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Warts
Why they return, why they spread and why over-the-counter remedies often fall short.
Warts are lesions caused by a virus, human papillomavirus, which infects the superficial layer of the skin and alters the way it grows. This alone explains three things patients find frustrating: that they spread by contact, that they can multiply on the same person, and that removing one does not stop others from appearing.
Their appearance varies with the site. On the hands they are usually rough, well-defined raised lesions; on the sole of the foot body weight pushes them inwards, so they become flat, painful under pressure and easily mistaken for a callus. On the face and neck they may be thin and filiform. Different sites respond differently, and this weighs on the choice of treatment more than appearance itself.
Many warts resolve spontaneously, but the timescale is unpredictable — months or years — and in the meantime the virus remains transmissible, both to oneself and to others. This is why waiting is not always the best choice, particularly when the lesions are in a painful site, are multiplying, or affect someone with reduced immune response.
Two practical warnings are worth more than many descriptions. First: do not cut or file them yourself, because the material that comes away contains virus and the act seeds them elsewhere — it is the most common reason one wart becomes five. Second: not everything that looks like a wart is one. Calluses, keratoses and other lesions can resemble them, and treating the wrong thing for months is a slow way of not solving it.
Wart or callus? Look at the skin lines
On the foot the two are constantly confused, and treating them the same way does not work. In a callus the skin lines cross the lesion without breaking, because the skin is merely thickened. In a wart the lines are interrupted, because the structure is altered by the virus, and small dark dots are often visible. It is a detail better seen with the dermatologist's lens than with the naked eye — but knowing the difference exists saves months of plasters on the wrong target.
How it shows
- Rough, well-defined raised lesions, often on hands and fingers
- On the sole of the foot: flat lesions, painful under weight
- Small dark dots within the lesion
- Interruption of the skin lines, which instead continue through a callus
- New lesions appearing near the original one
- On the face and neck, thin, elongated growths
How we proceed
- 1Dermatological visit: confirmation that it really is a wart
- 2Distinction from calluses, keratoses and other similar lesions
- 3Assessment of site, number and duration, which guide the choice
- 4Definition of the most suitable treatment for the case, site by site
- 5Follow-up over time: recurrences are frequent and need monitoring
Available treatments
- Dermatology visit
- Dermatoscopic diagnosis
- Cryotherapy with liquid nitrogen
- Dermatological surgery
- Monitoring for recurrence
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Frequently asked questions
Why do they keep coming back?+
Because treatment acts on the lesion, not on the virus present in the surrounding skin. Even when a wart is completely removed, the papillomavirus can remain in the area and give rise to new lesions. This does not mean the treatment was poorly done: recurrence is part of the picture, and it is why scheduling a follow-up is better than considering the matter closed.
Are they contagious?+
Yes, by direct contact and through damp surfaces: swimming pools, shared showers, changing rooms, mats. Transmission is easier where the skin is macerated or has small abrasions. It also applies to oneself: touching, scratching or filing a wart can transfer the virus to other sites, and it is the most common way one becomes several.
Do over-the-counter products work?+
Sometimes, on small, single lesions in easy sites. They fail more often when the wart is plantar and deep, when there are many, or when what is being treated was not a wart. The main risk is not ineffectiveness in itself: it is spending months on a wrong assumption while the lesions multiply.
Can I remove it myself with a blade or file?+
No, and it is the thing that most often makes the situation worse. The material removed contains virus and is spread onto the surrounding skin and onto the tools, which then return to other areas. It also creates a small wound, which is exactly the condition in which the virus takes hold best. It is the most common reason a patient arrives with five warts where they had one.
Related reading
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