Warts on the face

Warts on the face are benign skin lesions caused by infection with the human papillomavirus (HPV). They belong to the group of viral warts and are formed due to the excessive proliferation of keratinocytes, which are epidermal cells, under the influence of a viral infection. Their location on the face—particularly around the eyelids, cheeks, chin, or jawline—poses a significant aesthetic and psychological problem and requires considerable therapeutic caution due to the thin skin and the risk of scarring. Warts can appear singly or in clusters, and their treatment should be preceded by proper dermatological diagnosis to differentiate them from other lesions, including seborrheic keratosis or neoplastic changes.

Warts on the face – what they look like

The clinical picture of warts on the face depends on the type of HPV virus and the body's immune response. On the face, the following are most commonly observed:

Flat warts (verrucae planae) – small, smooth, slightly raised papules above the skin surface:
- flesh-colored, yellowish, or light brown,
- with a diameter of 1–5 mm,
- often appearing in numerous clusters,
- located on the forehead, cheeks, and nose bridge.
Common warts (verrucae vulgares) – less often on the face, more often near the hairline:
- with a rough, hyperkeratotic (horny) surface,
- with visible pinpoint vessels (thrombosed capillaries).

Characteristic features:

absence of pain (unless the lesion is mechanically irritated),
slow growth,
possibility of spreading through autoinoculation (dissemination during shaving, depilation, scratching).

In differential diagnosis, one should consider:

seborrheic keratosis,
molluscum contagiosum,
soft fibromas,
early forms of basal cell carcinoma (in atypical cases).

Dermatoscopic examination allows for the evaluation of the typical vascular pattern and confirmation of the nature of the lesion.

Warts on the face – causes

The direct cause of warts is infection with the HPV virus, most commonly types 2, 3, 10, and 27. Transmission occurs through direct skin-to-skin contact or indirectly through contaminated objects.

Factors that promote the development of warts on the face:

Microscopic skin damage:
- shaving,
- hair removal,
- cosmetic procedures performed without maintaining aseptic conditions.
Reduced overall immunity:
- chronic stress,
- autoimmune diseases,
- immunosuppressive treatment. -
Atopic dermatitis – disrupted epidermal barrier.
Frequent contact with a moist environment (e.g., swimming pool).

The HPV virus infects the basal layer of the epidermis, integrating its DNA with the host cells. This leads to the disruption of the cell cycle, accelerated proliferation of keratinocytes, and the formation of a visible wart.

It's worth noting that:

the incubation period can last from a few weeks to several months,
in some patients, the lesions may resolve spontaneously (especially in children),
adults more often experience a chronic course and recurrences.

Warts on the face – treatment

Treatment of facial warts should take into account:

location of the lesion,
type of wart,
patient’s age,
risk of scarring or discoloration.

Therapy involves:

Topical treatment (pharmacological)

keratolytic agents (salicylic acid, lactic acid) – less commonly used on the face due to the risk of irritation,
topical retinoids – especially in the treatment of flat warts,
imiquimod – an immunomodulating drug that stimulates antiviral response.

Destructive methods

cryotherapy (freezing with liquid nitrogen),
electrocoagulation,
laser therapy,
medical plasma.

The effectiveness of the therapy depends on:

precision of the procedure,
complete elimination of the lesion,
enhancement of local immunity.

It is not recommended to:

remove the lesions by oneself,
squeeze,
use aggressive chemical preparations without medical consultation.

Complications from improper treatment may include:

scars,
post-inflammatory discoloration,
spread of the virus on the face.

Wart treatments on the face

In the case of lesions located on the face, precision and minimizing damage to surrounding tissues are particularly important.

The most commonly used procedures include:

Laser removal of skin lesions
- precise vaporization (evaporation) of the affected tissue,
- controlled depth of action,
- minimal risk of scarring with proper qualification.
Electrocoagulation
- coagulation (protein denaturation) under the influence of high temperature,
- effective for single lesions.
Cryotherapy
- controlled freezing of the lesion with liquid nitrogen,
- induction of necrosis in HPV-infected cells.
Medical plasma (e.g., Plexr Plus)
- technology utilizing the phenomenon of sublimation (transition from solid to gaseous state),
- no direct contact with the tissue,
- high precision in areas of thin skin (e.g., eyelids).

The choice of method should be preceded by a dermatological consultation and, in case of doubt, a dermatoscopic examination.

Post-procedure recommendations include:

avoiding UV radiation exposure,
using regenerating preparations,
strict adherence to post-procedure recommendations.

In the case of numerous lesions, staged treatment may be necessary.