Warts: the full therapy pathway

There is no severity grade for warts in the way there is for acne or psoriasis. What clinical guidance sorts them by is form and site, because those decide the thickness of skin a treatment has to cross, what may legally be applied at home, and how much scarring risk any destructive method carries.

The patterns Tap a card to see what it looks like

• 1 Common warts The classic form, on the backs of hands, fingers, knees and around the nails, where the skin is ordinary thickness and treatment reaches the virus most easily. What it looks like What common warts looks like Firm, raised, rough-surfaced growths with a cauliflower texture, skin-coloured to grey-brown, often several clustered together. Dark pinpoints are usually visible in the surface once the top layer is pared back. Turn back
• 2 Plantar warts and verrucas The same virus under body weight, on the sole. Pressure pushes the growth inward instead of outward and builds a callus over the top of it. What it looks like What plantar warts and verrucas looks like A flattened, callus-ringed patch that interrupts the skin lines running across the sole, often more tender squeezed from the sides than pressed from above. Several may merge into a single mosaic plaque, which is the form that resists treatment most stubbornly. Turn back
• 3 Flat warts Verruca plana: smaller, smoother and far more numerous, favouring the face, neck, backs of hands and shaved skin, where razors spread them along a line. What it looks like What flat warts looks like Dozens of small, flat-topped, skin-coloured or faintly brown bumps, often barely raised, sometimes arranged in a scratch-line. They are the form most likely to be mistaken for something else entirely, and the form no counter treatment is licensed to touch. Turn back
• 4 Warts around and under the nails Not a distinct virus, but a distinct problem: growths at the nail fold and under the plate, common where nails are bitten or cuticles picked. What it looks like What warts around and under the nails looks like Rough thickening banking up against the nail fold, sometimes lifting or distorting the plate. These are the slowest to answer anything, the most painful to treat destructively, and the ones where damage to the nail matrix is a real consideration. Turn back

What changes the plan, whatever the pattern

• A suppressed immune systemClearance of a wart is immune work, so the medication that protects a transplanted organ or calms an autoimmune disease also removes the mechanism this condition normally resolves through. Warts in that setting are more numerous, more persistent, and more likely to need specialist management rather than a longer course of the same thing.
• Diabetes, neuropathy or poor circulation in the feetEvery over-the-counter wart product carries the same warning against use on a foot in this situation, and it is not boilerplate: these preparations destroy tissue deliberately, and a foot that heals slowly or cannot report pain converts a small chemical burn into an ulcer. Foot warts here belong with a clinician or podiatrist from the first appointment.
• Many warts at once, or warts that keep appearingTreating twenty warts individually is neither practical nor how clinics approach it. High numbers shift the strategy from destroying each growth toward provoking an immune response that reaches all of them, which is the logic behind the immunotherapy tier and the reason a single treated wart can be followed by distant ones disappearing.
• Skin that marks easily after injuryFreezing and other destructive methods work by injuring skin, and skin that responds to injury with lasting pale or dark patches can be left with a mark more visible than the wart was. This is a real trade-off in deeper skin tones and on the face, and it is a legitimate reason to prefer the slower chemical route or to wait.

Look-alikes Not every warts is warts

• ? Could it be Corns and calluses? The tell How corns and calluses differs Both are thickened skin from pressure, and both sit where verrucas sit. Paring the surface separates them: a callus shows uniform layers, a wart shows pinpoint bleeding from clotted capillaries and interrupted skin lines. Turn back
• ? Could it be Molluscum contagiosum? The tell How molluscum contagiosum differs A different virus producing smooth, dome-shaped, pearly bumps with a central dimple, usually in children. It resolves on its own and is not treated with wart preparations. Turn back
• ? Could it be Seborrhoeic keratosis? The tell How seborrhoeic keratosis differs Warty, stuck-on brown growths that arrive with age and are entirely harmless. They are not infectious, do not respond to wart treatments, and are the commonest thing an adult treats for months as a wart. Turn back
• ? Could it be Skin cancers on sun-exposed skin? The tell How skin cancers on sun-exposed skin differs Squamous cell carcinoma in particular can look like a stubborn wart on a hand, forearm or face. A growth that bleeds, ulcerates, enlarges steadily or arrives alone on older sun-damaged skin is the reason a wart that behaves oddly gets examined rather than treated. Turn back

The pattern behind that list is worth stating plainly: everything in it is either harmless and untreatable by this page's methods, or serious and delayed by them. Both failure modes cost the same thing — months — which is why a growth that does not fit the description in the stage above is worth showing to someone before a twelve-week course begins.