another first line treatment in some cases, especially if there is just one new wart. You simply place a piece of duct tape or other strong adhesive tape over a single wart. Several studies have shown that occlusive taping works as well as more aggressive treatments like freezing warts, and it is very safe. There is no scientific evidence about why taping works. Some dermatologists use hypnosis for treating warts. Like occlusive taping, the evidence for its usefulness is limited, but it is also very safe.

“Second line” treatment is for warts that did not clear up with the simpler treatments. The most common second line treatment is called “cryotherapy.” Cryotherapy uses liquid nitrogen, which is extremely cold, to literally freeze the wart and kills the infected cells. Like other treatments, liquid nitrogen also kills healthy skin, so doctors use it cautiously. There is some evidence that the medication cimetidine (Pepcid®, Tagamet® and others) can increase the immune system’s strength and help it fight warts. Your doctor may choose to use it if your child’s warts don’t improve with other methods.

“Third line” treatments include injections with chemicals that increase the immune system’s response to get it to kill the virus. These are mostly experimental treatments, and they can have significant side effects.

Dangerous Wart Symptoms

Except for genital warts, there is no major risk in having these viral infections. Children and teens may pick at their warts, however, which can cause them to become infected with bacteria. Also, some other kinds of skin tumors may appear like common warts at first, and later turn out to be more serious. Here are some things to watch out for:

  • Redness or swelling around a wart
  • Bleeding or oozing of pus or other material from a wart
  • Rapid growth in the size of a wart or numbers of warts
  • Sudden or rapid change in the appearance of a wart
  • Pain in or around a wart
  • Warts on or around the mouth or eyes
  • Warts in the genital area

If any of these occur, please be sure to call your doctor’s office right away.

Other points of concern

Because none of the treatments now available for warts completely kill the virus that causes them, there is a high risk that warts will recur in the same or a new location. If your child is unfortunate enough to have recurrent warts, it will be important for you to work with him or her to identify warts as early as possible. This will help him or her to start treatment right away, which is always the most effective thing to do.

Genital warts are in a special category because they can cause cancer of the vagina or cervix. Because genital warts are transmitted by sexual contact, they are a sexually transmitted infection (STI). This means that people who have genital warts are quite likely to have other STIs, like gonorrhea, Chlamydia, syphilis, or HIV/AIDS. If your teen has genital warts, please be sure to have a frank conversation about these risks as well as about the possibility of pregnancy. You may want to ask your doctor to discuss the different forms of protection and prevention of the consequences of sexual activity, especially with multiple partners.

Genital warts are always a sign of sexual contact. This means that genital warts in children and non-sexually active teens are evidence of child sexual abuse. If you are worried that this might be happening to your child, first let him or her know that s/he is safe with you. Let your child know that s/he can talk with you if someone is hurting him or her. Then please make an urgent appointment with your doctor to talk about it. Please try not to pressure your child to talk about it, though. That can feel to your child as if you are angry with him or her. Your doctor will be able to put you in touch with a team of experts who can talk with you and your child and can get the important information as gently and respectfully as possible.

Other Conditions that Might Be Present

Another skin condition that is common in children is called “molluscum contagiosum.” A different virus causes this condition, which consists of tiny raised, flesh-colored bumps which are flat on top and often have a tiny opening in their center. Sometimes the bumps have a pearly-white core. Molluscum always goes away on its own, and although you can treat it with salicylic acid, most doctors prefer just to wait for it to clear up.

Skin cancer is extremely rare in children and teens, but please be sure to see your doctor or dermatologist if your child develops a bump that looks like a wart but that suddenly changes color, shape, or size.