Плоскі бородавки (МКХ-10: B07) ⚠️

Plane Wart (Flat Wart, Verruca Plana): A Common Viral Skin Growth with a Harmless Course

What Are Plane Warts?

Plane warts, often called flat warts or verruca plana, are harmless skin growths caused by a virus known as the human papillomavirus (HPV). They’re most common in children, teenagers, and young adults. These warts are small, flat, often appear in groups, and sometimes clear up on their own—especially in younger people.

Although they’re not dangerous, plane warts can be quite bothersome, mainly because they often show up on visible areas like the face and hands. They can also be stubborn to treat and may multiply, which sometimes means medical help is needed.

What Causes Plane Warts and How Do They Spread?

Plane warts are caused by HPV, usually types that carry a low risk of cancer (such as types 3, 10, and 28). While many people carry HPV, not everyone gets warts. This is because whether warts appear depends on how susceptible someone is and their immune system’s strength.

Things that can increase the chance of getting flat warts include:

Weakened immune system: For example, due to HIV, cancer treatments, or autoimmune diseases;
Hormonal and metabolic issues: Such as diabetes, obesity, or long-term poor nutrition;
Pregnancy: Hormonal and immune changes can encourage wart growth;
Ongoing infections and stress: These can lower your body’s defences and activate HPV;
Skin damage: Small injuries or scratching help the virus get in (self-spreading);
Poor hygiene and close contact: Sharing personal items, skin-to-skin contact, or touching contaminated surfaces;
Children: Because they often have close physical contact and thinner skin.

The virus spreads through direct contact with infected skin or touching objects that carry the virus. It can also spread to nearby skin by scratching or touching the warts.

How Are Flat Warts Diagnosed?

Doctors usually diagnose plane warts just by looking at them. They have a typical look that experienced skin specialists can recognise during an examination.

In tricky or unusual cases, other tests might be done:

Dermatoscopy: A special magnifying tool that helps see tiny blood vessels and skin patterns typical of flat warts;
HPV typing: To find out exactly which HPV strain is involved, especially if warts keep coming back or don’t respond to treatment;
Skin biopsy: Taking a small sample if there’s concern about cancer or if the wart doesn’t improve with usual treatments. Under the microscope, features like thickened skin layers and specific cell changes can be seen.

What Do Flat Warts Look and Feel Like?

Flat warts are small, slightly raised spots with a smooth, flat surface. They often appear in groups or lines, especially after skin injury (a reaction called the Koebner phenomenon). Their colour can range from skin tone to pale brown or greyish, depending on how thick the skin is and sun exposure.

Here are some key features:

Size: Usually 2–5 mm across and 1–2 mm high;
Texture: Soft, smooth, and a bit velvety to the touch;
Edges: Well-defined, often with a slight raised rim around the wart;
Hair growth: Usually no hair grows on the wart itself;
Common spots: Face, forehead, cheeks, chin, backs of hands, forearms, and shins;
Symptoms: Mostly no discomfort, though sometimes mild tingling or irritation when pressed.

What Dermatoscopy Shows

Using a dermatoscope helps tell flat warts apart from other skin bumps. Typical signs of plane warts include:

Lightly coloured surface: With fine graininess and little build-up of skin;
Less obvious “frogspawn” pattern: Compared to common warts, the tiny red dots (capillaries) are fewer or less bright;
Black or brown dots: These are tiny blood vessels that have clotted, but they’re less obvious in flat warts;
Clear border: A pale edge or ring may be seen between the wart and normal skin.

These details help doctors distinguish flat warts from early skin cancers, seborrhoeic keratosis, and pigmented spots.

What Else Could It Be? Differential Diagnosis

Flat warts can look like other harmless or more serious skin conditions. It’s important to get the right diagnosis, especially if the wart looks unusual or won’t go away. Possible alternatives include:

Papillomatous nevus: More uneven and pigmented, often present from birth;
Nevus sebaceous: Yellowish, waxy patches usually on the scalp or face in children;
Halo nevus: A pigmented mole with a pale ring around it, usually without thickened skin;
Dermatofibroma: Firm, brownish lumps that dimple when pinched;
Common warts (verruca vulgaris): Taller, rougher, with black dots on the surface;
Plantar wart: Found on the soles, deeper and often painful;
Molluscum contagiosum: Dome-shaped bumps with a small central dimple, soft when touched;
Nodular basal cell carcinoma: Slow-growing pearly lump that may ulcerate or bleed;
Amelanotic melanoma: A rare, non-pigmented skin cancer that needs a biopsy if suspected.

Risks and Why It Matters

Flat warts are not linked to cancer and carry almost no risk of becoming malignant. Still, it’s important to keep an eye on any changes, especially if a wart:

Grows quickly or unevenly;
Changes colour, becoming darker or patchy;
Develops ulcers or thickened, rough skin;
Starts to hurt, bleed, or become inflamed.

Other concerns include:

Appearance: Warts on the face or visible areas can affect confidence;
Injury: Warts on hands or wrists can get irritated by friction or knocks;
Self-spreading: Scratching or shaving may cause new warts nearby;
Carrying the virus: Having many warts might mean a weaker immune system or higher viral load.

How Are Flat Warts Managed and Monitored?

If the warts aren’t causing problems or bothering you, doctors often suggest watching and waiting, especially in children and teens, since they often clear up naturally.

However, it’s best to see a skin specialist if:

The warts are spreading or joining together;
They change in look or feel;
They get injured or inflamed;
They cause distress or affect your wellbeing;
You have a weakened immune system or chronic skin issues.

Keeping track with photos and skin maps helps monitor changes, especially if you have many warts or they tend to come back. Checking at least twice a year—before and after summer—is recommended.

Treating Flat Warts

The goal of treatment is to remove visible warts, stop them from returning, and avoid complications. Gentle methods are preferred, especially on the face or sensitive areas.

Common treatments include:

Laser therapy: Good for small groups or cosmetically important spots;
Cryotherapy: Freezing the warts with liquid nitrogen, often needing several sessions;
Electrocoagulation or curettage: Removing wart tissue under local anaesthetic;
Radiofrequency removal: A precise, less damaging method suitable for multiple warts;
Topical treatments: Such as salicylic acid, retinoids, imiquimod, or other antiviral and skin-softening creams (used under medical advice);
Surgical removal: For unusual warts or when diagnosis is uncertain, followed by lab examination.

Trying to remove warts yourself is not recommended because it can cause bleeding, infection, scarring, and spread the virus. All treatments should be done by trained professionals in sterile conditions.

How to Prevent Plane Warts

Preventing flat warts means reducing your exposure to HPV, keeping your skin healthy, and supporting your immune system.

Good hygiene: Don’t share personal items like razors or towels;
Look after your immune health: Get enough sleep, eat well, manage stress, and stay active;
Protect your skin: Avoid small injuries and treat any skin problems quickly;
Shield from UV: Use sunscreen on exposed skin and avoid too much sun or tanning beds;
Avoid touching warts: Don’t scratch, shave over, or pick at them;
Regular skin checks: Especially if you have a weakened immune system or often get viral skin issues;
HPV vaccination: Though mainly for high-risk cancer-causing strains, it may help reduce spread or offer some protection.

With early spotting, proper care, and good advice, most flat warts can be treated successfully—helping you avoid cosmetic worries and reducing the spread of HPV.