Skin papillomas are small, benign growths that appear on the surface of the skin, often resembling warts or tiny tags. While these growths are usually harmless and noncancerous, they can sometimes cause discomfort or concern about appearance, leading many people to seek information about their causes, prevention, and treatment options.
What Are Skin Papillomas?
Skin papillomas are noncancerous growths that develop on the outer layer of the skin. They are benign outgrowths of skin cells that project from the skin surface, creating a distinctive appearance. When these growths appear on the skin, they are commonly known as warts or, in some cases, skin tags.[1]
These growths form from the epithelium, which is the top layer of flat cells covering the skin. A papilloma typically creates a nipple-shaped or raised outgrowth. The appearance can vary considerably, with some papillomas looking rough and bumpy, while others appear smooth or flat. They can range from very small, pinhead-sized bumps to larger growths several centimeters across.[2]
Skin papillomas are small patches that resemble moles and appear primarily on the neck, armpits, and the area under the chest or where a bra sits in women. The color may be similar to normal skin or have a brown hue. They project from the skin either with a broad base or with a small stem, giving them a mobile or fixed appearance depending on their attachment.[3]
Epidemiology
Skin papillomas, particularly when they appear as warts, are extremely common worldwide. These growths affect approximately 10% of the global population at any given time. The prevalence varies by region, with studies showing rates of 0.84% in the United States and 12.9% in Russia for non-genital warts.[6]
Age plays a significant role in the distribution of these growths. Warts are even more common among school-aged children, affecting between 10% and 20% of this age group. Young adults also experience higher rates of infection. The underlying virus that causes most papillomas affects around 11% to 12% of the global population.[8]
Skin tags, a specific type of skin papilloma also known as acrochordons, appear in about 46% of the general population. Unlike viral warts, skin tags become more common with age, affecting older age groups more frequently than younger people. They appear equally in males and females, showing no significant gender preference.[8]
Certain populations face higher risks. People who handle raw meat regularly, such as butchers, are more susceptible to developing specific types of warts. Individuals with weakened immune systems also experience papillomas more frequently and may find them harder to eliminate.[6]
Causes
The vast majority of skin papillomas are caused by human papillomavirus, commonly known as HPV. This is a large family of viruses with more than 170 different types identified. Among these, types 6, 7, and 11 are most commonly associated with papillomas, and these are considered low-risk types because they rarely lead to cancer.[4]
HPV is highly contagious and spreads through direct physical contact. When an infected person touches their skin papilloma and then touches another area of their body or another person, the virus can transfer. The virus thrives in warm, moist environments, which explains why papillomas often appear in areas where skin folds or where friction occurs regularly.[5]
Not all skin papillomas are caused by viruses. Some types, particularly skin tags, may develop without any viral infection. While these growths also contain some HPV in research studies, one study found no significant link between skin tags and HPV infection. These non-viral papillomas are called acrochordons.[8]
The virus typically enters the body through tiny breaks in the skin. Once inside, it can remain dormant for weeks, months, or even years before causing visible growths. During this incubation period, which averages about three months, the infected person shows no symptoms but may still be capable of spreading the virus to others.[3]
Risk Factors
Several factors increase the likelihood of developing skin papillomas. Understanding these risk factors can help people take preventive measures and know when they might be more susceptible to these growths.
Obesity is a significant risk factor for developing papillomas, particularly skin tags. Overweight individuals are more likely to develop these growths due to excessive sweating and increased skin friction. Sweating favors the formation of papillomas, especially where the body forms folds, which are typical in obese individuals. The moist, warm environment created by overlapping skin provides ideal conditions for HPV to thrive.[3]
People with diabetes face a higher risk of developing papillomas because of their compromised immune system. The weakened immune response makes diabetic individuals more susceptible to infections, including viral infections like HPV. For this reason, it’s particularly important for people with diabetes to see a dermatologist if they develop papillomas.[3]
A weakened immune system from any cause increases vulnerability to skin papillomas. People who are immunocompromised due to medical conditions or medications that suppress immune function are more likely to develop warts and may have difficulty clearing the infection naturally. This includes individuals with HIV, those taking immunosuppressive drugs, or people undergoing chemotherapy.[6]
Hormonal imbalances play a role in papilloma development. People with disturbed hormonal systems, including thyroid gland disorders, may be more prone to developing these growths. Pregnancy also increases the likelihood of papillomas appearing, likely due to the significant hormonal changes that occur during this time.[3]
Genetics appears to influence susceptibility to papillomas. Heredity plays a role, as having relatives with papillomas suggests both a genetic predisposition and simply a factor of close contact with infected family members. The presence of papillomas in relatives is a sign not only of genetic risk but also of potential virus transmission through everyday contact.[17]
Certain behaviors and habits increase exposure to HPV. Using public facilities like swimming pools, showers, or gym equipment barefoot raises the risk of infection, particularly for plantar warts on the feet. People whose occupations involve frequent exposure to cold, moist environments, such as butchers handling raw meat, face higher risks of developing specific types of warts.[6]
Skin damage promotes the development of papillomas. Scratching at or picking existing warts can lead to further infection and spreading of the virus to other areas of the body. Areas of the skin that experience frequent trauma or irritation are more likely to develop these growths.[1]
Symptoms
Skin papillomas typically do not cause significant physical discomfort, though they can be bothersome in certain locations. The primary concern for most people is the appearance of these growths and the cosmetic issues they create.
The most obvious symptom is the visible growth itself. Papillomas appear as small, raised bumps on the skin. They can have various appearances depending on their type and location. Common warts typically feel like rough bumps and may have black dots that look like seeds. These black dots are actually tiny blood vessels that have become blocked.[6]
Some papillomas appear flat or only slightly raised from the skin surface. Others project outward more noticeably, sometimes on a thin stalk that makes them mobile when touched. The surface texture varies considerably, ranging from smooth to very rough and irregular. Some may have a cauliflower-like appearance, especially when multiple papillomas cluster together.[2]
The color of skin papillomas ranges from skin-colored to brown, grey, or even black. Most match the surrounding skin tone closely, but some develop a brownish hue that makes them more noticeable. The size can vary from barely visible pinhead-sized spots to growths several centimeters in diameter.[6]
While usually painless, papillomas can become uncomfortable in certain situations. Those located in areas where clothing rubs against them, such as under bra straps or around collars, may become irritated. When papillomas grow in locations that experience frequent friction, they are likely to cause itching, burning sensations, and pain when touched, especially during summer when there is intense sweating.[3]
Trauma to papillomas can cause bleeding. If papillomas are injured through friction or irritation, they may bleed. This is particularly common with papillomas that have a stalk or are located where they frequently catch on clothing or jewelry. In winter, they can get tangled in woolen outfits, causing injury.[3]
Hot and humid areas of the body are more prone to present papillomas with symptoms. The throat, armpits, under the chest, eyelids, and groin are common locations where increased friction of the skin occurs. These body parts with corrugations favor the development of papillomas and may experience more discomfort.[3]
Papillomas typically do not cause systemic symptoms like fever or fatigue. The effects remain localized to the skin where the growth appears. However, if papillomas become infected due to injury or scratching, secondary bacterial infections can develop, potentially causing additional symptoms like increased pain, redness, swelling, or discharge.[2]
Prevention
Although it’s impossible to completely prevent skin papillomas, several strategies can significantly reduce the risk of developing these growths or prevent existing ones from spreading.
Vaccination offers protection against certain types of HPV. The HPV vaccine protects the body from papillomaviruses HPV6, HPV11, HPV16, and HPV18. While this vaccine is most commonly associated with preventing cervical cancer and genital warts, it also provides protection against some types of skin papillomas caused by these specific HPV strains.[3]
Maintaining good hygiene practices is essential for prevention. Regular handwashing helps remove HPV from the skin before it can cause infection. Avoiding direct contact with warts on your own body or other people’s skin reduces transmission risk. If you have a papilloma, avoid touching it unnecessarily, and always wash your hands thoroughly after any contact.[7]
Protecting skin in public places helps prevent infection. Wearing sandals or shower shoes in public showers, locker rooms, and around swimming pools protects your feet from HPV that may be present on wet surfaces. The virus thrives in warm, moist environments, making these locations particularly risky for transmission.[15]
Avoiding skin damage reduces the risk of HPV infection. The virus enters the body through tiny breaks in the skin, so preventing cuts, scrapes, and other injuries helps keep HPV out. It’s particularly important to avoid picking at or scratching existing papillomas, as this can spread the virus to other areas of your body. Never shave over areas with papillomas, as this can cause injury and spread.[3]
Being gentle with your skin during bathing helps prevent spread. Avoid scrubbing the body with a sponge during the bath if you have papillomas, as vigorous scrubbing can damage the growths and facilitate viral spread to other body areas.[3]
Avoiding jewelry and clothing that irritate papillomas prevents injury. If you have papillomas on your neck, avoid wearing necklaces that can irritate them, cause bleeding, and potentially spread the virus. Similarly, choose clothing that doesn’t rub against or catch on existing growths.[3]
Weight management can reduce the risk of developing skin tags and some papillomas. If papillomas are observed due to obesity, losing weight is recommended to stop their spread. Reducing body weight decreases skin folds and excessive sweating, both of which contribute to papilloma development.[3]
Strengthening your immune system helps your body fight off HPV naturally. Most HPV infections are cleared by a healthy immune system within two years. Maintaining overall health through adequate sleep, balanced nutrition, regular exercise, and stress management supports immune function.[7]
Pathophysiology
Understanding how skin papillomas develop at the cellular level helps explain why these growths appear and how they can be treated effectively. The process involves complex interactions between the virus and normal skin cells.
When HPV infects skin cells, it causes those cells to grow faster than normal. Warts occur when skin cells in the epidermis, the upper skin layer, multiply more rapidly because they are infected with the human papillomavirus. This accelerated growth causes the characteristic raised appearance of papillomas.[15]
The virus specifically targets cells in the epithelial surface. The epithelium of the skin is the top layer of flat cells, and when HPV infects these cells, it causes them to proliferate and project outward. This creates the distinctive papillary appearance that gives these growths their name. The cells form finger-like or frond-like structures that extend from the skin surface.[4]
Blood vessels grow into the papilloma to supply it with nutrients. A typical wart develops its own blood supply as it grows, which appears as dark dots or specks in the center of the growth. These are small capillaries that have become visible through the surface of the papilloma. When these blood vessels become blocked or damaged, they create the characteristic black dots often seen in warts.[15]
The immune system plays a crucial role in controlling papillomas. Each person’s immune system reacts differently to HPV infection, which explains why some people develop papillomas after exposure while others do not. The body’s immune response determines whether the virus remains dormant, causes visible growths, or gets eliminated entirely.[3]
Papillomas are characterized by the growth of epithelial cells that typically form outward-projecting structures. This exophytic growth pattern means the cells grow outward from the skin surface rather than downward into deeper tissue layers. This growth pattern gives rise to their distinctive raised appearance that makes them visible and sometimes bothersome.[4]
The virus can remain inactive in skin cells for extended periods. After initial infection, HPV may stay dormant for weeks, months, or even years before triggering visible papilloma formation. During this time, the infected person may have no symptoms but can still potentially transmit the virus to others through skin contact.[3]
Most HPV infections and resulting papillomas are self-limiting in people with healthy immune systems. Studies indicate that about half of warts disappear on their own within a year, and two-thirds resolve within two years. This natural resolution occurs when the immune system successfully recognizes and eliminates the virus-infected cells.[15]
The virus does not spread through the bloodstream to other locations. Each papilloma represents a local infection of skin cells. However, scratching or injuring a papilloma can release viral particles that can then infect nearby skin, causing new papillomas to appear in adjacent areas. Although papillomas are not transmitted easily from person to person, they can multiply in the same patient’s body in the event of injury.[3]