Verrucas: Causes & When to See a GP First

A verruca is a wart on the sole of the foot: the same infection, just a different location. As the British Association of Dermatologists explains: “plantar warts are usually due to just a few [HPV] strains. Infection makes the skin over-grow and thicken, leading to a benign (non-cancerous) skin growth.” Because they’re on a weight-bearing surface, verrucas often get pushed inward rather than sitting proud of the skin, and can be uncomfortable to walk on.

They typically appear as a white, thickened patch of skin, often with a small black dot at the centre: a tiny blood vessel that has clotted. Some occur singly; others cluster into tightly packed groups known as mosaic warts, which are usually painless but can be more stubborn to treat. A single, protruding verruca (sometimes called myrmecial) tends to be the more painful type. Verrucas are not hereditary.

They’re common: estimates put the general prevalence at 7–12%, rising to as much as 30% in children and young people: particularly those using communal facilities like swimming pools and changing rooms, where the virus spreads via direct contact with infected skin or contaminated surfaces.

Mostly not, once it’s established as a straightforward, asymptomatic verruca. The NHS position: “A GP may be able to freeze a wart or verruca so it falls off a few weeks later,” with referral to a podiatrist available “if you have a large or very painful verruca.” But routine removal of a benign, non-troublesome verruca is generally not funded: one NHS Integrated Care Board’s published commissioning policy explicitly names warts among the benign lesions it “will not routinely fund referral to secondary care” for, unless it’s causing significant functional problems, pain from unavoidable pressure, frequent bleeding, or recurrent infection.

That’s one region’s policy rather than a single national rule, but it reflects how most NHS areas now approach benign lesion removal. In practice, most verrucas that aren’t causing real problems are left alone or self-treated with pharmacy products, and private treatment is the route people take when they want it dealt with faster.

The strongest trial evidence available (a Cochrane systematic review of 85 randomised trials, nearly 9,000 participants, covering warts and verrucas together as HPV-related lesions) found:

• Salicylic acid, the standard first-line pharmacy treatment, “significantly increased the clearance of warts compared to placebo”, about 1.5 times more likely to clear than no treatment, used daily for at least 12 weeks.
• Cryotherapy, the most familiar in-clinic treatment, was not statistically significantly better than placebo in the pooled trial data, and the review found no significant difference between cryotherapy and salicylic acid directly either.
• Combining the two performed better than salicylic acid alone.

That’s a more modest picture than the confidence with which freezing is usually sold. The British Association of Dermatologists’ own patient guidance is consistent with this caution, noting that verrucas “not causing any adverse symptoms such as pain should be left alone,” and that up to 65% resolve by themselves within two years without any treatment at all. Doing nothing is a legitimate, evidence-backed option for a painless verruca that isn’t spreading: treatment is for when you’d rather not wait, it’s painful, or it’s stubbornly persisting.