Treating Warts (Verruca)

Expert Evaluation and Evidence-Based Management

A small, rough bump on your foot, finger, or hand that keeps coming back isn’t just a nuisance. It could be a wart, and if it is, you deserve a proper diagnosis and a clear plan to eliminate it. Warts are more common than most people realize and far more stubborn than many expect.

Warts (verrucae) are benign viral skin growths caused by the human papillomavirus (HPV). They’re not cancerous. They don’t invade deeper tissue. But they spread easily, resist simple home remedies, and can become genuinely painful, especially when they develop on the soles of your feet. Left untreated, they often multiply and persist for months or even years.

At Connolly Dermatology, we provide expert evaluation and wart treatment guided by evidence-based care. Our board-certified dermatologists accurately identify the type and severity of your warts and recommend interventions matched to your specific situation, whether that’s a single stubborn plantar wart or widespread lesions requiring more aggressive management.

If you have a growth that won’t go away, schedule an evaluation with the specialists at Connolly Dermatology and get the answers and treatment you need.

Understanding Warts (Verruca)

How Warts Differ From Corns, Moles, and Other Skin Lesions

Warts develop when HPV infects the uppermost layers of your skin through tiny cuts, cracks, or breaks in the surface. Once inside, the virus hijacks keratinocytes and triggers rapid, uncontrolled cell proliferation. The result is a rough, thickened growth that sits on or just above the skin surface.

Over 150 strains of HPV exist, but only a handful infect non-genital skin. The most common culprits are HPV types 1, 2, 3, 4, 10, 27, and 57. Each type tends to produce a distinct wart appearance and favors specific body locations.

Warts vary significantly in how they look and where they appear. Understanding the different types helps you recognize them and helps your dermatologist choose the most effective treatment approach.

Types of Warts

Common Warts (Verruca Vulgaris): The most frequently seen type. These are firm, rough, dome-shaped growths with a cauliflower-like surface texture. They typically appear on the fingers, hands, elbows, and knees. Caused primarily by HPV types 2 and 4.

Plantar Warts (Verruca Plantaris): These develop on the sole of the foot and get pushed inward by the pressure of walking, making them appear flat or embedded in the skin. Unlike calluses, plantar warts display tiny black dots, thrombosed capillaries, when the surface is pared. They can be intensely painful.

Flat Warts (Verruca Plana): Small, smooth, flat-topped papules that tend to appear in large clusters. They favor the face, forehead, backs of hands, and shins. Caused by HPV types 3 and 10, they spread easily through shaving.

Filiform Warts: Narrow, finger-like projections that extend outward from a thin stalk. They most commonly appear on the face around the eyelids, lips, and nose and spread rapidly. Despite their alarming appearance, they’re benign and usually respond well to treatment.

Periungual and Subungual Warts: These grow around or beneath the nails, making them notoriously difficult to treat. They can distort or destroy the nail plate over time. Nail biters and people with chronically wet hands face elevated risk.

Mosaic Warts: A cluster of multiple plantar warts fused together over a wide area of the foot. They tend to be more resistant to treatment than isolated plantar warts.

Warts vs. Other Skin Lesions

People frequently mistake warts for corns, calluses, or other skin conditions. The table below outlines key distinguishing features.

This table outlines common differences. Any new, growing, or changing skin lesion should be evaluated by a dermatologist to rule out concerning causes.

Are Warts Dangerous?

Common, plantar, flat, and filiform warts caused by low-risk HPV strains carry no cancer risk whatsoever. They are benign. They do not transform into malignant growths.

However, certain high-risk HPV strains, primarily HPV 16 and 18, are linked to anogenital warts and associated with cervical, penile, and oropharyngeal cancers. These are distinct from the cutaneous HPV types responsible for common warts. Individuals with rare inherited conditions such as epidermodysplasia verruciformis face elevated risk of HPV-related squamous cell carcinoma, particularly with ongoing sun exposure. This population warrants close, consistent dermatologic monitoring.

Signs and Symptoms of Warts

Warts can look remarkably different depending on their type and location. Recognizing their general features helps you identify them early and understand when evaluation is worthwhile.

Size and Shape

Most warts start small, just 1 to 2 millimeters, and can grow to 1 centimeter or more if left untreated. Common warts are typically round or dome-shaped. Plantar warts appear flat due to constant pressure from walking. Filiform warts are elongated and finger-like. Flat warts are small, smooth, and grouped closely together.

Color

Warts are usually skin-colored, gray, yellow, or light brown. Some appear darker in individuals with deeper skin tones. Flat warts are often flesh-colored or slightly pink. Plantar warts may appear gray or brown with a well-defined border.

Surface Texture

The hallmark of most warts is a rough, irregular surface, often described as resembling cauliflower or cracked skin. Flat warts are the exception, presenting with a smooth surface. Beneath the rough exterior, tiny black dots are often visible. These are thrombosed capillaries and represent one of the most reliable clinical signs distinguishing warts from corns and calluses.

The Black Dot Sign

When a dermatologist pares down a plantar wart with a blade, tiny pinpoint bleeding occurs from these capillaries. This is a key diagnostic feature. A corn or callus does not bleed in this way because it lacks the vascular component that HPV-infected tissue creates.

Location

Warts appear on virtually any skin surface. Common warts favor the hands, fingers, and knees. Plantar warts grow exclusively on the soles of the feet. Flat warts appear on the face, legs, and backs of hands. Filiform warts cluster around the eyelids, nose, and mouth. Periungual warts develop around or under fingernails and toenails.

Changes Over Time

Some warts stay small and stable. Others expand, multiply, or spread to new sites through autoinoculation, a process where scratching or picking transfers the virus to adjacent skin. Plantar warts tend to grow deeper and become more painful over time if not treated.

Symptoms To Watch For

Many warts cause no discomfort at all. They simply appear on your skin and stay there. Others produce symptoms ranging from mild irritation to significant functional impairment.

Watch for the following:

•         Pain or tenderness, especially with pressure (plantar warts during walking or standing)
•         Itching or irritation around the growth
•         Bleeding when the wart is bumped, scraped, or shaved
•         Nail deformity or lifting of the nail plate (periungual or subungual warts)
•         Rapidly spreading multiple warts
•         Cosmetic distress, particularly for warts on the face or hands

See a dermatologist promptly if you notice:

•         Rapid or unexpected growth
•         A change in color, shape, or surface texture
•         Ulceration, persistent bleeding, or crusting
•         Significant pain that limits daily activity
•         Multiple new warts appearing in quick succession

These changes don’t automatically signal something dangerous, but they warrant professional evaluation to distinguish warts from other conditions, including squamous cell carcinoma, which can occasionally present on previously wart-affected skin.

Risk Factors for Developing Warts

Anyone can develop a wart. But certain factors make HPV infection significantly more likely. The virus spreads through direct skin-to-skin contact and thrives wherever the skin’s protective barrier is compromised.

Age

Warts are most common in children and teenagers, with studies suggesting prevalence rates as high as 10 to 20 percent in school-aged populations. The immune system hasn’t yet developed robust HPV-specific defenses, making younger skin more susceptible. Adults can and do develop warts, though their immune systems generally resolve infections more efficiently.

Immune System Status

This is the single most significant risk factor for persistent or widespread warts. People with compromised immune systems, through HIV infection, organ transplant immunosuppressive therapy, hematologic malignancies, or medications like azathioprine and ciclosporin, develop warts more frequently and struggle far more to clear them. In organ transplant recipients, wart prevalence exceeds 90 percent after a decade of immunosuppression.

Skin Trauma and Breaks

HPV enters through microscopic cuts, abrasions, or breaks in the skin. Activities that cause repeated skin trauma, such as sports, manual labor, and nail biting, create entry points for the virus. Shaving over existing flat warts actively spreads them along the shave lines.

Communal Environments

Public swimming pools, locker rooms, and communal showers are well-established transmission environments. Warm, moist surfaces allow HPV to survive outside the body for brief periods. Walking barefoot in these spaces significantly elevates the risk of plantar wart infection.

Existing Skin Conditions

People with eczema or atopic dermatitis have a defective skin barrier that makes HPV entry easier. Chronic hand dermatitis and psoriasis also compromise the protective function of the skin surface.

Occupational Exposure

Butchers, meat processors, and individuals working in cold, moist environments develop a specific wart variant caused by HPV 7, known as butcher’s warts. These typically affect the hands and are associated with prolonged exposure to contaminated surfaces.

Prior Wart History

Having had warts before increases the likelihood of future infections. The virus can persist in apparently normal skin surrounding a treated wart, which explains why recurrence rates remain notable even after complete clinical clearance.

Can You Prevent Warts?

You can reduce your risk, though no strategy eliminates it completely. The following precautions make a meaningful difference.

Protect Your Feet in Shared Spaces

Wear flip-flops or pool shoes in locker rooms, communal showers, and pool areas. This simple habit dramatically reduces plantar wart exposure.

Avoid Picking or Scratching Warts

Autoinoculation, the spreading of the virus to nearby skin through contact, is one of the most common reasons warts multiply. Resist the urge to pick, scratch, or bite.

Cover Cuts and Broken Skin

Intact skin is your best defense. Keep minor wounds clean and covered, and avoid contact with other people’s warts when your skin is broken.

Get Regular Dermatologic Exams

Routine skin checks allow a dermatologist to identify new warts early and treat them before they multiply or become harder to manage.

Diagnosis and Evaluation of Warts

Most warts are straightforward to identify. But accurate diagnosis matters, because not every rough or keratotic growth is a wart, and misidentifying the lesion leads to ineffective treatment. A dermatologist brings diagnostic precision to that evaluation.

Clinical Examination

In the majority of cases, an experienced dermatologist can diagnose a wart through direct physical examination. The rough keratotic surface, the characteristic black dots, the location, and the patient’s history all provide strong clinical evidence. For plantar warts, gentle paring of the surface with a blade reveals pinpoint capillary bleeding, a reliable diagnostic hallmark that distinguishes warts from corns and calluses.

Dermoscopy

A dermatoscope provides magnified, polarized visualization of the skin surface, revealing details invisible to the naked eye. Under dermoscopy, warts display a characteristic pattern of dotted or looped red vessels within white halos, corresponding to the thrombosed capillaries visible as black dots clinically. Peer-reviewed research published in the International Journal of General Medicine confirms that these dermoscopic patterns reliably distinguish warts from seborrheic keratoses, amelanotic melanoma, and other verrucous lesions with overlapping appearances.

Lesion Paring

For plantar and palmar lesions, careful paring with a scalpel blade is both diagnostic and therapeutic. Removing the hyperkeratotic surface reveals the vascular architecture of the wart beneath and determines the depth of involvement, information that directly guides treatment selection.

Skin Biopsy

When a lesion doesn’t behave like a typical wart, particularly in immunocompromised patients or individuals with long-standing, treatment-resistant, or rapidly growing lesions, a punch or shave biopsy provides tissue for histopathologic examination. This is the gold standard when squamous cell carcinoma cannot be confidently excluded.

Histopathology

Under the microscope, warts display epidermal hyperplasia, papillomatosis, hyperkeratosis, parakeratosis, and enlarged keratinocytes with clear halos around their nuclei, features called koilocytic changes. These are the hallmarks of HPV-infected tissue and confirm the diagnosis when clinical doubt exists.

When Should You Get a Wart Evaluated?

See a dermatologist if you notice:

•         A new growth that does not resolve within a few weeks
•         A plantar lesion causing pain during walking or standing
•         Multiple warts appearing rapidly
•         A lesion that bleeds, ulcerates, or changes shape
•         Warts in an immunocompromised individual
•         Nail distortion or periungual lesions
•         Any growth that concerns you

Even if a growth turns out to be a simple wart, professional evaluation eliminates diagnostic uncertainty and puts you on the most effective treatment path from the start.

Wart Treatment Options

No single treatment eliminates warts in every patient every time. The virus lives in the basal layer of the epidermis, so treatments that only destroy the surface can leave enough viral DNA behind to trigger recurrence. Effective management combines the right treatment method with the right follow-up strategy.

Your dermatologist will recommend an approach based on the wart type, location, size, your immune status, and your preferences. Here’s what the evidence supports.

Observation (Watchful Waiting)

Not every wart requires immediate treatment. In healthy children, approximately 50 percent of warts resolve spontaneously within six months. Within two years, roughly 90 percent disappear without any intervention at all, as documented by DermNet NZ and supported by long-standing clinical evidence.

For asymptomatic warts in healthy individuals, particularly those that are small, non-spreading, and not cosmetically distressing, watchful waiting is a legitimate approach. Your dermatologist documents the lesion and monitors it at follow-up visits. If a wart persists, spreads, or becomes symptomatic, treatment begins.

In adults, warts are significantly more persistent. Observation is less often the preferred strategy unless the lesion is minimal and the patient is otherwise well.

Topical Salicylic Acid

Salicylic acid is the most extensively studied topical treatment for cutaneous warts and holds the strongest evidence base among first-line options. At concentrations of at least 50 percent, it produces meaningful cure rates when applied consistently over several weeks.

Salicylic acid works by breaking down the thickened keratin of the wart and generating a mild inflammatory response that activates the immune system against HPV-infected cells. Combination therapy, salicylic acid plus 5-fluorouracil, achieves cure rates approaching 63 percent in clinical studies, as reviewed by Practical Dermatology.

The treatment process:

•         Soak the wart in warm water for 5 to 10 minutes to soften the tissue
•         Gently debride the surface with a pumice stone or emery board
•         Apply the preparation accurately, avoiding surrounding healthy skin
•         Allow the treatment to dry and cover with a plaster or occlusive dressing
•         Remove the old layer the following day and repeat daily

Consistent daily application over 8 to 12 weeks is essential. Inconsistency is the most common reason treatment fails.

Cryotherapy (Liquid Nitrogen)

Cryotherapy is the most widely used in-office treatment for warts and among the most effective options currently available. Liquid nitrogen, applied at approximately -196 degrees Celsius, causes rapid freezing of wart tissue, intracellular ice crystal formation, and cell destruction. The immune response triggered by this damage also contributes to viral clearance.

According to the Merck Manual, cryotherapy achieves clearance rates of approximately 70 percent after 3 to 4 months of treatment sessions spaced 2 to 4 weeks apart. Its effectiveness correlates directly with treatment aggressiveness and depth of freeze.

Cryotherapy is appropriate for:

•         Common, plantar, filiform, and periungual warts
•         Warts that have failed topical treatment
•         Patients seeking faster, professionally administered results
•         Combination use with daily salicylic acid for improved outcomes

The procedure causes a stinging, burning sensation during application and results in blistering and peeling over the following few days. Some patients require multiple sessions. Potential risks include temporary hypopigmentation and, rarely, superficial nerve injury in sensitive areas.

Cantharidin

Cantharidin is a blistering agent derived from the blister beetle that causes the epidermal-dermal junction to separate, destroying HPV-infected tissue. Applied precisely to the wart surface in a clinic setting, it produces a blister within 24 to 48 hours. When the blister roof is removed, the wart tissue comes with it.

It is well-tolerated by children and adults alike because the application itself is painless. Most patients need two to three sessions spaced 3 to 4 weeks apart.

Curettage and Electrodesiccation

For large, isolated, or treatment-resistant warts, surgical curettage combined with electrodesiccation is highly effective. Under local anesthesia, the dermatologist scrapes away the wart tissue with a curette and then destroys the base with an electric needle to minimize recurrence.

Healing takes approximately two weeks. Recurrence rates of around 20 percent have been reported. This approach leaves a small scar and is not ideal for warts on pressure-bearing surfaces like the foot sole, where scars can become painful.

Laser Treatment

Pulsed dye laser destroys the blood vessels feeding the wart, starving the HPV-infected tissue. This treatment is particularly useful for warts that have resisted other approaches, warts in locations where scarring must be minimized, and periungual warts. Multiple sessions are typically required.

CO2 laser vaporization is another option for extensive or treatment-resistant warts, offering precise tissue ablation under local anesthesia.

Immunotherapy

For patients with multiple, widespread, or treatment-resistant warts, particularly those who are immunocompromised, immunotherapy represents one of the most effective advanced strategies available.

Intralesional bleomycin injection directly into the wart triggers potent local tissue destruction and immune activation. Studies have reported cure rates as high as 94 percent, as reviewed in Practical Dermatology. It is typically reserved for warts that have failed multiple prior therapies.

Candida antigen immunotherapy involves injecting a small amount of Candida extract into the wart to provoke a broad immune response against HPV-infected tissue. This approach can clear warts at both the injection site and distant, untreated sites, making it particularly appealing for patients with many lesions.

Topical imiquimod, an immune response modifier, stimulates interferon production and works well for anogenital warts, with more variable results for cutaneous warts.

Surgical Excision

Complete surgical excision is an option for solitary, resistant warts, though it is used selectively. Surgical scars can be more problematic than the original lesion, especially on the foot. When warranted, the dermatologist removes the entire lesion under local anesthesia with a small margin of surrounding tissue.

Will Warts Come Back After Treatment?

Recurrence is the most frustrating aspect of wart management. The virus can persist in clinically normal-appearing skin surrounding the wart, so even technically complete removal doesn’t guarantee the virus is fully eradicated. Recurrence rates depend heavily on the treatment method, the wart type, the HPV strain, and the patient’s immune function. Immunocompromised patients face the highest recurrence rates regardless of the treatment approach used.

Consistent follow-up with your dermatologist is the best strategy for catching recurrence early and retreating promptly.

What To Expect During Treatment

Guiding You Through Evaluation and the Next Steps

Many patients feel apprehensive when a skin growth needs closer evaluation or possible removal. At Connolly Dermatology, we guide you through your treatment plan so you know what to expect before anything begins.

Before Your Appointment

Preparing in advance helps your dermatologist understand the whole picture. Take note of when you first noticed the growth and whether it has changed. Note any symptoms like pain, itching, or tenderness. Bring a list of your medications and any relevant medical history.

During the Evaluation

During your visit, your dermatologist will review your medical history and then perform a focused skin exam. They’ll assess the texture, color, and other features of the growth. The dimple sign will be tested. A dermatoscope may be used to examine the lesion more closely.

Your dermatologist will explain what they’re seeing and take time to answer your questions. If the growth appears to be a typical dermatofibroma and you have no symptoms, observation may be recommended. If you want it removed or if atypical features are present, treatment options will be discussed.

When removal is appropriate, it can often be performed during the same visit. The procedure is done under local anesthesia and usually takes less than 30 minutes. Most patients experience minimal discomfort and can drive themselves home afterward.

After Treatment

After treatment, you’ll receive clear instructions on caring for the area as it heals. Most sites heal within one to two weeks. You’ll be advised about activity restrictions and when to return for suture removal if applicable.

If a biopsy or complete excision was performed, results are shared as soon as they’re available. Your dermatologist will explain what they mean and whether any next steps are needed. In most cases, no further care is required once healing is complete.

Why Choose Connolly Dermatology for Wart Treatment

Care Guided by Experience and Clinical Judgment

Warts seem straightforward. But they’re not always. Resistant cases, widespread infections, immunocompromised patients, and lesions in challenging locations all demand expertise that goes far beyond what over-the-counter products offer. Connolly Dermatology provides physician-led wart care grounded in clinical evidence and tailored to each patient’s individual needs.

Board-Certified Dermatologists

Our dermatologists are trained to accurately diagnose and manage the full spectrum of wart presentations, from a single plantar wart to widespread mosaic warts in an immunocompromised patient. Every treatment decision follows current clinical guidelines and reflects the best available evidence.

Advanced Diagnostic Technology

We use dermoscopy to evaluate lesions that aren’t immediately obvious on clinical examination. When a lesion raises concern for something beyond a routine wart, we have the tools and expertise to investigate appropriately, including biopsy when indicated.

Multiple Evidence-Based Treatment Approaches

We offer the full range of wart treatments: topical therapy, cryotherapy, cantharidin, curettage and electrodesiccation, laser treatment, and immunotherapy. Your dermatologist recommends the approach or combination of approaches best suited to your specific wart type, location, and medical history.

Honest Communication About Outcomes

Wart treatment takes time, patience, and often more than one session. We set realistic expectations from the start. You’ll know exactly what to expect from your chosen treatment, including recurrence risk and the potential need for follow-up. There is no pressure toward unnecessary or overly aggressive procedures.

Patient Education and Support

We explain what’s happening with your skin in plain, understandable language. During every visit, we take time to answer your questions, review your progress, and help you stay consistent with any at-home components of your treatment plan.

Comfortable, Compassionate Care

Warts can be embarrassing, especially when they appear on the hands or face. Our team understands that. We approach every appointment with discretion, clear communication, and a focus on making evaluations and procedures as comfortable as possible.

What To Expect During Treatment

Guiding You Through Evaluation and the Next Steps

Wart treatment can feel daunting, especially if you’ve already tried over-the-counter products without success. At Connolly Dermatology, we walk you through every stage of your care so you know exactly what’s happening and why.

Before Your Appointment

It helps to come prepared. Note when the wart first appeared and whether it has grown or spread. Record any over-the-counter treatments you’ve already tried and how your skin responded. Bring a list of current medications, especially if you take immunosuppressive drugs or have a condition affecting your immune system.

During the Evaluation

Your dermatologist reviews your medical history and examines the lesion thoroughly. They assess the type, number, size, and location of your warts and look for features that might indicate a different diagnosis. Dermoscopy may be used for a closer look. For plantar lesions, careful paring of the surface helps confirm the diagnosis and assess depth.

Your dermatologist explains what they’re seeing, discusses your options, and answers every question you have before any treatment begins. If the wart is straightforward and treatment is appropriate, it can often be performed during the same appointment.

Cryotherapy, the most commonly performed in-office treatment, takes only a few minutes. The liquid nitrogen is applied using a spray or cotton applicator. Most patients describe a stinging or burning sensation during application that resolves quickly. In-office procedures are typically completed in under 30 minutes.

After Treatment

Following cryotherapy, expect blistering and peeling in the treated area over the next several days. Your dermatologist provides aftercare instructions, including keeping the area clean, protecting the blister, and managing any discomfort. Most treated sites heal within 10 to 14 days.

Following curettage and electrodesiccation, the site heals over 1 to 2 weeks with appropriate wound care. Suture removal, if applicable, is typically scheduled within 7 to 10 days.

If tissue was sent for biopsy, results are shared promptly. Your dermatologist explains what the findings mean and whether any further treatment is needed. For most patients, one to several treatment sessions clear the wart entirely. Follow-up appointments monitor for recurrence and allow retreatment if needed.

Get Clear Answers from Connolly Dermatology

Make Informed Decisions About Your Skin Health

Warts are benign viral growths caused by HPV. They spread easily, persist far longer than you’d expect without proper treatment, and can become genuinely painful when they develop on high-pressure areas like the soles of your feet. The right management approach depends on the type of wart, where it appears, your immune status, and how it has responded to prior treatment.

If you have a wart that won’t respond to over-the-counter treatment, one that’s growing, spreading, or causing pain, or simply one you’d like evaluated by an expert, Connolly Dermatology is here to help. Our board-certified dermatologists provide accurate diagnosis and evidence-based care matched to what your skin actually needs.

Schedule a visit with a Connolly Dermatology dermatologist and take the first step toward clear, healthy skin.