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Warts are a common papular skin abnormality that result from the presence of the human papilloma virus (HPV) in the body. These HPV-produced epithelial and intraepithelial lesions are quite common in both children and young people. About twenty percent of all school-age youngsters develop the condition according to the National Institutes of Health (NIH). They frequently appear on hands, feet, fingers, and toes. Other types appear on genitals, anus, or oral tissues. Although most are harmless, the virus is contagious and tends to spread. Touching, including kissing or shaking an infected person’s hand, can spread HPV. The presence of a great many lesions may indicate the presence of an immune system disorder.

After acne, HPV lesions are the most often-cited reason that patients call a dermatologist. Their presence can cause embarrassment. An HPV cure isn’t available, but board-certified dermatologists such as Dermatology Specialists of Atlanta can help patients prevent, remove, and control them.

HPV Strains

More than one hundred and fifty different HPV strains exist, and many cause papular skin lesions. Different HPV varieties cause different skin lesions. The virus stimulates epidermal keratinocytes and causes them to grow. Most lesions are flesh-colored and cause no pain. Some types disappear without treatment, but others remain on the skin for an indefinite time. New lesions sometimes form as older ones heal.


Five varieties are frequently seen by Dermatology Specialists of Atlanta:

Common: Tend to grow on fingers and feel rough to the touch. This type may present tiny black dots (tiny, clotted capillaries). These lesions don’t require removal but most patients prefer to remove them. Treatment can prevent the patient from spreading the virus. Broken or previously damaged skin, e.g. a scrape or cut, may make it easier for the virus to spread.

Foot: Varieties are usually referred to as the plantar type. These lesions grow on balls of the foot or at the heel. The lesions are usually flat or hard to the touch. They may feel sandy or grainy. These lesions develop small black dots (clotted capillaries). These so-called ‘wart seeds’ may grow through several of the foot’s skin layers. Foot lesions can become painful as they grow or spread, especially when the patient tries to walk or play sports.

Flat: Types occur most often in children but present on patients of all ages. They may appear in clusters, especially on the face or head. These lesions are smaller and feel smooth to the touch, unlike common or plantar varieties.

Subungual-Periungual: Lesions that appear under the fingernails are known as subungual. Lesions under the toenails are known as periungual types. Lesions covered by the nails are more challenging to treat because of location. However, if left untreated, the lesions may cause nails to fall off.

Genital: These lesions present on genitalia and surrounding areas, including vulva, vagina, cervix, groin, anus, or thigh. In rare instances, this type may present in the mouth. Lesions may present as singly or in groups (looking a bit like a cauliflower), and are raised or flat in appearance. Untreated lesions may grow or proliferate without developing into cancer. Some types are considered sexually-transmitted disease (STD) and others may lead to cancer.


Warts are diagnosed according to appearance. Different names usually signify location and/or clinical appearance. For instance, “planar” types are flat; “plantar” types are found on the foot’s plantar surface; and “filiform” types look like threads.

In some cases, Dr. Kathleen J. Smith may recommend a biopsy of a suspicious-looking skin growth. Typically, HPV-induced lesions are:

  • Papillomatous: benign skin growth which consists of hypertrophied skin tissue
  • Visibly Corrugated: appears rough or sectioned
  • Hyperkeratotic: thickened stratum corneum (confined to the external skin layer of skin, i.e. ‘rootless’)

Most lesions are from five to ten millimeters in diameter. They may appear as a single lesion or seem to coalesce into a group of lesions, e.g. mosaic type, that are smaller (about three millimeters) in diameter.

Treatment Options

According to Mayo Clinic, the dermatologist may choose to freeze these lesions in order to remove them. Cryotherapy, also known as liquid nitrogen therapy, is the most common form of treatment. Most patients say cryotherapy isn’t painful or only mildly painful. Freezing the lesion causes a watery blister to form beneath and around the lesion. The hardened upper layer of skin (and the lesion) are usually sloughed off in a week to ten days.

Dr. Kathleen J. Smith may also recommend minor surgery to remove these lesions. The procedure involves cutting or burning skin tissue with an electric tool. The patient receives an anesthetic prior to this surgery to manage pain. This form of surgery may leave a scar. Surgery is often recommended when lesions don’t respond to another treatment type.


Patients in North Atlanta and Decatur shouldn’t suffer from embarrassment or pain associated with some types of warts. Contact Dr. Kathleen J. Smith at Dermatology Associates of Atlanta to arrange an appointment today at 678-904-4932.

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