Warts; different kinds, cause, prevention and best treatment
- J.A.T.W. Rosenberg; Wart, Pigmentation & Aging Specialist
- 13 hours ago
- 12 min read
WARNING: GRAPHIC MEDICAL PHOTOS IN THIS ARTICLE!Foot warts are also caused by HPV. Warts are benign skin growths caused by specific types of the human papillomavirus (HPV). There are more than 200 variants of HPV, but only some of them cause warts on certain parts of the body. Warts specialist Rosenberg, the leading expert in the field of warts and skin fibromas, explains that different types of HPV lead to different types of warts. In this article, we discuss the causes (including the HPV types involved), typical locations, risk groups, why some people get warts more often, and the recommended treatment methods for each type of wart. We emphasise CryoPen cryotherapy as an effective method for wart removal. This article is intended as a comprehensive reference for clients seeking reliable information about wart removal.
Common warts (Verruca vulgaris) cause and treatment
Common wart (verruca vulgaris) a flat wart
Common warts (verruca vulgaris) are rough, often grey-brown papules with a grainy, cauliflower-like surface. They usually occur on the hands, fingers or sometimes feet. Cause and HPV type: Common warts are caused by skin infection with HPV, especially types 1, 2 and 4lci.rivm.nl. They are spread through skin-to-skin contact, especially in children. Location: Often on the backs of the hands, finger joints or elbows, but also on the knees or feet after sports.
Risk groups: Children and young adults are most at risk: 10–20% of school-age children will develop a wart at some point. People with a weakened immune system (e.g. due to illness or medication) are more likely to develop new warts. People who work with moist meat (such as butchers) sometimes develop special warts (but these are called meat warts). Why some people have more warts: Warts spread easily through damaged skin. HPV enters through small cuts or injuries in the skin; dry or cracked skin increases the risk of infection. People who touch swollen or damaged skin a lot (e.g. wet hands or intensive exercise) are therefore more likely to develop warts.
Conclusion: good skin care (protection) is useful for keeping viruses out of the body as much as possible. This is also very important for the hands.
Treatment: Treatments can gradually remove warts. Commonly used options are:
CryoPen cryotherapy (freezing technique): Warts Specialist Rosenberg CryoPen as a safe standard treatment. This involves freezing the wart locally (similar to liquid nitrogen cryotherapy, but more precise). This causes targeted deep cell damage and after a few days the wart falls off by itself. Usually one or a few sessions are needed.
Salicylic acid: OTC products containing salicylic acid gradually dissolve the wart. The cream or patch is applied daily; several months of treatment may be necessary.
Other options: If first-line treatments are insufficient, the doctor may use treatments such as cantharidin (a skin exfoliant) or more invasive procedures (cutting, electrocoagulation or laser). These are painful and more likely to cause scarring. However, CryoPen usually has a higher success rate with minimal side effects.
Plantar warts (Verruca plantaris) cause and treatment
Foot warts develop under pressure points on the sole of the foot and can be painful when standing or walking. Cause and HPV type: Like common warts, they are caused by HPV. Plantar warts (on the soles of the feet) are mainly caused by HPV types 1, 2, 4, 27 and 57. They often develop where the skin is very thick (such as the heel or ball of the foot). Location: Under the heel, ball of the foot or big toe. The wart sometimes grows inwards (inward) into the foot, making it feel like a pebble under the skin. Mosaic warts (groups of small warts) on the foot are technically classified as plantar warts. Risk groups: Foot warts are common in teenagers and young adults. People who often walk barefoot (e.g. in public places) or have a job that requires prolonged standing are at greater risk. Why some people get them more often:Foot warts are caused by pressure and microtrauma to the skin. Prolonged sweating or wet feet increase the risk because HPV can penetrate more easily into moist, softened skin. Playing sports without clean socks or blisters can also contribute. People with eczema or diabetes are also more prone to athlete's foot and warts. Treatment: Foot warts often require extra strong freezing. CryoPen treatment (cryotherapy) is therefore recommended as the first line of treatment. This may require several sessions due to the hard skin. In addition to CryoPen, there are also:
Salicylic acid plasters or resin: These exfoliants are similar to those used for regular warts.
Surgical options: For stubborn plantar warts, the doctor may consider removing the warts by cutting or laser treatment.
Prevention: Always wear shoes or slippers at swimming pools and changing rooms to prevent spread.
Flat warts (Verruca plana) cause and treatment
Flat warts are smooth, thin papules measuring 2–5 mm, often occurring in large numbers (20–100 at a time). Cause and HPV type: They are caused by HPV types 3, 10 and 28. These HPV types usually infect thin skin. Location:They develop on the face (e.g. forehead or chin), neck and back of the hands, and sometimes on the forearms or knees. They are most common in children and teenagers (due to skin damage, such as shaving or scratching). Risk groups:Young people with acne or young people who touch things frequently may be susceptible. Women are more likely to get flat warts than men. Why some are more common: Flat warts form quickly in clusters and are sometimes difficult to remove because they are more subtle. People with skin irritation (Pilates, shaving) are more susceptible to HPV. Treatment: Because flat warts often occur simultaneously, cryotherapy is less effective on all lesions at the same time. However, CryoPen can be used for individual warts. The emphasis is on a gradual approach:
Cryotherapy with CryoPen: Target the most bothersome areas to stop growth. Because the CryoPen emits a very small jet, it is still a successful choice for large groups of warts, even if they are very small.
Peeling creams (such as retinoids or salicylic acid, glycolic acid): Apply gradually to the skin to make the warts disappear.
Other options: Topical immunotherapy (imiquimod) or treatments such as DCP immunotherapy (rarely used for skin warts).
Filiform warts (stalk warts) cause and treatment
Filiform warts are elongated and thread-like (‘stalk warts’) and usually skin-coloured. Cause and HPV type: They are caused by HPV types 1, 2, 4, 27 and 29. Location: They mainly occur on the face and neck, such as around the eyes, mouth, chin or neck. They can also sometimes appear on the armpits and neck folds. Risk groups: Common in young adults, the elderly and those with a weakened immune system. People who touch their face or shave may be more prone to them. Why some occur more frequently: Filiform warts grow quickly vertically; one example can quickly give rise to several new spiky protrusions. A prolonged weakened immune system (e.g. in HIV or immunosuppression) makes it easier for HPV to persist. Treatment: Because they are thin, filiform warts can be treated effectively by
CryoPen (cryotherapy): Targeted freezing usually leads to rapid breakdown.
Surgical removal: Often with small scissors or a laser cutting technique, after which the stalk can be removed immediately.
Other methods: Electrodessication (burning) or cauterisation may be required. CryoPen treatment is a pleasant option for many patients because it is relatively painless and does not leave any scars.
Genital warts (Condylomata acuminata) cause and treatment
Genital warts are warts on the genitals or around the anus. Cause and HPV type: Caused by sexually transmitted HPV types, especially HPV-6 and HPV-11. These two low-risk HPV types cause more than 90% of all genital warts. Location:In men, on the penis, scrotum or around the anus; in women, on the labia, vulva, vagina, cervix or anus. Genital warts are often pink to skin-coloured, sharply defined and sometimes have a ‘cauliflower-like’ shape. Risk groups: Sexually active young people and adults with multiple partners are at increased risk. People with a weakened immune system or existing STIs may develop more severe forms. In children, genital warts can in rare cases be non-sexually transmitted (e.g. via contaminated bedding). Why some are more common: Genital HPV infections persist in the mucous membrane for a long time. Our immune system cannot always completely remove warts. Factors such as smoking, pregnancy and contraception seem to influence their formation, but no firm conclusions can be drawn lci.rivm.nl. Treatment: Genital warts are cosmetically and functionally bothersome, so rapid removal is recommended. Possible treatments include:
CryoPen (cryotherapy): Local freezing can also be used to kill warts. This is done carefully because of the sensitive skin.
Topical agents: Creams or solutions such as podophyllotoxin, imiquimod or sinecatechins can be applied at home or in the clinic to break down warts.
Surgery: Small condylomata can be surgically removed or burned off.
Vaccination (prevention): Since 90% of genital warts are caused by HPV-6/11, the HPV vaccine offers protection. Talking to a doctor about vaccination for young people can help prevent genital warts.
Safe sex: Using condoms reduces the transmission of genital HPV warts, but in many cases this is not effective because the warts also occur outside the area covered by the condom.
💧 Water warts (Molluscum Contagiosum)
Water wart (molluscum contagiosum)
Description: Water warts, caused by the molluscum contagiosum virus (a poxvirus), are small, shiny, skin-coloured or pink bumps with a central indentation. They are highly contagious and common in children, but can also affect adults, especially those with weakened immune systems.
Locations: Often found on the face, trunk, arms and legs in children; in adults, they can also occur in the genital region.
Characteristics:
Contagious through direct skin contact or via contaminated objects
Usually painless, but may itch
Often disappear on their own within 6 to 12 months
Water warts (medical name: mollusca contagiosa) are not caused by HPV (human papillomavirus), but by a different virus: the molluscum contagiosum virus (MCV). This virus belongs to the poxviruses(Poxviridae), and therefore not to the papillomaviruses such as HPV.
Summary:
Water warts (mollusca contagiosa):👉 Cause: Molluscum contagiosum virus (MCV)👉 Type of virus: Poxvirus👉 Not related to HPV
More background:
There are four known types of MCV:
MCV-1 – most common form
MCV-2 – more common in adults (can be sexually transmitted)
MCV-3 and MCV-4 – very rare
Difference from HPV warts:
Characteristic | HPV-warts | Water warts |
Cause | Human papillomavirus (HPV) | Molluscum contagiosum virus (MCV) |
Form | Rough, cauliflower-like, calloused | Smooth, skin-coloured with a dimple (navel) |
Location | Hands, feet, genitals, etc. | Face, trunk, arms, groin, in children |
Age group | All ages | Mainly children |
🧓 Seborrhoeic keratosis (age spot)
Scientific name: Seborrhoeic keratosis Alternative names: Age spot, senile wart, verruca seborrhoica Please note: This is not a viral wart and is therefore not caused by HPV.
🔬 What is an age spot?
An age spot is a benign skin growth that develops as the skin ages. Despite its name, it is not a real “wart” like HPV-related types. Seborrhoeic keratoses are not contagious, not malignant and usually do not require treatment – unless they cause symptoms or are cosmetically bothersome.
📍 What do they look like?
Raised, often oily or waxy spots on the skin
Can vary in colour from light brown to black
Have a characteristic “stuck on” appearance
Often occur in multiples
Size varies from a few millimetres to several centimetres
Preferred locations: face, chest, back, shoulders and upper arms
👥 Who gets it?
Mainly occurs in people over the age of 50
Both men and women
Hereditary predisposition may play a role
Sometimes triggered by sun exposure
❗ Important differential diagnosis
Because age spots can resemble skin cancer (e.g. melanoma or basal cell carcinoma), it is important that a skin specialist or doctor assesses the area. If in doubt, a biopsy is often taken.
🧊 Treatment (optional)
Although treatment is not necessary, age spots can be removed for aesthetic or practical reasons. Most commonly used method:
Cryotherapy (CryoPen®): effective and safe method with minimal risk of scarring
✅ Conclusion
Although seborrhoeic keratoses are not infectious warts, they are often referred to as such by patients. As a skin specialist, it is therefore important to provide clarity about their benign nature and any cosmetic treatment options. Nevertheless, Rosenberg, a wart specialist (and also treats all other benign tumours), believes that it is a wise decision to keep your skin “clean” in order to better see if skin cancer is developing anywhere.
Skin tags (Acrochordon or fibroma) cause and treatment
Skin tags (small growths on a thin stalk) resemble warts but are NOT caused by HPV. Wart specialist Rosenberg emphasises that these benign skin fibromas have a different origin. What are skin tags?These are loose, soft skin tags (fibroepithelial papillomas) that mainly occur on the neck, eyelids, armpits or groin where the skin folds. They are often skin-coloured and vary in size from a few millimetres to centimetres. Cause: The exact cause is not entirely known. Important factors include friction and skin irritation (where skin rubs against skin), hormonal influences (such as during pregnancy), and metabolic factors such as obesity and insulin resistance. It has also been found that people with diabetes and high fat levels often have more skin tags. There is some evidence that HPV infections contribute to the formation of skin tags, but this is not the primary cause. Risk groups: Older and obese people are more likely to develop skin tags. Women are more likely to experience them during pregnancy due to hormones. Syndromes such as polycystic ovary syndrome or Birt-Hogg-Dubé syndrome can also be associated with many skin tags (fibromas). Why some people get them more often: People who wear tight-fitting clothing or experience repeated friction (e.g. necklaces, belts) may develop more skin tags. In addition, they may be hereditary and hormonally enhanced. In general, skin tags are not dangerous. Treatment: Removal of skin tags is usually cosmetic. Safe methods include:
CryoPen cryotherapy: As with warts, a skin tag can be frozen so that it dies off. One treatment is often sufficientdermnetnz.org. This is preferred by many patients because of the quick recovery and minimal pain.
Surgical removal: A doctor can cut through the stalk with scissors (e.g. electric scissors or a loop).
Electrocoagulation: Burning with electricity, especially for larger fibromas.
Ligation: Tying a string around the base of the stalk to stop the blood supply (less commonly used). Skin tags can return, especially if the above risk factors are present. At our practice, wart specialist Rosenberg is the expert in safely removing skin tags and warts with the CryoPen.
Risk factors and recurrence of warts
Warts are highly contagious: up to 60–80% of people who come into close contact with an infected person will become infected with HPV themselves lci.rivm.nl. However, not everyone gets warts: a breakthrough in immunity is necessary. Children and young people have a less developed immune system and scratch more often, making it easier for them to spread warts. People with a healthy immune system become free of warts within two years in 65–90% of cases, while those with compromised immune systems often retain stubborn warts. Certain routines and environmental factors increase the risk: direct contact with other people's warts or contaminated materials (towels, sports equipment) should be avoided. Well-cared-for skin (no cracks) and good hygiene help to minimise friction. Keeping your feet and hands clean, dry and intact (apply cream) reduces the risk of warts.
Treatment overview and CryoPen treatment
Removing warts can take patience. Many warts disappear spontaneously, but this can take up to 1–2 years. Wart specialist Rosenberg regularly sees clients in her skin practice who had warts for more than 10 years before undergoing treatment at Rosenberg. Because warts can easily recur and bother many people, dermatologists often recommend active treatment. Warts specialist Rosenberg notes that CryoPen cryotherapy is one of the most effective and skin-friendly methods. CryoPen uses freezing (extreme cold) to precisely destroy warts and fibromas without unnecessarily damaging healthy skin. In most cases, no anaesthetic is required and the skin heals well.
Other common treatments for warts include:
Salicylic acid (external): Gradual exfoliation of the wart with an acid, suitable for common warts.
Plaster therapy: Duct tape or plasters with medication to gently seal and peel the skin.
Topical agents (creams/liquids): Medicines such as cantharidin, imiquimod or podophyllotoxin that stimulate the immune response or cause tissue death.
Invasive (doctor): Cutting, electrocoagulation or laser treatment for stubborn warts.
Rosenberg always recommends a professional approach in a clinic, especially for foot and genital warts.
Prevention
Although there is no guarantee that warts can be prevented, it is wise to observe good hygiene:
Do not touch warts and wash your hands thoroughly after contact.
Do not share towels, socks or shaving equipment.
Keep skin surfaces intact: protect small wounds and keep skin supple.
Consider vaccination against HPV (Gardasil® 9) for young people (no guarantee). Please note: Rosenberg does not offer this service. Please contact your general practitioner for more information.
Wear flip-flops in public shower areas and at swimming pools.
With this knowledge and these treatment options, patients can look forward to wart treatments with confidence. Wart practitioner Rosenberg is known as a skin tag specialist and wart specialist, and is happy to help remove warts using the most modern and skin-friendly techniques and advice on how to strengthen your immune system.
Source
LCI guideline HPV anogenital warts (National Institute for Public Health and the Environment, RIVM).
Cleveland Clinic, ‘Warts’, Health Library Cleveland Clinic.
Al Aboud AM, Nigam PK. Wart. In: StatPearls [Internet]. 2025.
DermNet NZ, ‘Skin tags (Acrochordons)’, dermatological information site.
Medical News Today, ‘What are skin tags? Causes and treatment options’.
Cleveland Clinic, ‘HPV Vaccine’, Health Library (additional prevention).
Sources cited according to guidelines: full title and source at the bottom, referred to in the text with 【source†L lines】.
Sources
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