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Flat Warts

Dear Doctor

I used to wax sometimes thread. I say 2 months ago something bumps type, it is small skin tissues (dark in color). These are above level of skin surface when I touch I feel it.

I tried exfoliate it, used face wash and retinol cream but no effect. Its looks very ugly. Now I wash face daily and use normal cream.

It is what and how can I remove or exfoliate it.

flat warts

Dear Patient

Flat Warts

The skin lesions are suggestive of flat warts which are also known as verruca plana.

I suggest that you go to your nearest dermatologist to have a skin biopsy done to confirm the diagnosis. In this procedure the skin is numbed with local anesthesia and one of the swellings will be removed and sent to the lab to be examined under a microscope.


Flat Warts Causes

Flat warts are caused by human papilloma virus (HPV) 3, 10, 28 and 48.


Flat Warts Symptoms

Symptoms of flat warts include smooth, flesh colored papules (small swellings of 1-5 mm) with a flat top.

Flat warts tend to appear in a line because of autoinoculation which is reinfection that occurs when the person is scratching or shaving.


Flat Warts Treatment

The treatment of flat warts can be challenging. Though warts have a tendency to resolve on their own, they can persist for years. The treatment of flat warts includes the use of:

Topical medications

Medications which are applied on the skin to treat flat warts include:

1. Retinoids are applied on the warts daily to treat them. 0.05% Tretinoin cream is often the first line treatment for flat warts. This medication works by increasing cell turnover which helps the skin shed the cells infected by the virus. This vitamin A derivative should not be used by women who are pregnant or breastfeeding.

2. 5% Imiquimod cream is also applied on the warts since it induces the immune system to destroy them. It can be used with other topical medications.

3. 10% to 30% Glycolic acid can also be used for flat warts. This naturally occurring alpha hydroxyl acids (AHA) act as keratolytic by loosening the glue that binds the cells on the surface of the skin that have been infected by the virus. It therefore aides the exfoliation or sloughing off these infected skin cells. 30% Glycolic acid peels can be bought over the counter.



Electrocautery, which is burning the warts with an electric needle, is also used to treat flat warts.



Cryotherapy which is freezing the warts with liquid nitrogen, is also used to treat flat warts. Complications include postinflammatory hyperpigmentation especially in persons with dark skin.


Retinols vs Retinoids

You say that you have been using retinol cream and I would like to highlight the differences and similarities between retinols and the retinoids mentioned above.

Retinol and Retinoids Similarities

Retinols and retinoids are both made from vitamin A and they increase the turnover of the skin cells.

Both retinols and retinoids are used to prevent and reverse skin damage caused by UVA and UVB rays from the sun. They are also used to minimize wrinkles and treat acne vulgaris.

Retinols and retinoids should not be used by pregnant women and those who are breastfeeding.


Retinols and Retinoids Differences

The main difference between retinols and retinoids is that retinoids have a higher concentration of retinoic acid which is the active ingredient in both categories. As a result, one needs a prescription to get a retinoid but retinols can be purchased over the counter without a prescription.

Retinols which can be purchased over the counter without a prescription include:

  1. Retinyl palmitate which is found in Estee Lauder Advanced Night Repair.
  2. Retinol which is found in RoC and Neutrogena Ageless Intensive
  3. Retinaldehyde which is found in Avena

Retinoids which require a doctor’s prescription include:

  1. Adapalene with brand names like Differin and Clear
  2. Tretinoin with brand names like Retin-A and Renova
  3. Tazarotene with brand names like Tazorac and Zores

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