Warts: Causes & How Well Treatments Really Work

Warts are small, firm, rough lumps on the skin caused by infection with human papillomavirus (HPV). The NHS describes them simply: “Warts and verrucas are small lumps on the skin that most people have at some point in their life,” and they “feel firm and rough.” A verruca is the same thing on the sole of the foot. Warts can appear anywhere but are most common on the hands and fingers.

They are genuinely common. A study of over 1,400 children found prevalence rising from 15% at age 4 to 44% at age 11, and they’re described as “unusual before the age of 4.” Warts spread by direct skin-to-skin contact or by touching contaminated surfaces, with risk higher when skin is wet or broken, and interestingly, one study found that barefoot activity and swimming pool visits did not increase risk, countering a common assumption.

It’s genuinely mixed, and more complicated than for moles or skin tags: the NHS runs a tiered pathway rather than a blanket refusal to fund cosmetic-only removal.

First-line treatment is over-the-counter: “You can buy creams, plasters and sprays from pharmacies,” though the NHS is upfront that these “can take up to 3 months to complete, may irritate your skin and do not always work.” Beyond that, “a GP may be able to freeze a wart or verruca so it falls off a few weeks later,” and resistant cases may be referred on for stronger treatments, cryotherapy or surgical removal.

Funding is where it gets genuinely variable. The NHS’s own guidance says plainly: “Check with the GP if the NHS pays for this treatment in your area.” Unlike skin tags, warts aren’t automatically excluded as cosmetic, but provision differs by local commissioning area, so there’s no single UK-wide answer. If you’d rather not wait to find out, or your GP’s area doesn’t fund it, private treatment is the alternative.

This is worth saying plainly, because it’s easy to assume any treatment “just works.” The best available evidence (a Cochrane systematic review of 85 randomised trials and nearly 9,000 participants) found:

• Salicylic acid (the main pharmacy treatment) has “a definite but modest beneficial effect” over placebo, with warts about 1.5 times more likely to clear than with no treatment. It works better on hand warts specifically than on the whole body average.
• Cryotherapy (freezing), despite being the most familiar GP and clinic treatment, was not statistically significantly better than placebo across the pooled trial data: the review states the results “favoured neither intervention nor placebo.” Freezing harder (more aggressively) does work better than freezing gently, but causes more pain and blistering.
• Combining salicylic acid with cryotherapy performs better than either alone.

Some clinical-reference sources quote higher standalone success rates for cryotherapy (in the region of 70%), but those figures come from single clinical estimates rather than the pooled, placebo-controlled trial data above, and the two don’t fully agree. We think the more conservative, trial-based figures are the honest ones to quote, even though they’re less flattering than the marketing version of “freeze it and it’s gone.” Given the high rate of warts that clear by themselves regardless of treatment, no treatment at all is also a reasonable choice for many people: the case for active removal is usually about wanting it gone faster, or it being somewhere uncomfortable or embarrassing, not because doing nothing is unsafe.