Despite being benign, viral warts often worry parents, especially because they can be painful for children and cause them discomfort. Let’s find out how to recognize and treat them and what prevention tips to put into practice
Imagine you are preparing Thomas to go swimming and you notice two small growths on his foot. At first you might think of calluses, or perhaps small splinters stuck in the skin. Then, looking closer, you realize that those lesions are hard, slightly rough, and perhaps with some black dots in the center. It is at that moment that the suspicion arises: “Could they be warts?”.
What are warts
What are the causes of warts? These are very common viral skin lesions, especially in children, resulting from an infection with the human papillomavirus (HPV), a very widespread virus that penetrates the skin through microcuts or abrasions invisible to the naked eye. Once inside, it alters the normal cycle of skin cells, which begin to grow abnormally, forming the typical growth.
Despite being benign, viral warts often worry parents: not so much because of the danger itself, but because of the aesthetic discomfort, the pain they can cause (especially in the feet) and the fear of contagion within the family or at school.
Symptoms of warts
How to recognize warts? They can present themselves in different ways. Some are small, barely noticeable; others grow to become larger and more troublesome. In general they have a rough and grainy surface, and can be single or multiple. Their color varies from white to yellowish-gray to brown. A characteristic sign are the black dots that appear in the center, i.e. thrombosed capillaries: children sometimes mistake them for “seeds” or “dirt” inside the skin.
When the wart is on the foot, the pressure of the body weight tends to push it inward, making it flat and very painful. It is not uncommon for children to start walking on tiptoes, have a slight limp, or refuse to play sports because the pain gets worse when running.
Diagnosis of warts
Recognizing a wart is not difficult for a doctor, while for a parent the process may not be immediate. A small growth on the foot, as already mentioned, can look like a callus. The peculiar characteristics that we have described previously allow, to a careful eye, to distinguish viral warts from many other skin lesions. When in doubt, it is always better to consult your trusted pediatrician.
Frequent locations and differential diagnosis
Warts appear mainly on the hands, feet, elbows, knees, legs, face, but can also be found around the nails or in other more unusual locations.
It is important to distinguish them from calluses and calluses, which are yellowish thickenings of the skin due to pressure or rubbing, and from other benign lesions such as seborrheic keratoses, typical of adults.
While calluses improve by removing pressure (for example by changing shoes), warts persist for longer because, as mentioned, they are caused by a virus.
Are warts contagious?
«He has a wart. Is there a risk that he will also attack his little sister?”. Yes, warts are contagious, but not all people who come into contact with the virus develop the lesion. Much depends on the immune system’s ability to defend itself. Children with very low immune defenses are particularly susceptible to extensive infections, in unusual locations and resistant to therapies.
Mode of transmission and self-inoculation
Contagion can occur directly, by touching infected skin, or indirectly, via contaminated surfaces such as damp floors in swimming pools and changing rooms.
Children often spread warts on themselves through self-inoculation: if they scratch or rub a lesion, the virus can “transfer” to another part of the body.
Risk factors
Some situations increase the risk of running into viral warts:
- attending swimming pools, gyms or schools;
- have clammy skin or small wounds;
- decline in immune defenses.
It is therefore not surprising that children, who live in community environments every day, are among the most affected by this event.
Prevention
It is not always possible to avoid warts, but some behaviors reduce the risk:
- wear slippers in the swimming pool or public showers;
- dry your hands and feet well;
- do not share towels, files or scissors;
- teach children not to scratch the lesions and cover them with a plaster.
Warts and children
Children are the most affected group. For them, warts are not only a physical nuisance, but also a social problem. At school or at the pool, a child may feel uneasy about a visible wart on his hands or face. Some refuse to show themselves barefoot, others make excuses to avoid sporting activities.
In particular, plantar warts are the most painful and limiting for children. It is common for parents to notice this only after a few weeks, when the child begins to limp or complain of pain when wearing sneakers.
When to contact the pediatrician
Most warts do not require an urgent consultation. However, it is a good idea to contact your pediatrician especially if:
- the wart is very painful;
- grows rapidly or bleeds;
- the child presents many of them;
- It’s unclear whether it’s actually a wart.
The pediatrician will be able to reassure parents, identify the most suitable home treatments or, if necessary, refer the family to the dermatologist.
Types of warts
Warts are not all the same. The clinical appearance varies depending on the type of virus, the site of the body affected and the response of the immune system.
- Common (or “vulgar”) wart. It represents 70% of warts. It appears as a small round or oval growth with a rough surface. It often has the classic “black dots” in the center. It can develop almost anywhere on the skin, but is most often found on the fingers, around the nails, on the backs of the hands, elbows, or knees.
- Plantar wart. It is the most contagious type of wart. It is generally located under the sole of the foot, in children who walk barefoot in swimming pools and gyms. This also has the classic black dots and is generally painful;
- Warts on the toes. Small but annoying, easily confused with calluses.
- Mosaic warts Many small warts close together that form a single plaque. These are also often located on the sole of the foot, but are generally not painful. They are difficult to treat and often cause recurrences.
- Periungual warts. Very common in children, they often affect more than one finger and cause relapses. The habit of biting your nails promotes its spread. They can make nails brittle and be painful.
- Flat warts. They arise mainly on the face, forehead, neck, back of the hands and fingers, arms and lower limbs. They are small, smooth, brownish or flesh-colored and often numerous. They spread through shaving and are more common in adolescents (they are in fact also called “juvenile warts”).
- Filiform warts. Frequent on the face, thin and elongated with a narrow base like tentacles. They are the color of skin. Other frequent locations are on the neck, lips, eyelids and nostrils. They are quite easy to treat.
- Genital warts. Sexually transmitted, they always require medical attention.
- Warts on the hands. Very frequent in children, often visible on the back of the fingers.
- Seborrheic warts (or seborrheic keratoses). Unlike warts, they are not contagious and are not caused by a virus, but are benign growths typical of adults, dark brown or black in color. They do not require therapy.
How to remove warts?
Many warts tend to disappear spontaneously within months or years, thanks to the work of the immune system. In fact, approximately 65% tend to regress within 2 years. However, you can’t always wait: if the wart is painful, is located in a delicate area or creates psychological discomfort, there are various treatments that can be used to eliminate it. However, relapses are very frequent and considered normal.
There is no definitive single therapy: the choice depends on factors such as:
- skin type;
- number, size, location and duration of lesions;
- presence of other skin or systemic diseases;
- pain threshold.
Each therapy has different effectiveness and side effects. In children the treatment should be effective and painless, but currently there is no perfect therapy for everyone. The approach to choose must therefore be considered with your pediatrician or dermatologist. Let’s see what the main treatments available are:
- Salicylic acid. It is the most common treatment and also available without a prescription. Applied consistently, it softens and gradually consumes the wart until it comes off. May produce a mild local irritative effect. It heals approximately 50–75% of warts after 6 weeks.
- Over-the-counter products (such as monochloroacetic acid). Practical for the simplest forms, they work by progressively destroying the tissues infected by HPV. They require repeated applications and should be handled with caution to avoid damage to healthy skin.
- Cryotherapy. It is performed by a dermatologist if topical products fail, but is often the first choice for facial/genital warts. It involves using liquid nitrogen or other agents to “freeze” the warts. It can be a little painful and requires multiple sessions.
- Diathermocoagulation and electrocoagulation. Outpatient procedures that “burn” the lesion with heat or electric current. Useful for small thread-like warts (for example on the face).
- Laser therapy. A precise and effective technique, but more expensive, reserved for resistant cases.
- Immunological treatments, i.e. imiquimod, cantharidin, bleomycin, photodynamic treatment. They are used in particularly stubborn or recurrent cases, always under specialist supervision.
- Natural remedies. Very popular (garlic, aloe, duct tape), but with little scientific evidence of effectiveness. It may be useful to use soft bandages or plasters to limit contact of the lesions with the rest of the skin.
In conclusion, an initial approach can be decided together with the pediatrician, who will evaluate the situation and recommend the most suitable home treatments. In extensive, resistant or recurrent cases, however, the pediatrician will send the child to the dermatologist, who will be able to propose targeted and more advanced solutions.
