Appearance

Common warts appear as papules and nodules with a keratotic and papillomatous surface. They occur anywhere, but are most common on the hands in young people and children.

Other types include:
Filiform warts - these are small finger-like warts consisting of hyperkeratotic projections.

Diagnosis

This is usually obvious, but if necessary paring down will produce tiny pin point bleeding of the capillaries in the roots of the wart.

Aetiology ¹

They are caused by the human papilloma virus (HPV). Trauma and wetness are contributory in contracting warts.

Management

• Warts may require no treatment if the patient is happy to tolerate them, but they may wish to have them treated for the sake of appearance or because they are causing discomfort.
• Keratolytic agents can be used if they are numerous or large. Topical salicylic acid has the largest evidence base.²
• Patients can treat small warts at home using salicyilic acid available from a pharmacy without prescription. Keratolytics should not be used on the face.
• Multiple small warts are best treated with cryotherapy. Cryotherapy sprays containing dimenthyl ether and propane are available for purchase without prescription and are becoming increasingly popular.
• One study found no statistical difference in terms of outcome between cryotherapy and application of 80% phenol in the treatment of warts of the hands.³
• Single larger warts can easily by removed by curettage and cautery.

When to Refer

Persistent warts may need removal by curettage and cautery. Treatment with the pulsed dye laser is effective in stubborn warts on fingers. This works by ablating the blood vessels within the wart. Multiple treatments are needed.

Treatments currently being evaluated include antimitotic therapy such as bleiomycin and retinoids, and immune stimulators such as dinitrochlorbenzene.⁴

Prognosis

Approximately 65% of warts will disappear within two years,⁵ although in few individuals they may persist for a long time.