Warts on Tongue – Causes, Removal, and Home Remedies

Warts are a common ailment that has been recognized as afflicting humans for millennia. They were first discovered to be of infectious nature in the late 1800s, and a viral cause was hypothesized in 1907.[1]

In this article, we will be presenting the causes, symptoms, dangers, and treatment modalities of warts on the tongue.

What are warts?

Warts are growths of the skin or mucous membranes (which are the linings of body cavities). They are benign growths, meaning they are not cancers, though some warts may progress to become cancerous.[2]

Warts are caused by a family of viruses, known collectively as human papillomavirus (HPV), which invade the cells of the epithelium, which is the lining of all external body surfaces, and internal body cavities.[3] There are several types of HPV, and they are responsible for causing warts in different locations in the body.[4]

Some warts are contagious and spread by skin-to-skin contact. This is true whether the wart is transmitted from one person to another, or from an area on a person’s body to another area on the same person’s body, a process called autoinoculation. This means that scratching or picking the wart may cause the virus to be transmitted through the fingers to other parts of the body.[5]

What are tongue warts?

Warts on Tongue

Sometimes people get warts on the tongue. These may be caused by several different types of HPV, which result in different types of warts that are called:[6]

  • Squamous cell papilloma: These are the most common benign growths of the oral epithelium. [7]
  • Verruca vulgaris (common warts): The most common HPV wart affecting the skin, this type of wart can also be found in the mouth.[8]
  • Condylomata acuminata (ano-genital warts): These warts originally are found around the genitals and anus, and may be transmitted to the mouth. They are considered a sexually transmitted disease.[9] (Condylomata acuminata is a plural. Its singular is condyloma acuminatum [10])
  • Focal epithelial hyperplasia (Heck’s Disease): This type of wart is mostly prevalent in native populations such as Native North, Central, and South American Indians, and Inuit communities.[11]

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What Causes warts on tongue?

The human papilloma virus causes warts on tongue. HPV is popularly known to cause genital warts but often, people are not aware that it can also cause warts in mouth & throat.

Usually, it caused by having oral sex with a partner that have genital warts or infected by HPV. Formation of several bumps inside the mouth along with tongue is can be a primary sign of HPV infection.

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As we’ve established, warts that occur in the mouth, and more specifically: warts on the tongue, come in 4 types. These 4 types are caused by different types of HPV. There is some discrepancy between studies as to which HPV types are involved in which warts.

Studies have also reported HPV DNA in people that don’t seem to have any warts, where it might be a latent infection (a dormant virus that is not currently active) or a subclinical infection (where the virus is present and active but at a level that does cause symptoms).[12]

Below we will outline those types and the ways through which they might have happened to appear on the tongue.

  • Squamous cell papilloma is caused by HPV types 6 and 11.[13]
  • Verruca vulgaris (common wart) is caused by HPV types 2, 4, and 40.[14] The common wart is a very common occurrence in the skin and it rarely afflicts the mouth. When it does, it is through contact with warts in other areas of the body, or through scratching or picking at the wart, and then introducing the virus via the fingers to the mouth. [15] Though very rare, some studies have reported verruca vulgaris warts on the tongue as standalone infections, without a source in another area of the body. [16]
  • Condyloma acuminatum (ano-genital wart) is caused by HPV types 2, 6, 11, 12, and 116.[17], [18] Infection with condylomata acuminata starts as a genital infection in the person or a sexual partner and is transmitted to the mouth through contact between the mouth and the genitals via autoinoculation or oral sex.[19]

The appearance of this type of wart on the tongue (or in the mouth, in general) is strongly associated with engaging in the practice of oral sex. [20] The risk of infection in the mouth is actually correlated to the number of sexual partners for all types of sexual activities. There is a 20% chance of contracting oral condylomata acuminata when the number of lifetime sexual partners is 20 or more.

Smokers – and particularly heavy smokers – are also at higher risk than non-smokers. [21] Studies have recorded a rise in the incidence of oral HPV infection in the past few decades, and have attributed it to the increase in engagement in oral sex and premarital sex, and having multiple sexual partners. [22]

  • Focal epithelial hyperplasia (Heck’s Disease) is caused by HPV types 13 and 32.[23] Native American and Inuit populations are particularly at risk of contracting Heck’s Disease.[24] Other risk factors may include bad hygiene, communal lifestyles, poverty, and preexisting HIV infection, where the lesions are quite extensive.[25]

What are the symptoms of tongue warts?

Each of these types of warts is slightly different in where it appears on the tongue and its appearance.

  • Squamous cell papilloma usually appears on the lower (ventral) surface of the tongue and on the frenulum, which is the little fold of tissue in the middle, connecting the lower surface of the tongue to the floor of the mouth.

The wart itself has small, fingerlike projections, which resembles a cauliflower, growing outward from the epithelium (exophytic). [26]

  • Verruca vulgaris warts are commonly found in children but can occur at any age. The wart usually grows rapidly reaching an average size of about 5 mm, then remains at that size, often for years. [27] The warts are sessile (meaning not on a stalk), well-circumscribed, exophytic (growing out beyond the epithelium), and with small projections. [28]
  • Condylomata acuminata also show a predilection for the frenulum, and are similar in appearance to papillomas, but are usually larger, more deeply rooted, more clustered, and more diffuse. [29] Warts may sometimes cause discomfort, discharge or bleeding.[30]
  • Focal epithelial hyperplasia warts are often multiple. They have the same color as the surrounding mucous membrane but may be a bit paler, with some projections. The warts are soft, smooth, and dome-shaped, sessile, measuring 1-10 mm. These warts also may persist for years and may resolve spontaneously without treatment.[31], [32], [33]

Aside from the warts themselves, there are usually no other symptoms. Sometimes patients report warts as a roughness in their mouth, or they accidentally bite them and complain of bleeding. [34] The warts are sometimes unsightly and a cause of embarrassment. [35]

Are warts on the tongue serious?

Warts are usually not a serious condition. Many warts remain unchanged for years, and resolve without any intervention, with a low risk of recurrence. [36] There are, however, possibilities of complications, and warts have a risk of progressing to cancer. 25%-35% of oral carcinomas have shown HPV DNA. [37] Warts may even be an indication of sexual abuse!

  • Squamous cell papilloma does not usually progress to cancer. [38]
  • Verruca vulgaris is contagious, and therefore can be spread to other areas of the body, or to others. [39]
  • Condylomata acuminata warts, when diagnosed in children, may point very strongly to sexual abuse, owing to their genital origins. Physicians should notify the appropriate authorities in such cases. [40]

Why didn’t my immune system stop HPV?

There are two basic types of immunity in our bodies[41]: humoral and cell-mediated.

Humoral immunity is combating pathogens by producing antibodies against them.

Cell-mediated immunity functions through cells – called T-lymphocytes – attacking the invading pathogens, and usually ends with these lymphocytes engulfing the pathogens.[42]

The first-time infection with HPV can be stopped through antibodies that are produced against certain proteins in the virus’s coat, but the main mode of immunity against the virus is through cell-mediated immunity, which explains why the warts are often self-limiting. Sometimes, however, the immune system is unable to clear warts for years, for reasons not completely understood.

Some theories state that this is due to an inability of the T-lymphocytes to target viral proteins because they cannot identify those proteins, or through the viruses themselves suppressing immunity. Another theory is that the virus particles escape detection by the immune system.

Removal of warts on the tongue

About 65% of warts resolve spontaneously within 2 years, and 95% within 4 years. In children, 50% will resolve within a year.

There is great variability in the time of resolution of warts, and therefore no reliable prognosis can be offered in each case. [43]

How will a professional remove wart on my tongue?

  • Squamous cell papillomas are painless and may be left without treatment. They usually remain unchanged and do not spread, or progress to cancer. If they must be removed for any reason, then the head and base are surgically excised. [44]
  • Verruca vulgaris warts are also treated the same way: through surgical excision. [45]
  • Condylomata acuminata warts should be removed surgically as well. All warts in any location of the body should be removed at the same time to reduce the risk of autoinoculation. Laser ablation could result in the virus particles becoming airborne, and thus spreading, and is therefore not advised.

Podofilox (Condylox) is an antimitotic topical agent that is prescribed for the treatment of condylomata on the genitals and anus. It has not been approved by the FDA for the treatment of warts on the tongue, but it may prove effective. [46]

  • Focal epithelial hyperplasia can usually be left untreated, as warts usually resolve spontaneously and do not tend to turn malignant. In some cases, surgical excision could be indicated, such as when the patient complains of constantly biting the wart while chewing, causing pain and bleeding. This has been shown to occur in about 49% of cases. There are also other methods of treatment, such as cryotherapy, CO2 laser, electrocoagulation, retinoic acid, imiquimod, and immunostimulants such as interferon. [47]

Are there any home remedies I can use for my warts?

There are some alternative treatments that may be effective to use on warts.[48]

  • Immersing the wart in hot water (113° F / 45° C) for 30 minutes, twice a week may result in resolution.
  • Propolis is a resin that has been shown to be effective against common warts.
  • Raw garlic cloves can be rubbed onto common warts every night, and then covered.
  • Tea tree oil has been reported as successful in resolving warts.

What is Thuja? Is it a good remedy for my warts?

Thuja occidentalis[49] – also known as the eastern white cedar – is a tree native to North America, whose bark, twigs and oil have been used as medicinal products for years. [50] It has been shown effective against warts [51], especially when combined with a natural patch.

Natural patches include banana peel patches, which are applied to the wart and fixed in place, and garlic patches, which are thinly sliced and placed on the wart after it has been covered with a thin layer of castor or olive oil, and also taped or fixed in place. 3 or 4 drops of Thuja oil are applied to the wart before applying the patch. This process should be repeated nightly for about 3 weeks.

More evidence is required to ascertain the effectiveness of thuja in the treatment of warts. [52]

Always consult with a physician before using home remedies.

How can I prevent warts on the tongue?

Best way to prevent it is by avoiding indulging in oral sex. This will prevent HPV infection from spreading one partner to another.

Since humoral immunity in the form of antibodies can be effective against HPV, the use of vaccines is currently being researched. [53] Vaccines against HPV types 6, 11, 16 and 18 are already in use in many countries, and vaccines against other types are currently in development. [54]

The effect of these vaccines in protection against HPV infections is still undetermined. For them to be effective, the vaccines have to be taken before the individual becomes sexually active. The vaccines are promising, though, as studies have shown that taking the vaccines produces a strong humoral immune response. [55]

 

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[2] Ural A, Arslan S, Ersöz Ş, Değer B. Verruca vulgaris of the tongue: a case report with literature review. Bosnian Journal of Basic Medical Sciences. 2014;14(3):136-138. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333997/
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[55] Harper DM, Franco EL, Wheeler CM, et al. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet. 2006;367:1247-1255.

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