Official reprint from UpToDate®
www.uptodate.com ©2015 UpToDate®

Cutaneous warts

Beth G Goldstein, MD
Adam O Goldstein, MD, MPH
Rachael Morris-Jones, FRCP, PhD, PCME
Section Editors
Robert P Dellavalle, MD, PhD, MSPH
Moise L Levy, MD
Ted Rosen, MD
Deputy Editor
Abena O Ofori, MD


Human papillomaviruses (HPV) infect epithelial tissues of skin and mucous membranes. The most common clinical manifestations of HPV infection are warts (verrucae). There are over 150 distinct HPV subtypes; some tend to infect specific body sites. As an example, HPV type 1 commonly infects the soles of the feet and produces plantar warts, while HPV types 6 and 11 infect the anogenital area and cause anogenital warts. (See "Condylomata acuminata (anogenital warts) in adults".)

The clinical findings and management of cutaneous warts will be reviewed here. Anogenital warts (condylomata acuminata) are reviewed separately. (See "Condylomata acuminata (anogenital warts) in adults" and "Treatment of vulvar and vaginal warts" and "Condylomata acuminata (anogenital warts) in children".)


Cutaneous warts occur most commonly in children and young adults [1]. They are also more common among certain occupations such as handlers of meat, poultry, and fish. Predisposing conditions for more extensive or recalcitrant involvement include atopic dermatitis and conditions associated with decreased cell-mediated immunity (eg, acquired immune deficiency syndrome [AIDS], organ transplantation) [2,3].

Infection with HPV occurs by direct skin contact, with maceration or sites of trauma (Koebner phenomenon) predisposing patients to inoculation. Latent HPV infection also may occur in normal skin. The reservoir for HPV appears to be individuals with clinical or subclinical infection. Transmission via inanimate objects has been proposed; however, this has not been definitively proven. The incubation period is approximately two to six months.

Spontaneous remission of warts occurs in up to two-thirds of children within two years; spontaneous resolution in adults tends to be slower and may take up to several years or longer [4]. Warts in patients with intact cellular immunity are the most likely to regress without therapy [5,6]. Recurrence is common.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Oct 2015. | This topic last updated: Nov 10, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2015 UpToDate, Inc.
  1. Kilkenny M, Marks R. The descriptive epidemiology of warts in the community. Australas J Dermatol 1996; 37:80.
  2. Barbosa P. Plantar verrucae and HIV infection. Clin Podiatr Med Surg 1998; 15:317.
  3. Viac J, Thivolet J, Chardonnet Y. Specific immunity in patients suffering from recurring warts before and after repetitive intradermal tests with human papilloma virus. Br J Dermatol 1977; 97:365.
  4. Sterling JC, Gibbs S, Haque Hussain SS, et al. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. Br J Dermatol 2014; 171:696.
  5. Pyrhönen S, Johansson E. Regression of warts. An immunological study. Lancet 1975; 1:592.
  6. Rogozinski TT, Jablonska S, Jarzabek-Chorzelska M. Role of cell-mediated immunity in spontaneous regression of plane warts. Int J Dermatol 1988; 27:322.
  7. Bae JM, Kang H, Kim HO, Park YM. Differential diagnosis of plantar wart from corn, callus and healed wart with the aid of dermoscopy. Br J Dermatol 2009; 160:220.
  8. Lee DY, Park JH, Lee JH, et al. The use of dermoscopy for the diagnosis of plantar wart. J Eur Acad Dermatol Venereol 2009; 23:726.
  9. Kwok CS, Gibbs S, Bennett C, et al. Topical treatments for cutaneous warts. Cochrane Database Syst Rev 2012; 9:CD001781.
  10. Bruggink SC, Gussekloo J, Berger MY, et al. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial. CMAJ 2010; 182:1624.
  11. Tabrizi SN, Garland SM. Is cryotherapy treating or infecting? Med J Aust 1996; 164:263.
  12. Berth-Jones J, Bourke J, Eglitis H, et al. Value of a second freeze-thaw cycle in cryotherapy of common warts. Br J Dermatol 1994; 131:883.
  13. Micali G, Dall'Oglio F, Tedeschi A, et al. Treatment of cutaneous warts with squaric acid dibutylester: a decade of experience. Arch Dermatol 2000; 136:557.
  14. Choi MH, Seo SH, Kim IH, Son SW. Comparative study on the sustained efficacy of diphencyprone immunotherapy versus cryotherapy in viral warts. Pediatr Dermatol 2008; 25:398.
  15. Aghaei S. Treatment of disseminated facial warts through contact immunotherapy with diphenylcyclopropenone (DPCP). Dermatol Online J 2006; 12:10.
  16. Upitis JA, Krol A. The use of diphenylcyclopropenone in the treatment of recalcitrant warts. J Cutan Med Surg 2002; 6:214.
  17. Haedersdal M, Selvaag E, Petersen CS. Immunotherapy with diphenylcyclopropenone of recalcitrant warts: a retrospective analysis. Acta Derm Venereol 2000; 80:217.
  18. Buckley DA, Keane FM, Munn SE, et al. Recalcitrant viral warts treated by diphencyprone immunotherapy. Br J Dermatol 1999; 141:292.
  19. Weisshaar E, Neumann HJ, Gollnick H. Successful treatment of disseminated facial verrucae with contact immunotherapy. Eur J Dermatol 1998; 8:488.
  20. Rampen FH, Steijlen PM. Diphencyprone in the management of refractory palmoplantar and periungual warts: an open study. Dermatology 1996; 193:236.
  21. van der Steen P, van de Kerkhof P, der Kinderen D, et al. Clinical and immunohistochemical responses of plantar warts to topical immunotherapy with diphenylcyclopropenone. J Dermatol 1991; 18:330.
  22. Naylor MF, Neldner KH, Yarbrough GK, et al. Contact immunotherapy of resistant warts. J Am Acad Dermatol 1988; 19:679.
  23. Orecchia G, Douville H, Santagostino L, Rabbiosi G. Treatment of multiple relapsing warts with diphenciprone. Dermatologica 1988; 177:225.
  24. Choi JW, Cho S, Lee JH. Does immunotherapy of viral warts provide beneficial effects when it is combined with conventional therapy? Ann Dermatol 2011; 23:282.
  25. Audrain H, Siddiqui H, Buckley DA. Diphencyprone immunotherapy for viral warts in immunosuppressed patients. Br J Dermatol 2013; 168:1138.
  26. Silverberg NB, Lim JK, Paller AS, Mancini AJ. Squaric acid immunotherapy for warts in children. J Am Acad Dermatol 2000; 42:803.
  27. Wilkerson MG, Connor TH, Wilkin JK. Dinitrochlorobenzene is inherently mutagenic in the presence of trace mutagenic contaminants. Arch Dermatol 1988; 124:396.
  28. Lee AN, Mallory SB. Contact immunotherapy with squaric acid dibutylester for the treatment of recalcitrant warts. J Am Acad Dermatol 1999; 41:595.
  29. Iijima S, Otsuka F. Contact immunotherapy with squaric acid dibutylester for warts [corrected]. Dermatology 1993; 187:115.
  30. Hama N, Hatamochi A, Hayashi S, et al. Usefulness of topical immunotherapy with squaric acid dibutylester for refractory common warts on the face and neck. J Dermatol 2009; 36:660.
  31. Dasher DA, Burkhart CN, Morrell DS. Immunotherapy for childhood warts. Pediatr Ann 2009; 38:373.
  32. Choi JE, Seo SH, Kim IH, Son SW. Prospective study of urticaria after diphencyprone therapy in patients with viral warts. Int J Dermatol 2007; 46:1313.
  33. Culp BL, Wells MJ. Generalized urticaria with use of diphencyprone in the treatment of warts. J Drugs Dermatol 2007; 6:529.
  34. Short KA, Higgins EM. Urticaria as a side-effect of diphencyprone therapy for resistant viral warts. Br J Dermatol 2005; 152:583.
  35. Adalatkhah H, Khalilollahi H, Amini N, Sadeghi-Bazargani H. Compared therapeutic efficacy between intralesional bleomycin and cryotherapy for common warts: a randomized clinical trial. Dermatol Online J 2007; 13:4.
  36. Dhar SB, Rashid MM, Islam A, Bhuiyan M. Intralesional bleomycin in the treatment of cutaneous warts: a randomized clinical trial comparing it with cryotherapy. Indian J Dermatol Venereol Leprol 2009; 75:262.
  37. Herschthal J, McLeod MP, Zaiac M. Management of ungual warts. Dermatol Ther 2012; 25:545.
  38. Hayes ME, O'Keefe EJ. Reduced dose of bleomycin in the treatment of recalcitrant warts. J Am Acad Dermatol 1986; 15:1002.
  39. Isçimen A, Aydemir EH, Göksügür N, Engin B. Intralesional 5-fluorouracil, lidocaine and epinephrine mixture for the treatment of verrucae: a prospective placebo-controlled, single-blind randomized study. J Eur Acad Dermatol Venereol 2004; 18:455.
  40. Yazdanfar A, Farshchian M, Fereydoonnejad M, Farshchian M. Treatment of common warts with an intralesional mixture of 5-fluorouracil, lidocaine, and epinephrine: a prospective placebo-controlled, double-blind randomized trial. Dermatol Surg 2008; 34:656.
  41. Hursthouse MW. A controlled trial on the use of topical 5-fluorouracil on viral warts. Br J Dermatol 1975; 92:93.
  42. Harwood CA, Perrett CM, Brown VL, et al. Imiquimod cream 5% for recalcitrant cutaneous warts in immunosuppressed individuals. Br J Dermatol 2005; 152:122.
  43. Micali G, Dall'Oglio F, Nasca MR. An open label evaluation of the efficacy of imiquimod 5% cream in the treatment of recalcitrant subungual and periungual cutaneous warts. J Dermatolog Treat 2003; 14:233.
  44. Hengge UR, Esser S, Schultewolter T, et al. Self-administered topical 5% imiquimod for the treatment of common warts and molluscum contagiosum. Br J Dermatol 2000; 143:1026.
  45. Grussendorf-Conen EI, Jacobs S. Efficacy of imiquimod 5% cream in the treatment of recalcitrant warts in children. Pediatr Dermatol 2002; 19:263.
  46. Hengge UR, Goos M, Arndt R. Topical treatment of warts and mollusca with imiquimod. Ann Intern Med 2000; 132:95.
  47. Grussendorf-Conen EI, Jacobs S, Rübben A, Dethlefsen U. Topical 5% imiquimod long-term treatment of cutaneous warts resistant to standard therapy modalities. Dermatology 2002; 205:139.
  48. Stefanaki C, Lagogiani I, Kouris A, et al. Cryotherapy versus imiquimod 5% cream combined with a keratolytic lotion in cutaneous warts in children: A randomized study. J Dermatolog Treat 2015; :1.
  49. Pezeshkpoor F, Banihashemi M, Yazdanpanah MJ, et al. Comparative study of topical 80% trichloroacetic acid with 35% trichloroacetic acid in the treatment of the common wart. J Drugs Dermatol 2012; 11:e66.
  50. Focht DR 3rd, Spicer C, Fairchok MP. The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart). Arch Pediatr Adolesc Med 2002; 156:971.
  51. de Haen M, Spigt MG, van Uden CJ, et al. Efficacy of duct tape vs placebo in the treatment of verruca vulgaris (warts) in primary school children. Arch Pediatr Adolesc Med 2006; 160:1121.
  52. Wenner R, Askari SK, Cham PM, et al. Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial. Arch Dermatol 2007; 143:309.
  53. Robson KJ, Cunningham NM, Kruzan KL, et al. Pulsed-dye laser versus conventional therapy in the treatment of warts: a prospective randomized trial. J Am Acad Dermatol 2000; 43:275.
  54. Park HS, Choi WS. Pulsed dye laser treatment for viral warts: a study of 120 patients. J Dermatol 2008; 35:491.
  55. Sparreboom EE, Luijks HG, Luiting-Welkenhuyzen HA, et al. Pulsed-dye laser treatment for recalcitrant viral warts: a retrospective case series of 227 patients. Br J Dermatol 2014; 171:1270.
  56. Akarsu S, Ilknur T, Demirtaşoglu M, Ozkan S. Verruca vulgaris: pulsed dye laser therapy compared with salicylic acid + pulsed dye laser therapy. J Eur Acad Dermatol Venereol 2006; 20:936.
  57. Johnson SM, Roberson PK, Horn TD. Intralesional injection of mumps or Candida skin test antigens: a novel immunotherapy for warts. Arch Dermatol 2001; 137:451.
  58. Clifton MM, Johnson SM, Roberson PK, et al. Immunotherapy for recalcitrant warts in children using intralesional mumps or Candida antigens. Pediatr Dermatol 2003; 20:268.
  59. Horn TD, Johnson SM, Helm RM, Roberson PK. Intralesional immunotherapy of warts with mumps, Candida, and Trichophyton skin test antigens: a single-blinded, randomized, and controlled trial. Arch Dermatol 2005; 141:589.
  60. Glass AT, Solomon BA. Cimetidine therapy for recalcitrant warts in adults. Arch Dermatol 1996; 132:680.
  61. Orlow SJ, Paller A. Cimetidine therapy for multiple viral warts in children. J Am Acad Dermatol 1993; 28:794.
  62. Yilmaz E, Alpsoy E, Basaran E. Cimetidine therapy for warts: a placebo-controlled, double-blind study. J Am Acad Dermatol 1996; 34:1005.
  63. Lee SH, Rose B, Thompson CH, Cossart Y. Plantar warts of defined aetiology in adults and unresponsiveness to low dose cimetidine. Australas J Dermatol 2001; 42:220.
  64. Rogers CJ, Gibney MD, Siegfried EC, et al. Cimetidine therapy for recalcitrant warts in adults: is it any better than placebo? J Am Acad Dermatol 1999; 41:123.
  65. Field S, Irvine AD, Kirby B. The treatment of viral warts with topical cidofovir 1%: our experience of seven paediatric patients. Br J Dermatol 2009; 160:223.
  66. Broganelli P, Chiaretta A, Fragnelli B, Bernengo MG. Intralesional cidofovir for the treatment of multiple and recalcitrant cutaneous viral warts. Dermatol Ther 2012; 25:468.
  67. Blouin MM, Cloutier R, Noël R. Intralesional cidofovir in the treatment of cutaneous warts in a renal transplant patient. J Cutan Med Surg 2012; 16:462.
  68. Simone CD, Capizzi R, Carbone A, et al. Use of acitretin in a case of giant common warts in an HIV-infected patient. Eur J Dermatol 2008; 18:346.
  69. Stefani M, Bottino G, Fontenelle E, Azulay DR. [Efficacy comparison between cimetidine and zinc sulphate in the treatment of multiple and recalcitrant warts]. An Bras Dermatol 2009; 84:23.
  70. Sloan K, Haberman H, Lynde CW. Carbon dioxide laser-treatment of resistant verrucae vulgaris: retrospective analysis. J Cutan Med Surg 1998; 2:142.
  71. Schroeter CA, Kaas L, Waterval JJ, et al. Successful treatment of periungual warts using photodynamic therapy: a pilot study. J Eur Acad Dermatol Venereol 2007; 21:1170.
  72. Salem A, Nofal A, Hosny D. Treatment of common and plane warts in children with topical viable Bacillus Calmette-Guerin. Pediatr Dermatol 2013; 30:60.
  73. Daniel BS, Murrell DF. Complete resolution of chronic multiple verruca vulgaris treated with quadrivalent human papillomavirus vaccine. JAMA Dermatol 2013; 149:370.
  74. Venugopal SS, Murrell DF. Recalcitrant cutaneous warts treated with recombinant quadrivalent human papillomavirus vaccine (types 6, 11, 16, and 18) in a developmentally delayed, 31-year-old white man. Arch Dermatol 2010; 146:475.
  75. Abeck D, Fölster-Holst R. Quadrivalent Human Papillomavirus Vaccination: A Promising Treatment for Recalcitrant Cutaneous Warts in Children. Acta Derm Venereol 2015; 95:1017.
  76. al Aboosi M. Treatment of plane warts by tretinoin-induced irritant reaction. Int J Dermatol 1994; 33:826.
  77. Kim MB, Ko HC, Jang HS, et al. Treatment of flat warts with 5% imiquimod cream. J Eur Acad Dermatol Venereol 2006; 20:1349.
  78. Schwab RA, Elston DM. Topical imiquimod for recalcitrant facial flat warts. Cutis 2000; 65:160.
  79. Khan Durani B, Jappe U. Successful treatment of facial plane warts with imiquimod. Br J Dermatol 2002; 147:1018.
  80. Lee S, Kim JG, Chun SI. Treatment of verruca plana with 5% 5-fluorouracil ointment. Dermatologica 1980; 160:383.
  81. Rodríguez-Cerdeira C, Sánchez-Blanco E. Glycolic acid 15% plus salicylic acid 2%: a new therapeutic pearl for facial flat warts. J Clin Aesthet Dermatol 2011; 4:62.
  82. Kartal Durmazlar SP, Atacan D, Eskioglu F. Cantharidin treatment for recalcitrant facial flat warts: a preliminary study. J Dermatolog Treat 2009; 20:114.
  83. Al-Hamdi KI, Al-Rahmani MA. Evaluation of topical potassium hydroxide solution for treatment of plane warts. Indian J Dermatol 2012; 57:38.
  84. Sharquie KE, Khorsheed AA, Al-Nuaimy AA. Topical zinc sulphate solution for treatment of viral warts. Saudi Med J 2007; 28:1418.
  85. Zedan H, Hofny ER, Ismail SA. Propolis as an alternative treatment for cutaneous warts. Int J Dermatol 2009; 48:1246.
  86. Pollock B, Highet AS. An interesting response to diphencyprone (DPC) sensitization on facial warts: review of DPC treatment for viral warts. J Dermatolog Treat 2002; 13:47.
  87. Micali G, Nasca MR, Tedeschi A, et al. Use of squaric acid dibutylester (SADBE) for cutaneous warts in children. Pediatr Dermatol 2000; 17:315.
  88. Ritter SE, Meffert J. Successful treatment of flat warts using intralesional Candida antigen. Arch Dermatol 2003; 139:541.
  89. Lin MY, Xiang LH. Topical 5-aminolevulinic acid photodynamic therapy for recalcitrant facial flat wart in Chinese subjects. J Dermatol 2008; 35:658.
  90. Mizuki D, Kaneko T, Hanada K. Successful treatment of topical photodynamic therapy using 5-aminolevulinic acid for plane warts. Br J Dermatol 2003; 149:1087.
  91. Webster GF, Satur N, Goldman MP, et al. Treatment of recalcitrant warts using the pulsed dye laser. Cutis 1995; 56:230.
  92. Li Y, Yang K. Treatment of recalcitrant-pigmented flat warts using frequency-doubled Q-switched Nd-YAG laser. Lasers Surg Med 2001; 29:244.
  93. Ning S, Li F, Qian L, et al. The successful treatment of flat warts with auricular acupuncture. Int J Dermatol 2012; 51:211.
  94. Olguin-García MG, Jurado-Santa Cruz F, Peralta-Pedrero ML, Morales-Sánchez MA. A double-blind, randomized, placebo-controlled trial of oral isotretinoin in the treatment of recalcitrant facial flat warts. J Dermatolog Treat 2015; 26:78.
  95. Johnson LW. Communal showers and the risk of plantar warts. J Fam Pract 1995; 40:136.