Persistent warts in adults are common and often behave differently from warts in children. While many childhood warts resolve on their own, adult warts are more likely to linger, recur after treatment, or resist standard therapies. This difference is largely driven by immune response, repeated exposure, and the way adult skin responds to the human papillomavirus (HPV).
Adult Immune Response
The immune system plays a central role in clearing warts. In children, the immune response to HPV is often rapid and robust, which explains why many childhood warts resolve without treatment. In adults, immune recognition of the virus can be slower or less effective, allowing wart tissue to persist.
Several factors influence immune response in adults:
- Reduced immune surveillance at the skin level
- Previous HPV exposure leading to partial, not complete, immunity
- Chronic stress, illness, or fatigue affecting immune function
As a result, the virus may remain active within the skin for extended periods, even when the wart appears small or stable.
Adults are more likely to experience ongoing or repeated exposure to HPV over time. Work environments, communal facilities, gyms, swimming pools, and frequent travel all increase the chance of re-exposure to the virus.
Small breaks in the skin, often unnoticed, allow HPV to enter. In adults, repeated exposure can reinforce infection rather than trigger clearance, particularly when the immune response is delayed. This cycle helps explain why some adults develop warts that persist for years.
Skin Trauma
Minor skin trauma is a significant contributor to persistent warts in adults. Activities such as shaving, manual work, sports, nail biting, and footwear pressure create microscopic skin injuries that allow the virus to spread locally.
Common examples include:
- Plantar warts persisting due to constant pressure on the sole
- Periungual warts spreading with nail biting or cuticle damage
- Hand warts recurring in people with frequent manual skin contact
Repeated trauma not only allows viral entry but can also interfere with healing after treatment.
Treatment Resistance
Adult warts are more likely to become treatment-resistant, particularly after repeated partial clearance. Over-the-counter treatments, short courses of cryotherapy, or incomplete removal may reduce wart size without eliminating all viral tissue.
When small amounts of infected tissue remain:
- The wart may regrow slowly
- Surrounding skin can become inflamed
- Subsequent treatments may be less effective
This pattern is commonly seen in plantar, periungual, and mosaic warts, where depth and pressure limit treatment access.
Location Matters
Wart persistence in adults is strongly influenced by location. Certain areas of the body are more prone to long-term infection.
| Wart location | Reason for persistence |
|---|---|
| Soles of the feet | Pressure limits immune clearance |
| Around the nails | Restricted treatment margins |
| Fingers and hands | Frequent trauma and re-exposure |
| Weight-bearing areas | Slower healing response |
Warts in these locations are not necessarily more aggressive, but the environment makes clearance more difficult.
HPV Behaviour Over Time
HPV can behave differently in adult skin. The virus may remain dormant for long periods and become active again when conditions allow. This explains why some adults experience recurrence after months or years without visible warts.
Dormancy does not mean eradication. Viral DNA can persist in the skin, particularly if immune clearance was incomplete. Reactivation can occur without obvious triggers, leading to the impression that a wart has “come back” unexpectedly.
When Warts Do Not Resolve
Persistent warts in adults are not usually dangerous, but they can become problematic due to:
- Ongoing discomfort or pain
- Cosmetic concerns
- Spread to nearby skin
- Impact on walking or hand function
Long-standing warts are also more likely to cause uncertainty, particularly when appearance changes or treatment fails. Assessment helps confirm the diagnosis and rule out other skin conditions that can resemble warts.
Assessment in Adult Patients
Assessment focuses on understanding why the wart has persisted rather than simply removing visible tissue. Key considerations include:
- Duration and growth pattern
- Previous treatments and response
- Location and depth
- Evidence of spread or recurrence
This approach helps determine whether further treatment is appropriate and which method is safest.
Specialist Care in London
At London Wart Clinic, persistent warts in adults are assessed by clinicians experienced in managing treatment-resistant and anatomically complex warts, where immune response and skin behaviour are key factors.
This includes specialists such as Dr Nicki Bystrzonowski, Dr Giulia Luciano, Mr Georgios Pafitanis, and Mr Parviz Sadigh, who regularly assess warts that have not responded to standard treatments.
Treatment decisions are individualised, and suitability is determined following clinical assessment rather than assumptions based on age alone.