GPAtlas🧭 When to suspect
Cutaneous warts and verrucae are benign, very common epidermal proliferations caused by the human papillomavirus (HPV).
• The usual types are 1, 2, 4, 27 and 57 (plane warts by types 3 and 10).
• The high-risk mucosal strains linked to cervical and anogenital cancer (16, 18, 31, 33) do not cause ordinary skin warts.
• Diagnosis is clinical: a firm, rough, hyperkeratotic papule that interrupts the normal skin lines, often with pinpoint black dots (thrombosed capillaries) when the surface is pared.
Two judgements matter in primary care:
• Diagnosis – is this actually a wart (rather than a corn or, rarely, a squamous cell carcinoma)?
• Need – does it need treating at all?
Most warts are harmless and self-limiting: roughly two-thirds clear within two years without treatment, fastest in children.
Treatment is optional and is offered mainly for pain, spread, persistence, or cosmetic/psychological bother.
| Type | Typical features | Common sites |
|---|---|---|
| Common wart (verruca vulgaris) | Firm, rough, cauliflower-like (papillomatous) papule, 1 mm to > 1 cm | Backs of fingers/hands, knees, around nails (periungual) |
| Verruca (plantar wart) | • Inward-growing, flattened by pressure, tender on weight-bearing • Black dots on paring |
Soles of the feet |
| Mosaic wart | • Many small warts coalescing into a plaque • Often painless |
Soles, occasionally palms |
| Plane (flat) wart | • Multiple small, flat-topped, skin-coloured or light-brown papules • Spread by shaving |
Face, backs of hands, shins |
| Filiform wart | Finger-like fronds on a narrow stalk | Face, eyelids, neck |
Warts are more numerous and persistent in the immunosuppressed (organ-transplant recipients, long-term azathioprine or ciclosporin, HIV).
• Recurrence is commoner in smokers.
• Be wary of a solitary, atypical, bleeding or rapidly changing "wart", especially on the face or in an older adult.
• Appearances can mimic squamous cell carcinoma or amelanotic melanoma.
Source: DermNet · BAD cutaneous warts guideline 2014
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