At our clinic, we see a wide range of warts affecting patients of all ages. While many people think of warts as a single, uniform condition, they are in fact a group of distinct skin lesions with different appearances, behaviours, and implications depending on their type and location. Some are asymptomatic and incidental, while others cause pain, functional problems, or cosmetic concern, particularly when they affect the face, hands, feet, or genital area.
Warts are caused by infection of the superficial skin layers with certain strains of Human papillomavirus (HPV). The interaction between the virus, the skin, and an individual’s immune response determines how a wart looks, how long it persists, and whether it spreads. Understanding the different types of warts is therefore essential for accurate identification and appropriate clinical assessment, especially as several other benign and malignant skin conditions can resemble warts.
This page describes the main wart types encountered in clinical practice, focusing on their defining characteristics, usual anatomical distribution, and relevant considerations that influence assessment and management.
Common warts
Common warts are the most frequently encountered wart type. They are caused by several HPV subtypes, most commonly HPV 2 and 4.
Appearance and characteristics
Common warts typically present as firm, well-defined papules or nodules with a rough, hyperkeratotic surface. The surface may appear irregular or “cauliflower-like.” Small black dots can sometimes be seen within the lesion; these represent thrombosed capillaries rather than pigment.
Typical locations
- Fingers and hands
- Knuckles
- Elbows and knees
Behaviour and considerations
These warts are often painless but may become uncomfortable if exposed to repeated friction or trauma. They can spread through direct skin contact or autoinoculation, particularly where the skin barrier is disrupted. In children and young adults, common warts are especially prevalent, reflecting both exposure and immune factors.
Plantar warts (verrucae)
Plantar warts develop on the soles of the feet and are commonly referred to as verrucae. They are most often associated with HPV types 1, 2, and 4.
Appearance and characteristics
Unlike common warts, plantar warts are often flattened by pressure from walking. They may appear as thickened areas of skin with interruption of the normal skin lines. When pared, pinpoint bleeding points may be visible. Surrounding callus formation is common.
Typical locations
- Heel
- Ball of the foot
- Other weight-bearing areas
Behaviour and considerations
Pain on pressure is a frequent feature and can help distinguish plantar warts from simple calluses, although clinical assessment is required. Some plantar warts persist for long periods, particularly in adults, and may interfere with mobility or daily activities.
Flat warts (verruca plana)
Flat warts are smaller and subtler than other wart types and are commonly caused by HPV types 3 and 10.
Appearance and characteristics
These lesions are flat-topped, smooth, and usually only a few millimetres in diameter. They are often flesh-coloured, pink, or light brown and may be difficult to notice initially.
Typical locations
- Face, particularly the forehead and cheeks
- Backs of the hands
- Shins
Behaviour and considerations
Flat warts often occur in groups and may spread along scratch lines, a pattern known as koebnerisation. Facial involvement is common and may raise cosmetic concerns. Because flat warts can resemble other benign facial lesions, careful assessment is important.
Filiform warts
Filiform warts have a distinctive morphology and are usually associated with HPV types 1 and 2.
Appearance and characteristics
They present as elongated, finger-like projections extending from the skin surface. The base may be narrow, giving a stalked or pedunculated appearance.
Typical locations
- Eyelids
- Lips
- Around the nose
- Neck
Behaviour and considerations
Their prominent shape and facial location often make filiform warts more noticeable than other types. Lesions near the eyes or mouth require particular care during assessment due to the sensitivity of surrounding structures and the need to exclude alternative diagnoses.
Periungual and subungual warts
Periungual and subungual warts occur around or beneath the nails and are often caused by HPV types 1, 2, and 4.
Appearance and characteristics
These warts appear as rough, irregular growths around the nail folds or beneath the nail plate. Over time, they may distort nail growth or cause splitting and cracking of the surrounding skin.
Typical locations
- Around fingernails
- Around toenails
- Under the nail plate
Behaviour and considerations
Periungual warts are more common in individuals who bite their nails or have repeated trauma to the hands. Because of their location, they can be uncomfortable and more resistant to treatment. Nail-unit involvement also increases the importance of accurate diagnosis.
Mosaic warts
Mosaic warts are formed by clusters of closely grouped plantar warts.
Appearance and characteristics
Instead of a single discrete lesion, mosaic warts present as a plaque-like area made up of many small, tightly packed verrucae. The surface may appear flatter and less inflamed than that of an isolated plantar wart.
Typical locations
- Soles of the feet
Behaviour and considerations
Despite their extensive appearance, mosaic warts are not necessarily more symptomatic than solitary plantar warts. They may be mistaken for diffuse callus or other hyperkeratotic skin conditions, making professional assessment important.
Genital warts
Genital warts are caused primarily by HPV types 6 and 11, which are classified as low-risk HPV strains.
Appearance and characteristics
These warts are usually soft and may be flat, raised, or cauliflower-like. Their colour ranges from flesh-toned to pink or light brown. Lesions may be solitary or clustered.
Typical locations
- Vulva, vagina, cervix
- Penis and scrotum
- Perianal region
Behaviour and considerations
Genital warts are considered a sexually transmitted infection. Presentation and progression vary widely between individuals. Assessment should be conducted sensitively, and diagnosis should not be assumed based on appearance alone, as other genital lesions may look similar.
Warts in children
Warts are particularly common in childhood. Common warts and plantar warts account for the majority of cases seen in paediatric patients.
Characteristics in younger patients
- Lesions may be multiple and spread more rapidly
- Many warts resolve spontaneously over time
- Anxiety is often related to appearance rather than symptoms
In children, careful distinction between warts and other benign paediatric skin conditions is important, particularly where lesions affect the face or genital area.
Conditions that can resemble warts
A number of other skin lesions can mimic the appearance of warts, including:
- Corns and calluses
- Seborrhoeic keratoses
- Molluscum contagiosum
- Skin tags
- Certain benign or malignant tumours
Because of this overlap, persistent, atypical, or changing lesions should be assessed rather than assumed to be warts.
Assessment considerations
Assessment of a suspected wart involves evaluating its appearance, location, duration, and any associated symptoms such as pain, bleeding, or rapid change. Patient age, immune status, and prior history of similar lesions may also be relevant. In some cases, diagnostic uncertainty warrants further investigation to exclude alternative conditions.