Warts and Fungal Skin Infections: Complete Guide to Symptoms & Treatment

What Are Warts and What Causes Them?

Warts are benign skin growths caused by the human papillomavirus (HPV). They appear as rough, raised bumps on the skin, most commonly on the hands and feet. HPV enters through small cuts or breaks in the skin and stimulates rapid cell growth, creating the characteristic wart appearance. There are over 100 types of HPV, with different types causing warts in different locations.

Warts are one of the most common skin conditions, affecting approximately 7-12% of the general population. They are particularly common in children and young adults, with prevalence rates reaching up to 33% in school-aged children. The reason for higher rates in younger people relates to immune system development – as the immune system matures, it becomes more effective at fighting off the HPV virus that causes warts.

The human papillomavirus that causes warts is remarkably resilient and can survive on surfaces for extended periods. This is why public swimming pools, gym showers, and communal changing rooms are common places where the virus spreads. The virus enters the body through microscopic cuts or abrasions in the skin, which may be so small they're invisible to the naked eye. Once inside, the virus infects the keratinocytes – the main type of cell in the outer layer of skin – and causes them to multiply rapidly, creating the raised bump we recognize as a wart.

It's important to understand that not everyone who comes into contact with HPV will develop warts. The immune system plays a crucial role in determining whether an infection takes hold. People with weakened immune systems, such as those taking immunosuppressive medications or living with HIV, are more susceptible to wart infections and may find them harder to treat. Similarly, children who haven't yet developed full immunity to common HPV strains are more likely to develop warts than adults who have been exposed over time.

Types of Warts and Where They Appear

While all warts are caused by HPV, different strains of the virus tend to affect different areas of the body and produce characteristic appearances. Understanding the type of wart you have can help guide treatment decisions and set realistic expectations for how long treatment might take.

Common warts (Verruca vulgaris) are the most frequently encountered type, typically appearing on the fingers, hands, and around the nails. They have a rough, cauliflower-like surface and may contain tiny black dots, which are actually small blood vessels that have grown into the wart. These warts can range from a few millimeters to over a centimeter in diameter. Common warts are caused primarily by HPV types 2 and 4, though other types can also be responsible.

Plantar warts (Verruca plantaris) develop on the soles of the feet and can be particularly troublesome because walking puts pressure on them, pushing them deeper into the skin. Unlike common warts that grow outward, plantar warts grow inward and may feel like stepping on a pebble. They often have a callused appearance with a central core of black dots. Plantar warts can occur singly or in clusters called mosaic warts, and the pressure from walking can make them painful.

Flat warts (Verruca plana) are smaller and smoother than other types, appearing as slightly raised, flat-topped lesions. They most commonly occur on the face, arms, and legs, and tend to appear in large numbers – sometimes dozens at a time. Flat warts are particularly common in children and can spread rapidly through scratching or shaving. They're caused by HPV types 3, 10, and 28.

Seborrheic keratoses, sometimes called seborrheic warts, are actually not true warts at all – they're not caused by HPV and aren't contagious. However, they're often mistaken for warts because of their appearance. These benign growths appear as raised, waxy, brown or black lesions, typically on the face, chest, back, and shoulders. They become more common with age and are completely harmless, though they can be removed for cosmetic reasons if desired.

What Are Fungal Skin Infections?

Fungal skin infections (dermatomycosis) are caused by various fungi that thrive in warm, moist environments. The most common types include athlete's foot (tinea pedis), ringworm (tinea corporis), jock itch (tinea cruris), and nail fungus (onychomycosis). These infections affect an estimated 20-25% of the global population and are characterized by itching, redness, scaling, and sometimes cracked skin.

Fungal skin infections are incredibly common, ranking among the most frequent dermatological conditions worldwide. The fungi responsible for these infections – primarily a group called dermatophytes – have evolved specifically to infect human skin, hair, and nails. They feed on keratin, the protein that makes up the outer layer of skin, which is why they're limited to these superficial structures and don't typically cause deeper infections in healthy individuals.

The dermatophytes responsible for most fungal skin infections belong to three main genera: Trichophyton, Microsporum, and Epidermophyton. Different species within these groups tend to cause infections in different areas of the body, though there's considerable overlap. Trichophyton rubrum is the most common cause of athlete's foot and nail fungus worldwide, while Trichophyton tonsurans has become the predominant cause of scalp ringworm in many Western countries.

These fungi spread through direct contact with infected skin or by touching contaminated surfaces. Public areas where people walk barefoot – such as swimming pools, gym showers, and locker rooms – are notorious for harboring dermatophytes. The fungi can also spread through shared items like towels, shoes, and nail clippers. Some species are zoonotic, meaning they can spread from animals to humans, which is why pet owners occasionally develop ringworm infections from their cats or dogs.

Certain factors increase the risk of developing fungal skin infections. Warm, humid climates provide ideal growing conditions for fungi, which is why these infections are more common in tropical regions. Occlusive footwear that doesn't allow sweat to evaporate creates a perfect environment for athlete's foot. Immune suppression, diabetes, and poor circulation all increase susceptibility to fungal infections and can make them harder to treat. Athletes are particularly prone to these infections due to sweating, shared facilities, and the occlusive nature of athletic gear.

Common Types of Fungal Skin Infections

Athlete's foot (Tinea pedis) is the most common fungal skin infection, affecting up to 70% of the population at some point in their lives. It typically begins between the toes, causing itching, burning, and peeling skin. The infection can spread to the soles and sides of the feet, causing scaling and dryness. In some cases, it leads to painful cracking and fissuring of the skin, which can open the door to secondary bacterial infections. Contrary to its name, athlete's foot isn't limited to athletes – anyone can develop it, though athletes' foot environments make them particularly susceptible.

Ringworm (Tinea corporis) appears as circular, red, scaly patches with a clearer center – the classic "ring" appearance that gives it its name. Despite the name, no worm is involved; the circular pattern simply reflects how the infection spreads outward from a central point. Ringworm can occur anywhere on the body and is highly contagious. It's common in children and can spread quickly in schools, daycare centers, and sports teams through skin-to-skin contact.

Nail fungus (Onychomycosis) is a stubborn infection that affects the toenails more often than fingernails. The infection typically starts at the edge of the nail and progressively involves more of the nail plate, causing discoloration (yellow, brown, or white), thickening, brittleness, and separation from the nail bed. Nail fungus is notoriously difficult to treat because the nail provides a protective barrier that topical medications struggle to penetrate, and the slow growth of nails means treatment must continue for months.

Pityriasis versicolor is a superficial fungal infection caused by Malassezia yeast, which is normally present on human skin. Overgrowth of this yeast leads to patches of discolored skin that may be lighter or darker than surrounding areas. The condition is most common in young adults and is particularly noticeable after sun exposure, when the affected patches fail to tan normally. Unlike dermatophyte infections, pityriasis versicolor rarely causes itching.

What Symptoms Do Warts and Fungal Infections Cause?

Warts typically appear as raised, rough bumps that may contain small black dots. They can be painless or tender, especially plantar warts when walking. Fungal infections cause itching, redness, scaling, and peeling skin. Athlete's foot often presents with burning and cracked skin between toes, while nail fungus causes discoloration, thickening, and crumbling of nails.

Symptoms of Warts

The appearance of warts varies depending on their type and location, but they share common characteristics that help distinguish them from other skin conditions. Warts are typically well-defined, raised growths with a rough, textured surface. The classic "black dots" seen in many warts are actually thrombosed capillaries – tiny blood vessels that have clotted within the wart tissue. This is a hallmark feature that can help differentiate warts from other conditions like calluses or corns.

Common warts on the hands usually appear as dome-shaped bumps with a rough, grainy surface. They may be flesh-colored, white, pink, or gray. The texture is often compared to a cauliflower. These warts can occur singly or in clusters and may vary in size from a pinhead to larger growths. They're usually painless unless located in areas subject to pressure or friction.

Plantar warts feel different from common warts because the pressure of walking pushes them into the skin rather than allowing them to grow outward. They often develop a thick layer of hard skin (callus) over them and may feel like walking on a pebble. The pain can range from mild discomfort to significant enough to alter walking patterns. Mosaic warts – clusters of plantar warts – can be particularly troublesome and resistant to treatment.

Flat warts are subtle compared to other types. They appear as small, slightly raised bumps with flat tops and smooth surfaces. They're typically flesh-colored or slightly pink and may number in the dozens. Because they're small and smooth, they can sometimes be mistaken for acne or other skin conditions, especially when they appear on the face.

Symptoms of Fungal Skin Infections

Athlete's foot typically begins with itching, burning, and stinging between the toes, usually starting in the space between the fourth and fifth toes. As the infection progresses, the skin becomes red, scaly, and peeling. The interdigital form – the most common type – causes maceration (softening and whitening) of the skin between toes, often with painful cracking. A "moccasin" pattern affects the soles and sides of the feet with chronic scaling and dryness. A vesicular form causes blisters, usually on the sole or arch of the foot.

Ringworm on the body presents as circular or oval patches that are red and scaly at the edges but clearer in the center. The lesions expand outward over time, creating the characteristic ring pattern. Multiple rings may occur simultaneously, and they can merge to form irregular shapes. Itching is common and can range from mild to intense. The skin may be raised, blistered, or scaly at the active border of the ring.

Nail fungus develops slowly over months or years. Early signs include a white or yellow spot under the tip of the nail. As the infection spreads, the nail becomes thickened, discolored (yellow, brown, or white), and develops a crumbly, ragged texture. The nail may separate from the nail bed (onycholysis) and emit a foul odor in advanced cases. Toenails are affected far more often than fingernails, partly because they grow more slowly and have a moister environment.

When Should You See a Doctor?

See a doctor if warts are painful, bleeding, spreading rapidly, or don't respond to 4-6 weeks of home treatment. Seek care for fungal infections if symptoms persist despite treatment, spread to new areas, or you have diabetes or a weakened immune system. Facial or genital warts, and infections showing signs of secondary bacterial infection (increased redness, warmth, pus), require professional evaluation.

While most warts and minor fungal infections can be managed effectively at home, certain situations warrant professional medical evaluation. Recognizing when self-treatment is insufficient is important to prevent complications, reduce suffering, and ensure you receive appropriate care for your specific condition.

For warts, you should consult a healthcare provider if the wart is painful, especially if it's interfering with daily activities like walking. Warts that bleed, change color significantly, or grow rapidly should be evaluated to rule out other conditions. Warts on the face require professional treatment to avoid scarring, and genital warts always require medical attention as they may indicate sexually transmitted HPV strains and carry different health implications.

People with diabetes should be particularly cautious about foot conditions. Diabetic patients have reduced sensation and blood flow to their feet, making them more susceptible to infections and slower to heal. A simple wart or fungal infection can potentially lead to serious complications in diabetic individuals, so prompt professional care is advisable for any foot condition.

Similarly, people with weakened immune systems – whether from medications, HIV, or other conditions – should seek medical care for warts and fungal infections that might be easily managed at home by immunocompetent individuals. These infections can be more severe and resistant to treatment in immunocompromised patients.

How Can You Treat Warts at Home?

The most effective home treatment for warts is salicylic acid, which has a 70-80% success rate when used consistently for 12 weeks. Apply the acid daily after soaking the wart in warm water and filing down dead skin. Duct tape occlusion is another popular method with some evidence of effectiveness. Be patient – warts may take weeks to months to clear with home treatment.

Home treatment of warts is often successful, but requires patience and consistency. The goal of most wart treatments is to remove the infected tissue and stimulate the immune system to recognize and fight the underlying HPV infection. This process takes time because the virus is protected within the skin cells it has infected.

Salicylic acid is the most well-studied and effective over-the-counter treatment for warts. Available in various formulations including liquids, gels, pads, and plasters, salicylic acid works by gradually dissolving the keratin protein that makes up the wart tissue. Products range from 17% concentration (suitable for most warts) to 40% (for more stubborn cases or use on thicker skin). The key to success is consistent daily application and patience – treatment typically requires 6-12 weeks.

For optimal results with salicylic acid treatment, follow these steps: First, soak the affected area in warm water for 5-10 minutes to soften the skin. Then, gently file the wart surface with a pumice stone or emery board to remove dead tissue, using a tool dedicated solely to this purpose. Apply a thin layer of salicylic acid directly to the wart, being careful to avoid surrounding healthy skin. Cover with a bandage and repeat daily. White, macerated tissue indicates the treatment is working – this dead tissue can be filed away before the next application.

Cryotherapy products available over-the-counter use dimethyl ether and propane to freeze warts, mimicking the liquid nitrogen treatment used in medical offices. While less cold than professional cryotherapy (-57°C versus -196°C), these products can be effective for some warts. They work by destroying wart tissue through freezing, creating a blister that separates the wart from healthy skin. Results are mixed, and professional cryotherapy is generally more effective for stubborn warts.

Duct tape occlusion therapy is a popular folk remedy that has gained some scientific support, though study results have been inconsistent. The method involves covering the wart with duct tape for 6 days, removing it, soaking the wart, filing it down, leaving it uncovered overnight, and repeating. The proposed mechanisms include suffocating the wart and stimulating an immune response through irritation. While some studies show effectiveness comparable to cryotherapy, others show little benefit. Given its low cost and minimal risk, it's a reasonable option to try alongside or after other treatments.

How Do You Treat Fungal Skin Infections?

Fungal skin infections are treated with antifungal medications. Athlete's foot and ringworm typically respond to over-the-counter antifungal creams containing clotrimazole, miconazole, or terbinafine, applied twice daily for 2-4 weeks. Nail fungus requires longer treatment, often 6-12 months with prescription oral antifungals like terbinafine or itraconazole for complete cure.

Treatment of fungal skin infections has improved significantly with the development of modern antifungal medications. The choice of treatment depends on the type and severity of infection, the area affected, and patient factors such as other medications and overall health. Most superficial fungal infections respond well to topical treatments, while nail infections often require systemic therapy.

Treating Athlete's Foot

Most cases of athlete's foot can be successfully treated with over-the-counter antifungal products. Terbinafine (Lamisil) is particularly effective, often clearing infections in 1-2 weeks. Clotrimazole (Lotrimin) and miconazole (Micatin) are also effective options, typically requiring 2-4 weeks of treatment. Apply the antifungal cream, spray, or powder twice daily to clean, dry feet, extending application beyond the visible infection to catch spreading fungi.

Continue treatment for at least one week after symptoms resolve to ensure the infection is fully cleared – stopping too early is a common reason for recurrence. If the infection involves cracking and fissuring between the toes, the open skin may be susceptible to bacterial infection. In such cases, keeping the area dry and using an antibacterial preparation alongside the antifungal may be beneficial.

For athlete's foot that doesn't respond to over-the-counter treatment after 4 weeks, or that keeps recurring, prescription-strength topical antifungals or oral antifungal medications may be necessary. Oral terbinafine for 2 weeks is highly effective for stubborn athlete's foot.

Treating Ringworm

Ringworm on the body generally responds well to the same over-the-counter antifungal creams used for athlete's foot. Apply the medication to the affected area and extend about an inch beyond the visible border of the rash. Treatment typically takes 2-4 weeks. Because ringworm is contagious, wash hands after touching the affected area and avoid sharing towels or clothing until the infection clears.

Ringworm on the scalp (tinea capitis) requires oral antifungal medication because topical treatments cannot penetrate the hair follicle where the fungus resides. Treatment with oral griseofulvin, terbinafine, or itraconazole is typically needed for 6-12 weeks. A selenium sulfide or ketoconazole shampoo used twice weekly can help reduce contagiousness during treatment.

Treating Nail Fungus

Nail fungus is the most challenging fungal infection to treat due to the nail's protective barrier. Topical treatments available over the counter have limited effectiveness because they struggle to penetrate the nail plate. Ciclopirox (Penlac) nail lacquer is a prescription topical option that, when applied daily for 48 weeks, cures approximately 7-10% of infections – better than nothing, but not highly effective.

For most nail fungus cases, oral antifungal medications offer the best chance of cure. Terbinafine (Lamisil) taken daily for 6 weeks (fingernails) or 12 weeks (toenails) achieves cure rates of 70-80%. Itraconazole (Sporanox) is an alternative, sometimes given as pulse therapy (one week per month for 3-4 months). These medications require prescription and monitoring for potential liver effects, though serious side effects are rare.

Even with successful treatment, the nail takes time to grow out and appear normal. Fingernails grow about 3mm per month, toenails about 1mm per month. Complete cosmetic improvement may take 6-12 months after successful antifungal treatment as the healthy nail gradually replaces the damaged portion.

How Can You Prevent Warts and Fungal Infections?

Prevent warts by avoiding direct contact with warts, not walking barefoot in public areas, keeping skin intact and healthy, and not sharing personal items like towels. Prevent fungal infections by keeping skin clean and dry, wearing breathable footwear, avoiding walking barefoot in public showers, and treating infections promptly to prevent spread.

Prevention of both warts and fungal infections relies heavily on understanding how these conditions spread and taking practical steps to reduce exposure. While complete prevention isn't always possible, these strategies can significantly reduce your risk.

Preventing Warts

Avoiding contact with HPV is the primary prevention strategy. Don't touch other people's warts, and if you have warts yourself, don't pick at them – this can spread the virus to new areas. Cover warts with bandages to reduce the risk of spreading them to others or to other parts of your body. After touching a wart, wash your hands thoroughly.

Wear footwear in public showers, locker rooms, and pool areas where HPV can survive on wet surfaces. Keep your skin healthy and intact, as the virus enters through small cuts and abrasions. Avoid sharing personal items like towels, razors, and socks that might harbor the virus. If you bite your nails or cuticles, try to stop – this creates entry points for HPV and can spread warts from fingers to mouth.

Maintaining a healthy immune system helps your body fight off HPV infections. While most people develop some immunity to common HPV strains over time, lifestyle factors like adequate sleep, nutrition, and stress management support immune function. The HPV vaccines (Gardasil, Cervarix) protect against the strains that cause genital warts and cervical cancer, but not the strains that cause common skin warts.

Preventing Fungal Infections

Fungal infections thrive in warm, moist environments, so keeping skin clean and dry is fundamental to prevention. Dry thoroughly between toes after bathing – this area is particularly susceptible to fungal growth. If you're prone to sweaty feet, change socks during the day and consider using antifungal powder in your shoes and on your feet.

Choose footwear wisely. Shoes made of breathable materials like leather or canvas allow moisture to escape. Avoid wearing the same shoes every day – alternate pairs to give each time to dry completely. In hot weather or during exercise, synthetic moisture-wicking socks are better than cotton at keeping feet dry.

Protect your feet in public areas. Wear flip-flops or shower shoes in gym showers, pool areas, and hotel rooms. Don't share towels, shoes, or personal grooming items with others. If you have athlete's foot, treat it promptly to prevent it from spreading to your nails or to other people.

For people prone to recurrent infections, periodic use of antifungal powder or spray can help maintain protection. Some dermatologists recommend continuing antifungal treatment for a week after symptoms resolve, then using the product once or twice weekly as maintenance to prevent recurrence.

What Medical Treatments Are Available?

Medical treatments for warts include professional cryotherapy with liquid nitrogen, electrosurgery, laser therapy, and immunotherapy. For fungal infections, prescription oral antifungals like terbinafine and itraconazole are highly effective. Dermatologists can also offer combination therapies and address resistant cases that don't respond to standard treatments.

When home treatments fail or for more severe cases, healthcare providers can offer more powerful treatment options. A dermatologist is the specialist most experienced with wart and fungal infection treatment, though general practitioners can manage many cases effectively.

Professional Wart Treatments

Cryotherapy with liquid nitrogen is the most common professional wart treatment. The dermatologist applies liquid nitrogen (-196°C) to the wart, destroying the infected tissue through freezing. The procedure causes some pain and typically results in a blister that heals over 1-2 weeks. Multiple treatments spaced 2-3 weeks apart are usually needed. Success rates are approximately 70-75% after multiple sessions.

Electrosurgery and curettage involves numbing the area with local anesthetic, then burning the wart with an electric needle and scraping away the treated tissue. This method is particularly useful for large or stubborn warts. It's highly effective in a single session but carries a higher risk of scarring than other methods.

Cantharidin is a blistering agent derived from beetles that a doctor applies to the wart. It's painless during application but creates a blister over 24-48 hours that lifts the wart from the skin. The blister is then trimmed away at a follow-up visit. This method is particularly useful for warts in children because the initial application is painless.

Immunotherapy approaches attempt to stimulate the immune system to attack the HPV infection. Options include injecting the wart with Candida antigen (which triggers an immune response) or applying imiquimod cream (Aldara), which activates local immune cells. These treatments are particularly useful for patients with multiple or resistant warts.

Laser treatment using pulsed dye lasers can destroy wart blood vessels, effectively starving the wart of nutrients. While effective, laser treatment is expensive and usually reserved for resistant cases that haven't responded to other therapies.

Professional Fungal Infection Treatments

For stubborn or severe fungal infections, prescription treatments offer higher success rates. Oral terbinafine is highly effective for both skin and nail fungus, with cure rates of 70-80% for onychomycosis. Treatment duration is typically 6 weeks for fingernails and 12 weeks for toenails. Oral itraconazole is an alternative, sometimes preferred in certain situations.

For patients who cannot take oral antifungals, prescription topical treatments like efinaconazole (Jublia) or tavaborole (Kerydin) offer improved nail penetration compared to older topical agents, with cure rates around 15-18%.

Laser treatment for nail fungus has become available, though evidence for its effectiveness is still limited. The FDA has cleared several laser devices for "temporary increase in clear nail," but this falls short of claiming to cure fungal infection. Laser treatment is expensive and typically not covered by insurance.