Verrucas and warts produce outsized parental concern given that they are almost always harmless and most go away on their own. They are also extremely common in children, who pick up the virus in changing rooms, swimming pools, and from each other through everyday contact. Understanding what they are, what the treatment evidence actually says, and when treatment makes sense helps families avoid unnecessary treatment of a condition that would often have resolved anyway.
Healthbooq (healthbooq.com) covers common childhood skin conditions through the early years.
What They Are
Warts and verrucas are both caused by human papillomavirus (HPV). There are over a hundred different HPV strains, and the ones that cause common skin warts are distinct from the strains that cause genital warts and cervical cancer. The strains responsible for common warts in children are not the same types that the teenage HPV vaccination protects against.
Common warts (verruca vulgaris) appear as raised, rough, flesh-coloured or grey-brown growths, typically on the hands and fingers. They have a characteristic cauliflower surface with tiny black dots (thrombosed capillaries).
Verrucas (plantar warts) are warts on the sole of the foot, pressed flat by body weight into a painful inward-growing lesion. They often have a ring of hard skin around them and the black dots are visible.
Flat warts (verruca plana) are flatter, smoother, and skin-coloured; more common on the face and legs.
Natural History
The most important fact about warts in children is that most resolve without treatment. Studies consistently show spontaneous resolution in around 65 to 78 per cent of cases within two years. This is why "watchful waiting" is an entirely reasonable approach, particularly for warts that are not painful or spreading.
The immune system eventually recognises the HPV-infected cells and clears them. This process can take months to years and varies between individuals. Children with healthy immune systems generally clear warts faster than adults and faster than immunocompromised individuals.
Treatment Options
When treatment is appropriate (painful verruca, spreading warts, significant distress), several options are available.
Salicylic acid is the first-line treatment and has the best evidence from clinical trials. Preparations such as Bazuka, Wartner, and generic salicylic acid gel are available at pharmacies. The preparation is applied daily to the wart after soaking in warm water and removing any dead skin with an emery board or pumice stone. The surrounding normal skin can be protected with petroleum jelly. Treatment requires consistency over weeks to months.
A Cochrane review (Kwok et al., 2012) found that salicylic acid was more effective than placebo for clearance of warts, and that the evidence was comparable between salicylic acid and cryotherapy.
Cryotherapy involves applying liquid nitrogen to the wart to freeze and destroy the infected tissue. It is available at GP practices and some pharmacies. It is more painful than salicylic acid, usually requires multiple sessions every two to three weeks, and is not typically appropriate for young children who cannot tolerate the discomfort. A 2011 RCT by Cockayne and colleagues in the BMJ found that cryotherapy was not more effective than salicylic acid when both were used correctly.
Over-the-counter freezing kits (such as Wartner) use a different agent (dimethyl ether rather than liquid nitrogen) and reach lower temperatures: they are less effective than clinical cryotherapy.
Duct tape (the duct tape occlusion method, in which waterproof tape is applied and changed weekly) was studied in a 2002 trial that suggested it might outperform cryotherapy. Subsequent trials have not consistently replicated this, and it is not recommended in NICE guidance, but it is safe, cheap, and some families find it helpful.
School and Swimming
NICE guidance and NHS guidance are clear: children with warts or verrucas do not need to be excluded from school or swimming. There is no evidence that exclusion reduces transmission.
Covering a verruca at the swimming pool is commonly requested by pool operators and is reasonable as a courtesy. Flip flops in changing rooms reduce the risk of picking up HPV but do not guarantee protection.
When to See a GP
Most warts can be managed at home without a GP appointment. See a GP if the wart is on the face, if it is changing rapidly or in an unusual way, if the child is immunocompromised, or if the diagnosis is uncertain.
Key Takeaways
Warts and verrucas are caused by human papillomavirus (HPV), are very common in school-age children, and the majority resolve spontaneously within two years without treatment. Treatment is not always necessary and should be considered when the wart is painful, spreading rapidly, or causing significant distress. Salicylic acid preparations are the first-line treatment available over the counter and have the best evidence. Cryotherapy (freezing) is available at GP practices and pharmacies and is effective but requires multiple sessions. Children do not need to be excluded from school or swimming for warts or verrucas; covering a verruca for swimming is advisable but not mandatory.
