Conditions We Treat

Warts & Verrucas

At Livingstone Dermatology, we understand that your skin is a reflection of your health and well-being. We are committed to the latest advancements in dermatological science, and dedicated to providing you with quality care.

Overview

Warts and verrucas are benign proliferative growths on the skin and mucus lining caused by human papillomavirus (HPV). Verrucas are a specific type of wart (plantar warts) that grow on the soles of your feet, sometimes causing pain when walking.

Although these growths may resolve on their own, it’s not always quick or guaranteed. Thankfully, there are various treatments available to effectively remove warts and verrucas.

Wart and verruca treatment and removal in Singapore.
Warts and verrucas appear as rough, bumpy, cauliflower-shaped lesions on the skin.

What are warts and verrucas?

Warts are caused by HPV infections. More than 100 types of HPV have been identified, most of which can lead to the formation of warts in certain parts of the body, such as the face, hands, feet, and genitals. Common types of warts include:

  • Common warts (verruca vulgaris) – Common warts are most commonly caused by HPV types 2 and 4. Other HPV types that cause common warts include 1, 3, 27, 29, and 57. Common warts usually appear as painless, white papillary growth on the skin or mucosal surface as sessile or pedunculated lesions.
  • Flat warts (verruca plana) – Flat warts are typically caused by HPV types 3, 10, 27, and 41. These warts can grow on the face, neck, hands, and knees. Flat warts typically appear as smooth, skin-colored (or slightly darker) papules on the skin.
  • Plantar warts (verruca plantaris) – Plantar warts, also commonly referred to as verrucas, are specific types of warts that grow on the soles of the feet. These growths appear rough or bumpy, calloused, with black spots all over.
  • Deep palmoplantar warts – Deep palmoplantar warts are similar to common warts, but they grow deeper in the skin and may appear on the palms of the hands or soles of the feet. Deep palmoplantar warts can be caused by HPV types 1, 2, 3, 4, 27, and 57.
  • Cystic warts – Cystic warts are caused by HPV type 60. These warts are filled with horny material such as keratin. The cyst may rupture and spill its contents to the surrounding tissue, causing a granuloma.
  • Focal epithelial hyperplasia – Focal epithelial hyperplasia (FEH), also referred to as Heck’s disease, is caused by an infection of HPV types 13, 32, or both. FEH warts are rare and appear as soft, whitish or flesh-colored papules in the oral cavity.
  • Butcher’s warts – Butcher’s warts are caused by HPV type 7 infections and are commonly seen in butchers, meat, and fish handlers/cutters. Butcher’s warts may appear similar to common warts.

Typically, low-risk HPV types cause the development of warts, while high-risk HPV types are not likely to cause warts but are associated with developing into cancer. Hence, a proper diagnosis and genotyping of the HPV type is important for proper risk management.

What causes the warts and verrucas?

Various types of warts are caused by infections of the different types of HPV. Common routes of transmission of the virus include [6]:

  • Sexual transmission – Sexual contact is the most documented route of transmission of HPV infections. These can include skin-to-skin and skin-to-mucosa contact during sexual activity.
  • Skin-to-skin contact – Skin-to-skin contact with infected individuals can spread HPV.
  • Skin-to-mucosa contact – Skin-to-mucosa contact (such as the mouth) with infected individuals can spread HPV.
  • Surfaces – Contact with surfaces, such as by walking barefoot in public spaces (locker rooms, showers, swimming pools), or from sharing personal items with infected individuals are possible routes of transmission.
  • Vertical transmission – Vertical transmission refers to the spread of HPV from mother to newborn baby via the transplacental route.
Causes of plantar warts or verrucas in singapore.
Plantar warts or verrucas are a specific type of wart that grow on the soles of our feet, causing pain and/or discomfort when walking.

When should I be worried about a wart?

Although warts are typically caused by low-risk HPV types and can self-resolve over time, over-the-counter treatments can be applied to reduce their appearance or remove them. You should visit the dermatologist in these cases:

  • Over-the-counter treatments are ineffective
  • Warts cause pain or starts bleeding
  • If the warts appear on your face, rectum, or genital area
  • If you have diabetes, and the injured warts can cause an infection
  • If you have a weakened immune system


Ideally, you should visit a dermatologist for a proper diagnosis of warts and verrucas, as misdiagnosis can lead to improper and ineffective treatment.

Diagnosis of warts and verruca is commonly done with the following tests [1]:

  • Clinical examination – Usually, your dermatologist can diagnose warts on your skin based on visual inspection alone. In some cases, dermoscopy may be used to inspect the growths.
  • Laboratory tests – Laboratory tests may be required to detect and identify the virus. Common lab tests include immunohistochemistry, polymerase chain reaction (PCR), and Southern blot hybridisation. To perform these tests, your dermatologist may take some swabs from your skin, or take samples from the removed wart.
  • Biopsy – A biopsy is typically done to confirm the diagnosis.

How are warts and verrucas treated?

Warts often resolve on their own in a few years. However, some patients may want them removed or treated, various treatment options for warts and verrucas are available, but the effectiveness of each treatment varies and no single treatment is consistently effective for all patients. Treatment is typically done for relief of symptoms, aesthetic purpose, or if there is a risk of transmission to others [7].

  • Topical treatments – Common topical treatment for warts include salicylic acid, silver nitrate, monochloroacetic acid [8]. Topical treatments typically act by removing the layers of skin of the wart. Other types of topical treatment include imiquimod creams (immunotherapy) and 5-fluorouracil creams (chemotherapy) [8].
  • Cryotherapy – Cryotherapy uses liquid nitrogen to quickly freeze the wart tissues. These tissues eventually die and slough off.
  • Electrosurgery – Electrosurgery removal of warts can be done by electrocautery or electrosection. The procedure involves the use of an electric current to burn off or cut off the wart growths. Electrosurgery also reduces bleeding.
liquid nitrogen treatment for warts.
Cryotherapy for warts utilises liquid nitrogen to freeze and kill wart tissues for natural fall-off.
  • Laser removal – Laser treatments for wart removals involve ablating and destroying the small blood vessels supplying blood to the warts. Common types of lasers used include CO2 lasers, pulsed dye lasers (PDL) and YAG lasers.
  • Photodynamic therapy – Photodynamic therapy involves applying gels containing 5‐aminolevulinic acid (ALA) or 5‐methylaminolevulinic acid (MAL) to the warts. The gels are then treated with light, which activates the ALA and MAL gels to destroy the wart tissues [2].
  • Surgical excision – Surgical excision involves the removal of the warts using a scalpel.
  • Intralesional injections – Intralesional injections are applied directly into the wart. This treatment is commonly done if the warts are recalcitrant to other treatments. Common intralesional agents injected include bleomycin (chemotherapy), 5-fluorouracil, interferon (immunotherapy), Candida albicans antigen (immunotherapy), and MMR vaccine (immunotherapy) [2, 8, 9].


Effectiveness of each treatment may vary from person to person. It is important that you consult your dermatologist on the different treatment methods and any associated risks involved if you plan to undergo a wart removal procedure.

When should I be worried about a wart?

Although warts are typically caused by low-risk HPV types and can self-resolve over time, over-the-counter treatments can be applied to reduce their appearance or remove them. You should visit the dermatologist in these cases:

  • Over-the-counter treatments are ineffective
  • Warts cause pain or starts bleeding
  • If the warts appear on your face, rectum, or genital area
  • If you have diabetes, and the injured warts can cause an infection
  • If you have a weakened immune system


Ideally, you should visit a dermatologist for a proper diagnosis of warts and verrucas, as misdiagnosis can lead to improper and ineffective treatment.

Diagnosis of warts and verruca is commonly done with the following tests [1]:

  • Clinical examination – Usually, your dermatologist can diagnose warts on your skin based on visual inspection alone. In some cases, dermoscopy may be used to inspect the growths.
  • Laboratory tests – Laboratory tests may be required to detect and identify the virus. Common lab tests include immunohistochemistry, polymerase chain reaction (PCR), and Southern blot hybridisation. To perform these tests, your dermatologist may take some swabs from your skin, or take samples from the removed wart.
  • Biopsy – A biopsy is typically done to confirm the diagnosis.

Summary

Viral warts caused by HPV infections can usually resolve on their own. However, diagnosis of the warts cannot be ignored, as some types of HPV present high risk of malignancy.

Reach out to us if you have any questions or concerns about warts and HPV infections, our dermatologists are ready to address your concerns.

Frequently Asked Questions

Can warts go away on their own?

Most cases of HPV infections go away within 2 years, by then the warts may resolve on their own. However, if the warts are causing pain or distress, visiting a dermatologist for treatment or removal is recommended.

Wart and verruca removal treatments have varying efficacy, with no one treatment being effective for everyone. It is advised to opt for the least invasive and inexpensive treatment methods before going for other types of treatment if the warts still come back. In any case, consulting a dermatologist can help you select the ideal treatment for your condition.

Warts may come back even after removal and no one treatment guarantees that the warts will not return. This is because the virus that causes these warts are still in your body, and it may take a few years for the infection to clear.

Warts can typically go away on their own over time However, several home remedies are thought to be able to remove warts based on their antiviral or keratolytic (ability to break down keratin) properties. Common home remedies include apple cider vinegar, pineapples, or garlic. However, it is important to know that these home remedies are not proven to be effective, and depending on the ingredients used, may cause skin irritation. A visit to the dermatologist’s office is still the recommended course of action for wart removals, as this minimises the risk of complications or spreading of HPV.

Yes, warts can be contagious because the virus that causes warts can be spread. Common routes of transmission of HPV include sexual contact, skin-to-skin contact, and skin-to-surface contact.

Depending on the type of procedure, wart removals can take between 2 to 4 weeks to recover. Do note that warts may reappear even after treatment or removal.

References

  1. Al Aboud AM, Nigam PK. Wart. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431047/
  2. Zhu P, Qi RQ, Yang Y, Huo W, Zhang Y, He L, Wang G, Xu J, Zhang F, Yang R, Tu P, Ma L, Liu Q, Li Y, Gu H, Cheng B, Chen X, Chen A, Xiao S, Jin H, Zhang J, Li S, Yao Z, Pan W, Yang H, Shen Z, Cheng H, Song P, Fu L, Chen H, Geng S, Zeng K, Wang J, Tao J, Chen Y, Wang X, Gao XH. Clinical guideline for the diagnosis and treatment of cutaneous warts (2022). J Evid Based Med. 2022 Sep;15(3):284-301. doi: 10.1111/jebm.12494. Epub 2022 Sep 18. PMID: 36117295; PMCID: PMC9825897.
  3. Pavithra S, Mallya H, Pai GS. Extensive presentation of verruca plana in a healthy individual. Indian J Dermatol. 2011 May;56(3):324-5. doi: 10.4103/0019-5154.82495. PMID: 21772600; PMCID: PMC3132916.
  4. Bendtsen SK, Jakobsen KK, Carlander AF, Grønhøj C, von Buchwald C. Focal Epithelial Hyperplasia. Viruses. 2021 Aug 2;13(8):1529. doi: 10.3390/v13081529. PMID: 34452393; PMCID: PMC8402694.
  5. Miyata K, Go U, Mitsuishi T. So-Called Butcher’s Warts Appeared on the Hands of a Meat Handler. Case Rep Dermatol. 2020 Nov 9;12(3):219-224. doi: 10.1159/000509526. PMID: 33362507; PMCID: PMC7747054.
  6. Petca A, Borislavschi A, Zvanca ME, Petca RC, Sandru F, Dumitrascu MC. Non-sexual HPV transmission and role of vaccination for a better future (Review). Exp Ther Med. 2020 Dec;20(6):186. doi: 10.3892/etm.2020.9316. Epub 2020 Oct 13. PMID: 33101476; PMCID: PMC7579832.
  7. Witchey DJ, Witchey NB, Roth-Kauffman MM, Kauffman MK. Plantar Warts: Epidemiology, Pathophysiology, and Clinical Management. J Am Osteopath Assoc. 2018 Feb 1;118(2):92-105. doi: 10.7556/jaoa.2018.024. PMID: 29379975.
  8. Dall’oglio F, D’Amico V, Nasca MR, Micali G. Treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol. 2012 Apr 1;13(2):73-96. doi: 10.2165/11594610-000000000-00000. PMID: 22292461.
  9. Mullen SA, Myers EL, Brenner RL, Nguyen KT, Harper TA, Welsh D, Keffer S, Mueller J, Whitley MJ. Systematic Review of Intralesional Therapies for Cutaneous Warts. JID Innov. 2024 Jan 24;4(3):100264. doi: 10.1016/j.xjidi.2024.100264. PMID: 38585192; PMCID: PMC10990969.

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