Warts on the face
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Warts on the face are benign skin lesions with a proliferative nature, most commonly caused by an infection with the human papillomavirus (HPV, Human Papillomavirus). They are among the most common viral skin lesions and can occur in both children and adults. Their location on the face – within the cheeks, forehead, eyelids, around the mouth or chin – presents a particular therapeutic challenge due to the thin skin, high risk of aesthetic complications, and the necessity for precise differentiation from other lesions (e.g., fibromas, melanocytic nevi, or seborrheic keratosis). Although warts are benign, they require dermatological diagnosis, especially if the lesion grows rapidly, changes color, or becomes ulcerated.
Facial warts – what do they look like?
The clinical picture of warts depends on their type, duration, and the patient's immune response. These lesions are papular (raised above the skin surface) with varying degrees of keratinization.
Most common clinical features:
- diameter ranging from 1–10 mm (rarely larger),
- flesh-colored, yellowish, brownish, or grayish hue,
- smooth surface (flat warts) or rough, hyperkeratotic,
- well-defined edges,
- absence of pain (exceptions are irritated or secondarily infected lesions).
In dermoscopy, the following are characteristically visible:
- vascular loops or pinpoint blood vessels,
- areas of hyperkeratosis,
- small dark dots corresponding to thrombosed vessels.
On the face, it is often observed:
- numerous small papules in the forehead and cheek area (flat warts),
- single, thread-like projections around the eyelids and mouth (filiform warts).
The lesions may persist for months or years. In some patients, spontaneous regression occurs due to the activation of the immune response, but this process is unpredictable.
Warts on the face - causes
The direct cause of warts is an infection with the HPV virus, which belongs to the Papillomaviridae family. Over 200 types of HPV have been identified, some of which show tropism to the skin.
The most common HPV types associated with skin warts:
Infection occurs through:
- direct skin-to-skin contact,
- contact with objects contaminated with the virus,
- autoinoculation (transfer of the virus from other areas of the body).
Factors promoting infection and the development of lesions:
- microtraumas to the epidermis (shaving, depilation, mechanical peels),
- reduced immunity (e.g., immunosuppression, chronic stress),
- atopic dermatitis,
- young age (more common in children and adolescents).
The HPV virus infects keratinocytes in the basal layer of the epidermis, inducing their uncontrolled proliferation. This process leads to the formation of a hyperplastic lesion with a characteristic histopathological structure (acanthosis, hyperkeratosis, presence of koilocytes).
Warts on the face – types
On the face, several types of warts can be distinguished, differing in morphology and clinical course:
1. Flat warts (verrucae planae)
- numerous, small (1–5 mm),
- smooth, slightly elevated,
- flesh-colored or light brown,
- most common in children and young adults,
- location: forehead, cheeks, jawline area.
2. Common warts (verrucae vulgares)
- rough, hyperkeratotic surface,
- larger than flat warts,
- can appear singly or in multiples,
- less frequent on the face than on the hands.
3. Filiform warts (verrucae filiformes)
- narrow, elongated protrusions,
- location: eyelids, mouth area, neck,
- often solitary,
- easily irritated by mechanical factors.
4. Differentiation
Changes should be distinguished from:
- soft fibromas,
- seborrheic keratosis,
- molluscum contagiosum,
- melanocytic nevi,
- basal cell carcinoma (in case of atypical changes).
Proper diagnosis is based on dermatological examination, dermoscopy, and in doubtful cases - on histopathological examination.
Warts on the face – removal
Removing warts located on the face requires particular precision and clinical experience. The facial skin is thin, richly vascularized, and prone to post-inflammatory hyperpigmentation and scarring. The choice of method should consider:
- type of wart (flat, common, filiform),
- size and depth of the lesion,
- number of foci,
- skin phototype (risk of hyperpigmentation),
- patient's age,
- presence of comorbidities and immune disorders.
Not every wart requires immediate removal — in children, some lesions undergo spontaneous regression. However, in the case of multiple, growing lesions that are prone to injury or raise diagnostic doubts, medical intervention is recommended.
1. Cryotherapy (liquid nitrogen)
Mechanism: destruction of HPV-infected cells through rapid freezing and secondary necrosis.
Best indications:
- common warts,
- single, small lesions.
Advantages:
- quick procedure,
- high effectiveness in hyperkeratotic lesions.
Limitations on the face:
- less control over the depth of action,
- risk of post-inflammatory hyperpigmentation (especially in higher phototypes),
- possibility of blister formation and transient swelling.
It is not the first choice method for flat warts and in the eyelid area.
2. Laser therapy (CO₂ laser, Er:YAG)
Mechanism: controlled ablation (vaporization) of the lesion with simultaneous coagulation of vessels.
Best indications:
- filiform warts,
- single lesions in sensitive areas (eyelids, mouth area),
- lesions resistant to conservative treatment.
Advantages:
- very high precision,
- control over penetration depth,
- minimal damage to surrounding tissues,
- good aesthetic results.
The CO₂ laser is preferred for more elevated lesions, while the Er:YAG allows for even more delicate superficial ablation – beneficial for small lesions.
3. Electrocoagulation
Mechanism: thermal coagulation and destruction of tissue using high-frequency current.
Best indications:
- single common and filiform warts,
- lesions with clear boundaries.
Advantages:
- quick removal,
- possibility of simultaneous hemostasis.
Limitations:
- higher risk of scarring with deep coagulation,
- requires very precise technique on the face.
4. Medical plasma (Plexr Plus)
Medical plasma works by creating a micro-plasma discharge between the device tip and the skin surface. This causes sublimation (vaporization) of the tissue without direct contact with the substrate.
Best indications:
- filiform warts,
- small flat warts,
- lesions in challenging anatomical areas (eyelids, mouth area),
- patients with a high risk of scarring.
Advantages of plasma:
- no direct contact with the skin (lower risk of infection),
- very precise point action,
- minimal zone of thermal damage,
- shorter recovery time compared to classical electrocoagulation,
- low risk of scars with proper qualification.
Plasma is particularly valued in aesthetic dermatology in areas with thin skin where maximum control of the procedure is required.
5. Topical treatment
Keratolytic agents (salicylic acid) – mainly used outside the face; their use on the face is limited due to the risk of irritation.
Topical retinoids – preferred for flat warts, especially in adolescents; they work by normalizing keratinocyte proliferation.
Imiquimod – modulates the immune response; used in selected cases, especially for recurrent lesions.
Pharmacological treatment is usually less effective than procedural methods for single, well-demarcated lesions.
6. Surgical excision
Reserved for:
- atypical lesions,
- lesions with an ambiguous clinical appearance,
- suspicion of neoplastic transformation.
Allows for histopathological examination, which is crucial in differential diagnosis.
| Type of Wart | Preferred Method |
|---|---|
| Flat, multiple | topical retinoids, Er:YAG laser, plasma |
| Filiform (eyelids, mouth area) | plasma, CO₂ laser |
| Common, hyperkeratotic | cryotherapy, CO₂ laser |
| Recurrent lesions | laser therapy, plasma, immunomodulatory therapy |
| Atypical lesions | surgical excision + histopathology |
Post-procedure care
Regardless of the method, it is necessary to:
- use photoprotection (SPF 50),
- avoid irritating cosmetics,
- have dermatological check-ups in case of recurrence.
It should be emphasized that removal of the lesion does not eliminate the virus from the body. Recurrence may occur, especially in individuals with lowered immunity. Therefore, not only is the method of lesion destruction important, but also the assessment of the patient's overall immunological state.
