Flat Warts: Information & Flat Wart Specialists

Medically, flat warts are called verrucae planae (flat warts). They are medically harmless. Many people have them removed for cosmetic reasons.

Flat warts usually form

• on the back of the neck,
• on the forehead or face, as well as
• on the arms and hands.

They are usually the same color as the surrounding skin. Sometimes they also appear

• light brown,
• whitish to yellow, or
• pink

. The surface of flat warts is soft and often has fine little dots. Flat warts usually do not cause pain.

Human papillomaviruses (HPV) are the cause of these and many other types of warts. They are transmitted through contact infection. This means they reach the skin through contact with contaminated surfaces or infected people. The viruses then use cracks in the skin or open wounds to enter the body. Once inside, they multiply and can form warts.

However, a healthy immune system can usually fight off the viruses effectively. Many warts, including flat warts, often go away on their own.

People with weakened immune systems are at increased risk of HPV infection and the development of warts, such as:

• children,
• older adults,
• people taking certain medications, and
• people with certain pre-existing medical conditions.

Flat warts are quite common in children and adolescents because their immune systems are not yet fully developed. In these cases, the warts are known as verrucae planae juvenilis.

Flat warts are slightly raised and usually skin-colored © Olena | AdobeStock

Flat warts are caused by human papillomaviruses (HPV). To date, about one hundred different HPV types have been identified.

These viruses belong to the group of DNA viruses. DNA viruses infect the outermost layer of the skin—the epithelial cells—as well as some mucous membranes. The infected cells then proliferate uncontrollably within this skin layer, thereby forming warts.

Infection usually occurs through direct contact with an infected person. However, it is also possible through contaminated surfaces. Infected individuals can shed virus-carrying skin flakes. These can be transmitted through touch, such as walking barefoot in a swimming pool or sauna.

However, the formation of warts requires

• small cracks or wounds in the skin, as well as
• a weakened immune system.

With intact skin and a strong immune system, HPV viruses cannot take hold in the skin.

It may take several months after infection for a visible flat wart to form.

Like all warts, flat warts are generally not malignant. However, if in doubt, you should consult a dermatologist. They can usually tell at a glance whether it is a wart and, if so, exactly what type of wart it is.

Small skin growths are not always warts. They could also be calluses or corns. Malignant tissue changes, such as skin cancer, cannot be ruled out either. A dermatologist can identify this by irregular coloring and edges of the growth.

If the diagnosis is unclear or skin cancer is suspected, the dermatologist will take a tissue sample. This sample is then examined in a laboratory.

Like many other warts, flat warts can disappear on their own after several years without leaving a scar. It can take that long for the immune system to learn how to deal with HPV.

However, since there are several strains of HPV, other HPV viruses can still cause additional warts.

Most people affected find flat warts cosmetically bothersome and therefore wish to have them removed. Flat warts can also contribute to skin conditions, such as atopic dermatitis. For this reason, it is safer to treat them.

There are several methods available today for wart removal. You can perform some of them yourself at home. If in doubt, however, you should consult a doctor. They will provide an accurate diagnosis and help you decide on a course of treatment.

Under no circumstances should you try to cut off or scratch a wart. Doing so can release highly contagious viruses.

Layered cauterization of the wart

Products for cauterizing warts are available over the counter at pharmacies. The active ingredients are usually salicylic acid or lactic acid. There is also what is known as vitamin A acid. This acid is often preferred for treating flat warts on the face. It is well known from acne treatment.

The patient applies a layer of the solution to the surface of the wart two to three times a day. The wart dissolves and turns white. After allowing it to sit for a while, the affected layer of skin can be easily peeled off. You must proceed carefully. Do not damage unaffected skin, as viruses can enter or exit through these areas. This could cause the wart to spread further.

Repeat this procedure until the wart is completely removed. Wart removal by chemical cauterization usually takes three to four weeks.

Patches and petroleum jelly may also contain the caustic agents.

When using a caustic solution, make sure that only the wart comes into contact with the solution. Otherwise, healthy skin may also be damaged.

Wart Removal by Freezing

Cryotherapy is a very effective method for removing flat warts. This procedure involves applying liquid nitrogen to the wart using a spray or a cold probe, which creates temperatures as low as -196 °C.

These extremely low temperatures cause ice crystals to form in the tissue cells, which destroy the cells. The wart tissue dies off, and after a few days, the wart falls off on its own.

Cold sprays are available over the counter at pharmacies. When treating yourself, it’s important to practice aiming accurately beforehand, for example, on a piece of paper. Otherwise, you could injure healthy skin.

A doctor uses a cryoprobe to apply the liquid nitrogen precisely to the wart. Since the treatment can be very painful, people with a low pain threshold and children may opt for local anesthesia beforehand.

A blister often forms a few hours after treatment. Under no circumstances should you puncture or remove it, as this could allow viruses to escape.

Studies show that cryotherapy is more effective than chemical cauterization. In fifty percent of all cases, flat warts heal better after cryotherapy. When flat warts were treated with chemical cauterization, only 15 percent disappeared.

Cryotherapy for flat warts @ Evgeniy Kalinovskiy /AdobeStock

Removal of flat warts with a laser

Flat warts can also be removed with a laser. Local anesthesia is administered before treatment. The doctor then uses the laser to ablate the wart layer by layer.

However, remnants of the wart often remain. Therefore, you should be prepared for the flat warts to return and for the treatment to need to be repeated.

Laser treatment for flat warts @ Evgeniia /AdobeStock

Curettage of flat warts

For flat warts that cannot be removed by other means, the doctor uses a “wart spoon,” a sharp instrument. This allows the doctor to cut the wart out of the skin. This is a surgical procedure performed under local anesthesia.

Not only flat warts thrive in a moist environment, but so do many other types of warts. For this reason, do not walk barefoot in the swimming pool or sauna area. Always wear bathing shoes. This prevents potential pathogens from other people from coming into contact with your body in the first place.

Also, do not share your towel with others. After washing, dry yourself thoroughly between your fingers and toes to prevent warts from developing there.

You should always wash towels, underwear, and bedding at a minimum temperature of 60° C. This kills the viruses.

A strong immune system is particularly important. The immune system is the body’s most important defense once pathogens have entered the body. You can support your immune system by leading a healthy lifestyle. This includes not only a healthy diet but also sufficient exercise and as little stress as possible.

Various relaxation techniques can be helpful in combating psychological stress. These include, for example, the active relaxation technique “Progressive Muscle Relaxation according to Jacobson” or autogenic training.