Warts

What is Warts?

Warts are benign growths of the skin and mucous membranes caused by the human papillomavirus (HPV), of which more than 100 types are known.^[1] In people with a healthy immune system they are harmless and usually go away through natural immunity within months or years.^[2]

Common symptoms

Warts appear as small raised growths, and what they look like depends on the type and the place on the body. The main forms are common warts, flat warts, deep plantar warts on the sole, and genital warts.^[1]

• Rough, raised bumps on the hands, fingers or knees (common warts)
• Small, smooth, flat-topped bumps, often on the face or legs (flat warts)
• Painful, thickened spots on the sole of the foot, sometimes hard to tell from a callus (plantar warts)^[3]
• Soft growths in the genital or anal area (genital warts), which need medical evaluation^[4]

Causes and risk factors

Warts are caused by HPV infection of the skin. They can spread through direct or indirect contact, and breaks in the skin barrier make infection more likely.^[1] The virus probably enters through areas of minor injury, and risk factors include communal showers, handling meat at work and a weakened immune system.^[2]

Some HPV types carry a risk of cancer, particularly in genital warts and in people with weakened immunity, which is why genital and unusual warts need a physician's care.^{[1, 4]}

How it is diagnosed and treated conventionally

Warts are usually diagnosed by how they look, and a clinician should check any growth that is unusual, changing, bleeding or in the genital area.^[5]

Treatment can be difficult, and many warts resolve without it.^[1] A Cochrane review of 85 trials found that salicylic acid applied to the skin cleared warts more often than placebo, although the effect was modest. Cryotherapy was not clearly better than placebo or salicylic acid, and the review noted that cryotherapy probably causes more pain, blistering and scarring.^[6] Plantar warts in particular can be resistant to treatment.^[3]

Why Warts calls for a whole-person approach

Warts are an infection, but whether a wart appears, spreads or clears depends partly on the person. Most HPV infections are controlled or cleared by the body's immune responses, and warts appear more often in people with weakened immunity.^{[2, 3]}

Medical removal treats the lesion but does not directly address the host factors that decide whether the virus persists.

Immune response

Warts usually clear when natural immunity recognizes the virus, which is why they often disappear on their own and why immunosuppression raises risk.^[2] Immune-based treatments are used for stubborn warts: the Cochrane review found that dinitrochlorobenzene, a contact sensitizer, was more than twice as effective as placebo in two small trials of 80 participants.^[6]

Skin barrier and exposure

Events that disrupt the skin barrier make warts more likely, and the virus spreads through direct or indirect contact.^[1] Communal showers are a recognized risk factor.^[2]

Persistence and recurrence

Plantar warts shed virus that can infect nearby skin or other people, and they often resist treatment.^[3] Care often involves patience over weeks to months.

Stress, sleep and general health

Stress and poor sleep are not established causes of warts, and we are not aware of research that links them to wart persistence. Supportive care aimed at general health and stress is offered only as a way to feel better during a long-running skin problem, not as a treatment for the virus.

Acupuncture for Warts

What the research shows

Research on acupuncture for warts is limited, and most of it concerns flat warts and comes from China. In a single-blind trial of 60 people with flat warts, weekly auricular (ear) acupuncture for 10 weeks led to full recovery without recurrence in 16 of 30 people, compared with 1 of 30 using tretinoin ointment. The authors called for larger trials, and no adverse effects were reported.^[7]

Separately, a systematic review of 29 trials with 2,666 patients looked at fire needle therapy, a heated-needle technique used in Chinese medicine that differs from the fine, unheated needles of standard acupuncture. It found that fire needle therapy appeared more effective than immunomodulators or tretinoin for flat warts, with more skin pigmentation as a downside.^[8] Fire needle therapy is not a service we offer, and the review is included only to show what research exists.

We found no trials of standard acupuncture for common, plantar or genital warts.

How acupuncture may work

We found no mechanism research on acupuncture for warts. A review of traditional Chinese medicine, mainly herbal treatment, for HPV infections suggested that such treatments might act on immune function, but this is a proposal rather than a settled finding and it was not about acupuncture.^[9]

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points chosen for you, which may include points on the ear, and usually left in place for about 20 to 40 minutes. A course of several visits is typical, with reassessment along the way. Needles are not placed directly into warts or inflamed skin.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). If you have a weakened immune system, tell us and your physician before any treatment.

Ayurvedic medicine for Warts

The Ayurvedic view

Ayurveda describes warts as Charmakila and classifies them by which dosha is thought to dominate.^[11] In this traditional framework, warts reflect imbalance in the skin and blood tissues, and general digestion and routine are considered relevant. These are traditional categories used to choose treatment, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine, such as regular meals, plenty of cooked vegetables and steady sleep
• Herbs taken by mouth or applied, selected and prescribed individually by a qualified practitioner
• Transdermal medication therapy, meaning an herbal preparation applied to the skin, where appropriate

Classical texts also describe alkaline herbal preparations (Kshara), thermal cautery and surgery for warts,^[11] but these procedures are not part of our services. Panchakarma is not appropriate during pregnancy, acute illness or frailty, and it is not a treatment for the virus itself.

What the research shows

The research is very limited. We found no randomized trials of Ayurvedic treatment for warts. A published case series of different wart types treated with an injection of an alkaline herbal solution reported that warts shed within days and left minor scars, with no adverse reactions. A case series has no comparison group and cannot show that the treatment works.^[11]

Herbal medicine for Warts

Herbs and formulas that have been studied

Several plant-based treatments have been tested in small trials. They include propolis (a bee product) and echinacea taken by mouth, a garlic extract applied to warts, Chinese herbal preparations for flat warts and genital warts, and green tea extract ointment for genital warts.^{[12, 13, 14, 15, 16]}

What the research shows

The evidence is limited, and much of it is from small single-center trials. In a single-blind trial of 135 people with several wart types, oral propolis cleared the warts of 75 percent of those with flat warts and 73 percent of those with common warts, results better than echinacea or placebo, although this was one trial from one setting.^[12] In a trial of 50 patients with stubborn common warts, a garlic extract applied to a single wart (the largest, if there were several) gave a complete response in 96 percent, compared with a saline control.^[13]

For Chinese medicine, a trial of herbal treatment for flat warts reported a better response with herbs than with a Western medicine comparator (86.7 percent versus 71.7 percent), but its details are sparse.^[14] A trial of 160 people with genital warts found that adding oral Chinese herbs to CO2 laser removal was followed by a lower relapse rate than laser alone, 25.7 percent against 40.8 percent.^[15] A systematic review of traditional Chinese medicine for HPV infections said clinical indicators improved in genital warts and cervical cancer, with proposed effects on immune function.^[9]

The best-supported botanical product is a prescription green tea extract ointment for external genital warts. A meta-analysis of three placebo-controlled trials with 1,247 participants found it cleared warts more often than placebo with very low recurrence, with local redness and itching the most common effects.^[16] It is a prescription medicine used under a physician's direction.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Case reports describe bleeding when warfarin was combined with herbs including dang gui (Angelica sinensis), dan shen (Salvia miltiorrhiza), ginger, ginseng and Boswellia.^[17]

Herbal supplements can also injure the liver, and green tea extract is among the products implicated.^[18] About one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[19] Herbs should come from tested sources and be prescribed individually. Do not apply herbs or essential oils to open, bleeding or genital skin without your physician's approval. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or take medicines that affect the immune system.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes warts as arising from heat, dampness or stagnation of qi and blood in the skin, sometimes related to the liver channel. Researchers studying warts instead look at HPV infection of skin cells and the immune response that clears it, and some Chinese medicine studies measure immune cell markers.^{[1, 15]}

Ayurveda's view of an imbalance in the skin and blood tissues has no direct biomedical counterpart. The nearest idea is the host immune response that controls HPV.^[3] No study has shown that a dosha or a pattern corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for warts is complementary. Keep your physician or dermatologist, and do not stop or change prescribed treatments without your prescriber. We do not diagnose skin growths, and any growth that is new, changing, bleeding, or in the genital area should be evaluated by a clinician.

Please bring your diagnosis, a list of the treatments you have tried, a full list of medicines, creams and supplements, and information on any condition that affects your immune system.

When to seek urgent medical care

Most warts are not urgent, but some changes need prompt attention.

• A wart or skin growth that bleeds, grows quickly, changes color or does not respond to treatment
• Spreading redness, warmth, swelling, pus or fever around a wart, which may be infected
• Warts in the genital or anal area, or in the mouth or throat
• Many new warts in someone with a weakened immune system, for example from HIV, an organ transplant or immune-suppressing medicine
• A painful wart on the foot in a person with diabetes or poor circulation

If you have heavy bleeding or signs of a spreading infection with high fever, call 911 or go to the nearest emergency department.