What to Do About Common Warts

Common warts—clinically known as verruca vulgaris—are benign epidermal proliferations caused by infection with certain strains of human papillomavirus (HPV), most commonly HPV types 2 and 4. They typically appear as firm, hyperkeratotic, flesh-colored or slightly pigmented papules with a rough, cauliflower-like surface, frequently occurring on the hands, fingers, knees, and periungual regions.

Management depends on lesion characteristics, patient age, symptom burden, and treatment tolerance. First-line therapies include topical salicylic acid (15–40%), applied daily with occlusion and gentle debridement; cryotherapy with liquid nitrogen, administered every 1–3 weeks; and combination approaches, which often yield higher clearance rates than monotherapy. For recalcitrant or periungual warts, intralesional immunotherapy (e.g., candida antigen or mumps skin test antigen) or bleomycin injection may be considered. Surgical options such as electrodessication and curettage are reserved for isolated, thick lesions but carry higher risks of scarring and recurrence.

Spontaneous resolution occurs in approximately two-thirds of immunocompetent children within two years, though persistence is more common in adults. Patient education is essential: emphasize that warts are contagious via direct contact or fomites, advise against nail-biting or picking at lesions, and recommend routine hand hygiene and footwear in communal areas to reduce transmission and autoinoculation. Referral to dermatology is warranted for extensive, painful, treatment-resistant, or atypical-appearing warts—particularly in immunosuppressed individuals, where malignancy risk and diagnostic uncertainty increase.