Scratch Notes 1-3. Flat Warts in Pregnant Women

In this final part on flat warts, I’ll go through the questions I received most often from patients with flat warts during pregnancy in a Q&A format. When you become pregnant, hormonal changes and a weakened immune system can make it common for flat warts to appear or for existing warts to spread further. Many people visit after discovering flat warts during pregnancy because they worry about passing them to their baby after birth. Others come in for laser treatment after delivery and have a lot of concerns about breastfeeding. I’ll explain the related issues in detail now.

*Why do flat warts appear during pregnancy?

When a woman becomes pregnant, she is more likely to develop various infections because of rapid hormonal changes and reduced immunity. Flat warts are also caused by human papillomavirus (HPV), a viral infection, so it seems that we often see patients who come in during pregnancy with common warts on the hands and feet or flat warts on the face or body.

In particular, during the second and third trimesters, when immunity weakens, warts may grow larger or increase rapidly in number.

*Is there a chance of passing them to the baby after birth?

The HPV virus that causes flat warts can be transmitted through direct or indirect skin contact. However, it is not passed to the baby through breast milk during breastfeeding. This may sound a little confusing, but while touching flat warts on the skin may pose a risk of infection, it does not mean that HPV is present in breast milk simply because the mother has flat warts on the face or body.

Then what about direct skin contact? In theory, transmission is possible. If there are warts on the face or neck, for example, direct rubbing of the baby’s face against the mother’s face could spread the virus through contact. Touching the baby’s bare skin without washing your hands thoroughly can also increase the risk of transmission. If there are flat wart lesions around the breast, it is also not impossible for them to spread to the area around the baby’s mouth during breastfeeding.

At this point, you may wonder: even if breast milk itself does not contain HPV, if the baby’s mouth touches the mother’s breast area during breastfeeding, couldn’t the flat warts spread? Then shouldn’t breastfeeding be avoided?!

*Why are flat warts not easily transmitted to newborns?

In reality, even if the mother has flat warts on the breast, babies do not seem to catch them as easily as expected. For the following reasons, newborns do not easily develop flat wart infections.

1. The newborn’s skin barrier is stronger than you might think

✔ A newborn’s skin is protected by vernix caseosa.

Although a newborn’s skin is thin and delicate, the protective layer from the time in the amniotic fluid (vernix caseosa) makes it difficult for viruses to penetrate. You may think of vernix as dead skin and try to forcibly remove it, but it disappears naturally over time, so think of it as a helpful protective barrier and leave it alone.

✔ The skin surface is moist and regenerates quickly, making it difficult for HPV to invade.

Viruses infect through the skin surface where there are small cuts or abrasions, but a newborn’s skin is generally smooth and moist, so the risk of infection is low.

2. Newborns do not touch their faces with their hands very often

Adults unconsciously touch their faces frequently, but newborns are not yet skilled at freely moving their hands, so they do not repeatedly touch their faces very much. Even if there is contact with the flat wart virus in one place, they do not subsequently spread it to other areas. The risk of viral infection increases in areas with tiny cuts or friction, but newborns do not use their hands to injure their skin in the first place.

3. The protective effects of breast milk itself

Breast milk is rich in antiviral components (such as immunoglobulin A, lactoferrin, and lysozyme) that help suppress viral infections. In particular, immune factors in breast milk strengthen the baby’s oral mucosal immunity, making HPV infection less likely. In addition, breast milk continuously rinses the area around the mouth during feeding, which can reduce viral contact.

In other words, the combination of a newborn’s skin barrier, behavioral habits (not touching the face often), and immune system helps protect babies from flat wart infection.

*How can you prevent flat warts from spreading to a baby?

Even now that you know newborns are more resistant to flat wart infection than expected, mothers will still naturally feel anxious. Let’s look at ways to help prevent passing flat warts to a baby.

✔ Wash hands thoroughly

Be sure to wash your hands, especially before breastfeeding and before and after changing diapers.

✔ Avoid direct contact with the baby’s skin

If you have flat warts on the face or body, be as careful as possible to avoid direct contact with the baby’s face, hands, or skin.

✔ Use separate towels, clothes, and bedding

To avoid indirect contact, it is better to use separate towels, pillows, and blankets for the baby.

✔ Do not scratch or remove warts at home; go to a clinic and have them removed with a laser

Even if you pick at or scratch them by hand, warts will not be squeezed out or disappear like milia or acne. Doing so will only increase the chance of infection. It is better to have all visible lesions removed carefully and thoroughly with a laser at a clinic.

*When is the best time to treat flat warts in pregnant women?

During pregnancy, it is generally standard not to perform any treatments or procedures at a dermatology clinic other than ultrasound-based care such as LDM. CO2 laser itself is not thought to have significant systemic effects on pregnant women, but in the unlikely event of a secondary infection, even using antibiotic ointment can be something to be cautious about during pregnancy. That is why it seems safer and more comfortable for both the pregnant patient and the doctor performing the procedure to postpone treatment until after delivery.

✔ When to treat after delivery

Treatment is possible right after delivery, but since most people go directly to postpartum care facilities, it seems better to wait until the body has recovered—usually about 4 to 6 weeks—before starting treatment.

*After laser removal of flat warts on the breast, when can breastfeeding resume?

Many people wait until after delivery, and then have warts on the face, neck, and similar areas removed with a laser without much concern, feeling relieved afterward. However, those with multiple flat warts around the nipple or areola seem to worry more. For those who decide to breastfeed, there is additional concern about whether the warts could spread to the baby during feeding, whether breastfeeding can continue after laser removal, and how to care for the area afterward.

✔ Is it okay to breastfeed right after delivery without removing them?

The answer overlaps with what was explained above. Breast milk itself does not contain flat wart virus, and in fact contains antiviral components that help defend against flat wart infection. However, during breastfeeding, contact between flat wart lesions and the area around the baby’s mouth can understandably feel uncomfortable. In that case, a protective pad can be used so that the breast lesions do not directly touch the baby’s mouth, and it would be better to come to the clinic and have them removed as soon as circumstances allow.

✔ Can you continue breastfeeding immediately after laser removal?

After removing flat warts, a DuoDERM dressing is usually applied to the area for about 1 to 10 days until it heals, so there should not be major restrictions on breastfeeding. However, some people occasionally develop contact dermatitis from regenerative bandages such as DuoDERM. For those individuals, DuoDERM cannot be used, and a mupirocin antibiotic ointment must be applied until the scab falls off. If you are worried about the ointment getting on a newborn’s mouth, it is better to apply the antibiotic ointment right after breastfeeding, leaving as much time as possible before the next feeding, and then wipe the area where the ointment was applied once more with gauze soaked in normal saline just before the next feeding.

That concludes this long post about flat warts.

If you have any questions related to this, please leave a comment and I will answer to the best of my knowledge~