Symptoms

There are several types of warts:

• Filiform warts − look like small “skin tags.” They often show up on areas such as the eyelids and around the mouth and nose.
• Common warts − look like rough bumps on the skin. They are often seen on the hands but can be seen anywhere on the skin. They may bleed if picked at.
• Plantar warts − look like rough patches on the soles of the feet. They are often painful and can grow very large.
• Flat warts − look like very small flat, smooth bumps. They are often seen on the face.

Treatment

Most warts go away on their own within several months to years, so treatment may not be needed for many children. In general, surgical excision and cautery are no longer recommended in most instances or covered by insurance plans, as they have been shown to increase the likelihood of localized spread. There is no treatment guaranteed to cure warts. If your primary care provider recommends treatment, it is important that you follow the instructions exactly as suggested. In general, using two or more treatments at a time is more likely to be successful.

Initial treatment with topical salicylic acid and medical tape is usually recommended. Solutions of 17 percent salicylic acid are readily available over-the-counter. Compound W is an example of a product that contains 17% salicylic acid. Wart Stick is a product that contains 40% salicylic acid, which will be more effective at this higher concentration.

• First, soak warts for five minutes in hot water (no hotter than 110° F). Alternatively, this can be performed after a bath or shower.
• Pat area dry with towel.
• Gently file down the wart by removing layers of dead skin with a callus file, emery board, or pumice stone. Remember to only use the file or pumice stone on the wart and not on other skin areas in order to prevent spreading the warts.
• The salicylic acid product should then be applied to completely cover the wart.
• Once the salicylic acid is dry, the wart should be covered with air-tight tape, such as medical tape or household duct tape. Try to allow the tape to remain over the wart for 24 hours.
• Then remove the tape and repeat the soaking, filing, and salicylic acid application every day.

If the treated skin gets irritated, stop treatment for a few days until the skin feels better, then restart if the wart is still present.

Be patient! Treatment may take several months. It is important to remain consistent with treatment for best results.

Sometimes, once one or a few warts start to go away, any other warts present will also soon go away.

Referral to a Specialist

Most warts in children can be managed by your primary care provider with the treatment described above or with watchful waiting without any treatment.

Referral to a specialist is generally only indicated for warts that are causing significant pain or discomfort and that have not responded to several months of consistent treatment as recommended by your primary care provider.

Your specialist may discuss these treatment options with you:

• Cryotherapy (liquid nitrogen), also known as “freezing”
• Topical cantharidin application
• Candida antigen injections