Flat Warts

Flat warts are more prevalent amongst teenagers and children which is why they are also known as juvenile warts.   They are small, about the size of a pinhead, and as their name suggests flat warts have flat tops.  As many as a hundred may be clustered in one location.  They are a similar color to the skin, being pink, light brown or yellow, and are much smoother to the touch than other types of warts.   Common locations for flat warts are the face and the forehead, but these little lumps can also grow on the neck, arms, and hands.

Warts are caused by viruses.  They’re called human papilloma virus (HPV) and more than 100 strains have been identified.  The human papillomavirus (HPV) strains 3, 10, 28, and 49 are the main causes of flat warts.  Like many viral particles their favorite locations must be warm and moist which is why they home in on skin and mucosal surfaces. When they find a suitable place they invade the epidermis to grow, develop, and proliferate.   HPV is highly contagious and is transmitted via person- to-person contact or sometimes by touching infected objects.   

Sometimes it can take up to a year for flat warts to grow to a visible size, so you might not be aware you have them until sometime after the original infection.  Flat warts are flesh colored or white and slightly raised above the skin.  These warts are flat topped and smooth.  Scratches are common places you will find an infection of flat warts.  A flat wart will develop on the hands, face, and areas that are shaved frequently such as women's legs and men's faces.  Flat warts usually occur in multiples.  Very rarely will you find a flat wart all alone.  Most warts are not painful, though they can hurt if they are located in an area that is frequently bumped or under pressure.  More importantly, they are not dangerous.  Flat warts are benign growths.  The biggest problem that most people have with warts is that they are embarrassed by their appearance.

Since they occur in multiples and in areas prone to re-infection, flat warts can be rather difficult to treat.  Treatment is not always necessary as the warts will go away after a few months; a result of the body’s immune system fighting back.  When treatment is needed  the most common options are non-prescription drugs which cause the skin to be saturated with water.  Eventually the skin peels away taking the virus particles with it.  Moist patches are another option, and these are placed over the affected area for 48 hours at a time.  Success depends on the size of the wart and the depth of its growth.  Flat wart remedies may take up to three months to work.  If the problem persists and the warts are painful a doctor must be consulted.  They will have access to stronger chemicals such as salicylic acid, glycolic or retinoin to remove the top layers warts.  A doctor may even use cryotherapy, where the tissue is frozen with liquid nitrogen.  Other options include electro-surgery or pulsed laser beams which burn and kill the warts.  Then, they simply drop off.

A preliminary study has revealed that treatment with a poisonous chemical compound called Cantharadin may be beneficial to people with stubborn flat warts on their face.  All patients within the study were completely cured within 16 weeks and there were only mild adverse skin reactions to the topical solution. (Pelinxs S, Durmazlar K, Atacan D, Eskioglu F.  Cantharidin treatment for recalcitrant facial flat warts: A preliminary study.  Journal of Derm Treat. 2009; 20 (2): 114-119).

Even when treatment is successful warts can make an unwelcome comeback.  This is because the HPV virus may still be lurking in the body.

Alternate names:  verucca plana, plane warts, flat genital warts

1.  The Patient Education Institute www.nlm.nih.gov Medline Plus tutorials

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