Description of the procedure and method of treatment:

Warts group

Warts are nodules of the skin and mucous membranes developing as a result of human papilloma virus (HPV) infection. There are many types of HPV virus and some of them are potentially oncogenic. Lesions induced by HPV16 and HPV18 types are especially prone to malignant transformation, but many other types also carry some risk. Warts are common skin lesions and it is relatively easy to become infected. Since minor skin injuries are a conducive factor, lesions often occur on hands and feet. Particularly susceptible to infection are people with impaired cell-mediated immunity, who may experience the proliferation of numerous untypical warts. Skin lesions in the course of human papilloma virus infection may take a form of common warts, plantar warts, juvenile warts or genital warts (condyloma).

  • Common warts (verruca vulgaris)

Clinical picture: Usually multiple hard skin lumps of rough, sometimes villous surface, of the same colour as the surrounding skin or slightly darker, which usually develop in children and young adults. They are asymptomatic and show a tendency toward spontaneous regression. Approximately 40% of skin warts disappear without treatment within two years.

Location: Frequently placed on hands, especially fingers, but they may be found all over the body. New lesions occur in the vicinity of the primary wart as a result of autoinfection.

Treatment: There are many widely accepted methods of wart removal, including: CO2 laser ablation, electrocoagulation, cryotherapy, curettage, topical application of 10% salicylic acid or lactic acid, mono-, di- or trichloroacetic acid, 5-fluorouracil, bleomycin, and immunomodulating treatment (imiquimod). There are also attempts at using vascular lasers, e.g. KTP laser, in warts treatment.

  • Plantar warts (verruca plantares)

Clinical picture: Plantar warts may take the form of a single painful lesion that grows deep into the skin or multiple asymptomatic flat mosaic warts occupying a substantial foot area. Virus is usually spread in swimming pools and other places where people walk barefoot. Children and adolescents are especially prone to infection. Under the pressure of body weight lesions penetrate deeply into the skin and cause pain when walking. Warts sometimes feature minor haemorrhages visible in the form of black dots. Hypertrophic, chronic and recurrent lesions should be differentiated from verrucous carcinoma (carcinoma verrucosum, cuniculatum).

Treatment: Similar to the treatment of common warts. Major problem in the case of mosaic warts is a high recurrence rate.

  • Flat warts (verruca plana)

Clinical picture: Small flat-topped papules with a smooth surface, flesh-coloured, up to 4 mm in diameter. Lesions are usually numerous and asymptomatic. They occur at any age, but most often in children and young adults. The predisposing factors include atopic dermatitis, minor skin injuries and immunosuppression. Warts may resolve spontaneously after a longer or shorter period of time.


Location: Flat warts are often found on face and upper extremities, especially hands. Sometimes the Koebner phenomenon is observed - skin lesions appear along a scratch.

Treatment: Topical application of vitamin A derivatives, immunomodulators and preparations containing salicylic acid and 5-fluorouracil. Cryotherapy is also effective, however, entails a risk of postoperative discoloration and scarring.

  • Genital warts, condyloma (condylomata acuminata)

Clinical picture: Lesions in a form of hypertrophic warts. The infection is transmitted mainly through sexual contact. Warts on the genital mucosa take the shape of cauliflower-like growths on a narrow stalk. There is a link between the infection with certain HPV types (16,18, 31, 33, 35) and the development of neoplastic lesions in the genital area, cervix in particular. These changes pose a low risk of malignant transformation. Nonetheless, there are some features that should arouse suspicion: rapid growth of the lesion, increased pigmentation, coexistent ulceration or immovability. Suspected precancerous condition (VIN) or cancer unconditionally require histopathological examination. After the application of podophyllin, multiple mitoses occur; the image may then resemble squamous cell carcinoma (pseudomalignancy).

Location: Lesions are located on the genital mucosa. In women warts occupy the labia and vaginal area whereas in men usually retroglandular sulcus, glans, foreskin and urethra. Lesions may also develop around the anus, mons pubis and groins.

Treatment: Imiquimod, podophyllin, surgical removal (laser therapy, curettage, electroresection).: Imikwimod, podofilina, usunięcie zabiegowe (laseroterapia, łyżeczkowanie, elektroresekcja).

  • Molluscum contagiosum

Clinical picture: Hard, pearly papules of the size up to 0.5 cm, with a dimple in the centre, secreting grit-like content when pressed. Changes occur primarily in children as a result of the infection with molluscum contagiosum virus (MCV), which belongs to the poxvirus family. Papules persist for several months but they soften in time and resolve without scarring. Molluscum contagiosum is a disease with a short 6-week incubation period, self-limiting and resolving usually within 6-9 months.

Location: Lesions are located on the skin of face and extremities, especially hands, and in the genital area. The infection is also transferred through sexual contact - in that case lesions in women are usually located on the mons pubis and groins. Occasionally, lesions may occur on the mucous membranes.

Treatment: Lesions may be removed by cryotherapy, laser therapy (CO2 laser) or curettage.