I think my child has a wart, what should I do?

Warts are very common during childhood. They can appear anywhere on the skin, but most commonly seen on the feet and hands. Warts are caused by the human papilloma virus. Warts can be spread to others but they are not highly contagious. A wart will disappear without treatment in 2-3 years, but can spread and grow in size. Home treatment for warts will probably take a 2-3 month commitment. This type of treatment is recommended for uncomplicated warts. Dermatological treatment for warts is recommended for a large wart, multiple or clustered warts, warts that are infected, or warts on the face or lips.

What is a wart? What causes warts?

Warts are a type of infection caused by viruses in the human papillomavirus (HPV) family. There are at least 70 types of HPV viruses. These viruses are present everywhere—they are one of the most common childhood skin conditions. Warts can grow on all parts of your body. They can grow on your skin, on the inside of your mouth, on your genitals and on your rectal area. Some types of HPV tend to cause warts on the skin, while other HPV types tend to cause warts on the genitals and rectal area. Some people are more naturally resistant to warts and don’t seem to get them as much as other people. Under a magnifying glass the roughened surface of a wart often looks like a tiny cauliflower. The little black dots sometimes seen are the ends of blood vessels that the wart has recruited to bring it food. Contrary to well-established belief, the underside of a wart is smooth and round, and the entire wart is confined to the epidermis—the outermost layer of the skin and does not grow into the dermis. There are no 'roots'! Even though a wart does not have roots, warts can be difficult to destroy.

Description of Warts:

• Firm, raised, round, rough, and non-tender growth on the skin—may look like cauliflower
• Usually present for a while before parent's awareness
• Most often seen on the hands and feet
• Warts on pressure points of the foot can be tender
• Normal skin lines (fingerprints) are interrupted by the wart but a callus has normal skin lines over the top of it
• Black or dark brown dots can sometimes be seen within the wart

Can warts be passed from one person to another person? Are they contagious?

Yes. Warts on the skin may be passed to another person when that person touches the warts. It is also possible to get warts from using towels or other objects that were used by a person who has warts. Warts are typically spread when the virus touches a part of the skin where the outer protective layer is broken, either by minor trauma or by moisture. This happens most commonly on the fingers, elbows, knees, and the bottoms of the feet. Warts on the bottom of the feet are called plantar warts—named for the plantar surface (sole) of the foot. Plantar warts can be especially painful. Plantar warts often make running, jumping, and even walking, uncomfortable. The tenderness can change posture and cause strain elsewhere in the body.

Will warts go away without treatment?

The answer is sometimes yes and sometimes no. Sometimes, warts disappear on their own, although it may take many months, or even years, for the warts to go away—the body’s immune system expels the virus and the wart disappears. About 25% are gone within 3-6 months and 65% disappear within 2 years. Warts will not leaves scars, though some of the more aggressive wart therapies might. Some warts will not go away on their own no matter how long they are observed. It is not known why some warts disappear and others don't.

Do warts need to be treated?

Generally, yes. Most warts will eventually go away on their own, expelled by the body's immune system. About 25% are gone within 3-6 months and 65% disappear within 2 years. However, warts can bleed and cause pain when they're bumped. They also can cause embarrassment, for example, if they grow on your face. Treatment may also decrease the chance that the warts will be spread to other areas of your body (possibly where they are more difficult to treat) or they can be spread to other people. Treatments abound, varying from as gentle and simple as placing some medicine on before bed, to as high-tech and powerful as superpulsed carbon-dioxide-laser vaporization. The most important factor to consider when treating warts is there is no single best treatment and dermatologists’ treatments are not always the best answer. If the treatment is successful, the bulk of the wart is destroyed, but the body’s immune system must be engaged and must destroy the remainder of the wart. Even hypnosis has been utilized occasionally to activate the immune system.

Home treatment is recommended for most warts. Physicians use many options to treat warts (surgery, lasers, chemical cautery, electrodesiccation, lasers, and even chemotherapy) but freezing is the most common. Gentle freezing repeated every week or two—usually at least 4 times—is the more effective than a single aggressive attempt to freeze. Some of the methods that physicians use to treat warts may leave a scar.

How do I treat my child’s wart at home?

Treatments that may be carried out in the home may include over the counter treatments such as occlusive treatments. The active ingredient in most over-the-counter remedies is salicylic acid, a natural substance found in many plants (willow bark) and most fruits. It can be applied either as a liquid or a patch (I prefer the patch). With regular application, many warts will disappear within 12 weeks. These topical treatments often work best if the surface of the wart is disrupted with warm soaks and/or an emery board before application and after the treatment course is finished. Don't try any home remedies or over-the-counter drugs to remove warts on the genital area, however.

Over the counter wart home treatment (wart patches, like Duofilm or liquid acid, like Occlusal)

1. Soak child's foot/hand in tub to soften wart for at least 15 minutes
2. Remove the dead surface (pale, white skin) of the wart by gently rubbing the wart with the rough side of a disposable emery board. Try not to cause bleeding.
3. Apply a patch or a drop or two of acid directly to the wart
4. Cover the wart with a bandaid, then a generous amount of adhesive tape on top of the bandaid. The patch and acid must have skin contact at all times
5. Leave in place for 48 hours and then repeat steps 1-5 every other day, do not skip any treaments

A study conducted in Washington in 2002 has found that the ordinary common silver duct tape (YES –DUCT TAPE!) has superior activity to cryotherapy (freezing/liquid nitrogen). Overall, 85% of the duct tape patients were wart-free after 8 weeks and 60% of the cryotherapy patients. Most duct-taped warts disappeared within 28 days. Therefore, duct tape appears to be effective as a safe and nonthreatening treatment for warts in children.

Directions for duct tape treatment:

1. Make sure that the treatment area is clean and dry (you may use rubbing alcohol on the area and allow it to dry!)
2. Apply a piece of duct tape cut to fit the entire wart and surrounding area.
3. Leave the tape on for 6 days.
4. Early on the 7th day, remove the tape, soak the area in water and then rub the wart with an emery board or pumice stone (only use for this purpose!)
5. After 12 hours without duct tape, put a fresh piece on the wart and leave on for 6 days again. If the tape falls off – apply a fresh piece.
6. Continue the cycle for 2 months or until the wart is gone.

How can I prevent a wart and/or not make an existing wart worse?

• Use only disposable emery boards for treatment and then do not use it to file nails
• Encourage child not to pick or bite at warts
• Wear beach shoes at the pool and health club showers
• Be consistent with the treatment regimen—warts are generally difficult to eliminate—strict adherence to treatment directions is paramount

When should I call the office?

• The warts are very large or if multiple warts are present
• The warts are very tender or on the face or genitals
• The wart looks infected
• You have used home treatment for 6 weeks and are not seeing improvement
• You give up and want a dermatologist referral
• You have other questions or concerns

How are warts on the skin removed by a physician/dermatologist?

First of all, it's important to know that warts on the skin (such as on the fingers, feet and knees) and warts on the genitals are removed in different ways. Don't try any home remedies or over-the-counter drugs to remove warts on the genital area. You could damage the genital area by putting certain chemicals on it. You also shouldn't treat warts on the face without talking to the doctor first. The following are some ways to remove warts from the skin:

• Applying cantharidin—Your doctor may use cantharidin on your warts. With this treatment, the doctor "paints" the chemical onto the wart. Most people don't feel any pain when the chemical is applied to the wart. You'll experience some pain and blistering of the wart in about 3 to 8 hours. After treatment with cantharidin, a bandage is put over the wart. The bandage can be removed after 24 hours. When mixtures of cantharidin and other chemicals are used, the bandage is removed after 2 hours. When you see your doctor again, he or she will remove the dead skin of the wart. If the wart isn't gone after one treatment, your doctor may give you another treatment.
• Applying Liquid Nitrogen—Your doctor may use liquid nitrogen to freeze the wart. This treatment is called cryotherapy. This freezes the affected cells—the virus is not killed—it is released into the surrounding tissue where the body’s immune system subsequently destroys it. The connective tissue is not destroyed so the skin usually heals with little or no scarring. Applying liquid nitrogen to the wart causes a little discomfort. To remove the bulk of a wart, liquid nitrogen treatments may be needed every 1 to 3 weeks for a total of 2 to 4 times. A blister sometimes forms which crusts over and falls off. The skin may be debrided at this time using the pumice stone or emery board after soaking. If no improvement is noted, your doctor may recommend another type of treatment.
• Squaric Acid—this is a dilute solution that causes an allergic reaction in the skin which has been shown to help many warts resolve. The medicine should be used as directed by the doctor; however, the medicine is typically applied 3 times per week preferably at night. Side effects include redness, blisters, pustules, and broken skin at the site of the application. Some redness is necessary; however, if the site looks infected, please call the office.
• Other treatments for warts on the skin—Other ways that your doctor can remove warts on the skin include burning the wart, cutting out the wart and removing the wart with a laser. These treatments are stronger, but they may leave a scar. Ask your doctor about the risks and benefits of these treatments before you decide what kind of treatment to have for your child’s warts.

Is there specific treatment for the very painful plantar wart?

Plantar wars are warts of the sole or plantar surface of the foot. Since plantar warts are under pressure they grow inward causing pain on the bottom of the foot. Plantar warts can be differentiated from a simple callus by characteristic dark spots in the center and the characteristic “normal foot print” (like the finger print) lines are disrupted. Unfortunately, no ideal treatment for plantar warts exists.

Duct tape treatment described above has been studied as the most effective treatment at this time for the resolution of this type of wart. If after several cycles of duct tape treatments, the wart is still there—please call the office for advice.