Pediatrics - Warts

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Introduction

Warts are small growths that appear on the skin.  They vary in type, size, appearance, and location.  Warts usually are not painful. 

A virus causes warts.  Warts are very contagious and can be spread from person to person.  Some warts respond to over-the-counter treatments.  In some cases, warts need to be removed by a doctor.

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Anatomy

The skin covers the body and protects it from the environment.  The skin is composed of three major layers, the epidermis, dermis, and subcutaneous tissue.  The epidermis is the outermost layer of the skin.  It protects the inner layers of skin.  The cells at the bottom layer of the epidermis continually move upward to the outer layer.  They eventually wear off and are replaced by the next layer of cells.
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Causes

Viruses cause warts.  Different subtypes of the human papillomavirus virus (HPV) cause different kinds of warts.  Warts vary in size, appearance, and location.  They are typically small painless growths that appear on the outer layer of the skin.
 
Warts are highly contagious.  The viruses that cause warts spread by direct contact with a wart and by contact with surfaces that have the viruses on it, such as locker room floors.  Warts can take from one to eight months to appear after the virus is contracted.
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Symptoms

There are different types of warts.  Common warts usually develop on the hand, but may appear anywhere.  They are raised, rough, and have horn-like growths.  Subungual and periungal warts appear near and under fingernails or toenails.  Plantar warts occur on the bottom of the foot.  They can be painful and grow into the skin instead of outward.  Flat warts are small bumps that typically appear on the face or back of the hands. 

Genital warts are a sexually transmitted disease.  Genital warts appear in the pubic area, on the genitals, in the vaginal canal, or in the anus.  In rare cases, they may develop in the mouth as a result of oral sex.  Some people may not realize that they have genital warts because they may not have obvious symptoms.  Some of the viruses that cause genital warts are associated with an increased risk of cancer, particularly cervical cancer in women.
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Diagnosis

You should contact your doctor if your child’s wart changes color, shapes, or bleeds easily.  You should contact your doctor if over-the-counter treatments do not remove your child’s warts.  Your doctor can diagnose warts by examining your child’s skin.  Your doctor may take a tissue sample or biopsy to confirm the diagnosis. 

People with suspected genital warts need evaluation and treatment by a doctor.  Your doctor can diagnose genital warts by examining your child’s pubic area, genitals, and anus.  For females, a vaginal exam is necessary to detect genital warts on the cervix or vaginal canal.  Your doctor may apply a vinegar solution to suspected tissues.  The liquid causes infected areas to whiten.  Your doctor may also perform a blood test or take a biopsy or tissue sample to confirm a diagnosis.  Females should receive regular Pap Smear Tests to check for cell changes or cervical cancer. 
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Treatment

Some warts can be removed with over-the-counter treatments.  Your doctor can remove warts with liquid nitrogen or cryotherapy that freezes and removes warts.  Laser therapy and surgery can also remove warts.  Genital warts require professional treatment by your doctor.  You should not use over-the-counter products to remove genital warts.
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Prevention

Warts are very contagious.  Your child should avoid touching warts on another person or him or herself.  Warts can be spread from one part of the body to another.  Your child should wear shoes in locker rooms and public shower areas to protect his or her feet from contact with the virus.
 
Genital warts can be prevented by not having sexual contact with a person that has genital warts.  A person with genital warts should avoid sexual contact until after the warts are treated.  Doctors are not sure if male latex condoms prevent the spread of HPV.  Females should have regular Pap Smear Tests to detect cell abnormalities or cancer associated with HPV that causes genital warts.
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Am I at Risk

Warts are highly contagious.  Your child should avoid touching warts that are on other people or yourself.  The viruses that cause warts thrive in warm moist areas.  Your child is at risk for plantar warts if your child walks barefoot in locker rooms and public showers.  Your child is at risk for contracting genital warts if he or she engages in oral, vaginal, or anal sex with a person that has genital warts.
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Complications

In females, certain types of HPV that cause genital warts are associated with the development of abnormal cells or cervical cancer.  Females should receive regular Pap Smear Tests to check for cell changes and a blood test for HPV if they suspect they are infected.  Survival rates are high for cervical cancer that is treated early.
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Advancements

Recently, the Food and Drug Administration approved a vaccine against HPV to be administered to certain females.  Females who receive the vaccine should still undergo Pap smears.  Studies are ongoing to see if the vaccine would work in men.  Talk to your doctor to see if the new HPV vaccine would be right for your child.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.