GPAtlas🧭 When to suspect
Cutaneous warts and verrucae are benign, very common epidermal proliferations caused by the human papillomavirus (HPV) – most often types 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: is this actually a wart (rather than a corn or, rarely, a squamous cell carcinoma), and 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 – so 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), and 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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