The common wart, or verruca vulgaris, appears as a small, rough-surfaced bump on your child’s skin, frequently on their hands or feet. Interestingly, kids can be infected for months before the warts actually get big enough to see. Warts are benign, causing little harm to their bearer (the exception being genital warts). They can, however, drive the parent of said bearer insane.

Warts are caused by a virus called Human Papillomavirus. They are contagious. Kids catch them by touching someone else’s wart, or by touching a surface that has come in contact with a wart. The virus prefers to invade through cuts, abrasions, and chewed bits of skin, so children are fertile ground for invasion.

There are about 130 strains of HPV. The type of wart you get depends on the strain and on where it appears.

Types of warts include:

DermNet New Zealand

• Common warts. HPV types 2, 4 and 7, among others, cause the common wart. These warts can pop up anywhere, but they are most often seen on hands. “Periungal” warts are around the fingernails.
• Plantar warts. Most commonly HPV 1, but can be caused by other strains ( 2, 3, 4, 27, 28, and 58) “Plantar” means on the sole of the foot, so that’s where you find plantar warts. They can be painful, because constant pressure on the sole of the foot forces them to grow inward rather than outward. They can feel like a pebble in a shoe.
• Mosaic warts are a group of warts clustered together, usually on a foot.
• Filiform warts. HPV strains 1, 2, 4, 27, and 29.These are rapidly growing long strings, frequently found on eyelids and noses. Luckily they are less common.
• Flat warts. HPV 3, 10, 28 and 49. These warts are smaller, smooth, and more numerous. Kids will get between 20 and 100 separate warts all at once. They like to show up on the face.
• Genital warts. There are lots of strains but the worst are 16 and 18, which cause cervical, skin, and anal cancers. This is the one we have a vaccine to prevent, given at age 11 or 12.

There are many therapies for warts, and many interesting traditional remedies. None of them work terribly well. My favorite dermatologist once said, “treating warts is treating a non-disease with a series of treatment failures.” Left alone, warts will resolve on their own, so doing nothing is probably the best option. Duct tape and rubbing with  potatoes are absolutely safe to try.

There are medical treatment options if the warts are driving you nuts. (check out the American Academy of Dermatology)

• Chemical peels. Paint the wart with an acid every day after a good soak. Then abrade off the top layer of the wart with an emery board or pumice stone. (Don’t use the board or stone for anything else). You can buy salicylic acid over the counter, or a doctor can prescribe a stronger version. Some docs will also use tretinoin or glycolic acid, especially for flat warts.
• Cryotherapy, or freezing.We use liquid nitrogen to form a burn blister under the wart, so that the wart will die and scab off. This frequently requires repeated treatments every two weeks or so.
• Imiquimod (Aldara cream). This is a cream that encourages your body to make interferon, a part of your immune system that will fight off the virus.
• Canthariden. This is a poison made from beetles injected into the wart–not FDA approved.
• Electrosurgery and Curettage. Fancy words for burning it then scraping it off. Ouch.
• Excision. Cutting it out.
• Lasers (usually a pulse dye laser) and Infrared Coagulators. Painful and can leave a scar, both to your skin and your bank account.
• Bleomycin. This is a cancer chemotherapy drug injected into the wart. Not ideal, as it is very painful and can cause you to lose pieces of fingernails, or fingers. Just say no.
• DPCP, or diphencyprone. This is a potent contact allergen. The idea is that when your body reacts to the allergen it will attack the wart. Side effects include itching, welts, and blistering. Did I mention that common warts don’t have any side effects?
• Cidofovir. The new thing, in trials now. It is an antiviral that actually kills off the virus with minimal side effects. Very cool, but still in the future.

So, all in all, my favorite wart therapy is: do nothing. They will usually go away on their own. Exceptions are if the wart changes color, bleeds without good reason, becomes painful, or interferes with your child’s activities. It is also important to see a doc if your child has a weak immune system caused by AID’s or things like cancer chemotherapy.

So, to end, Mark Twain’s advice, via Tom Sawyer:

Put your hand into water collecting in the hollow of a tree stump at midnight and say: “Barley-corn, barley-corn, injun-meal shorts…Spunk-water, spunk-water, swaller these warts.” Then “walk away quick, eleven steps, with your eyes shut, and then turn around three times and walk home without speaking to anybody. Because if you speak the charm’s busted.”