Warts are predominately small, skin colored rough textured skin growths caused by a viral infection in the top layer of the skin. They are classified clinically as either deep or superficial. Deep plantar warts (myrmecia) are usually painful and the area can be swollen. Superficial warts may form into larger plaques called mosaic warts. They are benign (non-cancerous) lesions which are passed from person to person and can occur almost anywhere on the body – but are most common on the hands and feet. The viral culprit is a type of human papilloma virus that enters through direct contact with the skin. Children and teenagers are most at risk and some people seem to be more susceptible than others.
Skin MD and Beyond offers a wide variety of successful treatments for warts and are able to customize treatments for each patient. Dr. Wright will advise on the treatment(s) that are most suited to you.
Should you treat warts or just leave them?
The nice thing about warts is that whatever you do they usually go away by themselves – unless you have an underlying condition that affects your immune system. The bad thing is that it takes time for them to disappear.
- Three out of 10 warts will go away on their own in 10 weeks.
- Two-thirds of all warts will go away within two years without treatment.
- Warts persisting after two years are less likely to go away on their own.
- Warts seem to last longer in older children and adults.
Treatments for Warts
At Home Treatments
To start, you can buy topical preparations, containing salicylic acid (paint, ointment, gels) over the counter, but you must apply these for 12 weeks every day. You should soften the skin by soaking in warm water and then use a pumice stone or nail file (don’t let others use it afterwards), to rub off the top of the wart before applying.
Some people use the duct-tape method, which involves covering the wart for six days at a time, rubbing off the top of the wart by soaking in warm water and using a pumice stone or nail file before applying new tape. It is thought the process will stimulate the immune system to attack the virus. Seven in 10 warts will be gone within two months.
If you are not sure your wart is really a wart, or if you have diabetes, a compromised immune system or are pregnant, then see your doctor before trying to get rid of them yourself.
As with all warts, treatment choice is affected by the patient’s age, pain tolerance, treatment preference and Dr. Wright’s preference. Each method chosen requires numerous treatment sessions over weeks to months before the warts are completely resolved. Complete treatment requires multiple clinic visits as with each treatment the warts will become shallower and smaller in diameter as the virus causing the warts is destroyed.
How do we treat Warts?
- Preventative Medicine
- Cryotherapy Treatment (Liquid Nitrogen)
- Electro Surgery (Cautery) Treatment
- Prescription Medication
- Surgical Excision
- Laser Therapy
Keep your body clean. The best thing to do is wash your hands and body regularly. Warts spread easier when there are cuts or scratches, so make sure you properly take care of any open wounds.
Keep your immune system strong. People with weak immune systems will be more susceptible to having warts grow on their bodies. You can build your immune system by taking vitamins and other supplements.
Do not scratch. If you already have warts on your body, do not pick or scratch at them, as that will only aggravate them and cause them to grow more and spread.
Dry Off. Moisture allows warts to spread quickly, so make sure you are drying off your body each time you wash it or apply treatment to it. It is important to control sweating by wearing open shoes, avoiding running shoes and using cotton socks. Warts should be covered with waterproof tape in wet environments such as showers and swimming pools to avoid autoinoculation or infection of others.
Cryotherapy Treatment (Liquid Nitrogen)
Liquid nitrogen cryotherapy with a hand-held spray unit. This is a painful procedure, not usually tolerated by children. A 30 second freeze is usually given. Sometimes a double-freeze thaw cycle is used, whereby the wart is frozen for another 30 seconds after it has been allowed to thaw. To learn more click here.
You must have several treatments (usually a minimum of four) and cure rates are related to the number of treatments received, regardless of the interval between treatments (one, two or three weeks). A more rapid cure may be achieved by more frequent treatments. The liquid nitrogen is applied by a cotton bud or using a spray and can cause burning and blistering, especially during the treatment.
Liquid nitrogen is best avoided in darker-skinned patients, as permanent hypopigmentation may occur.
Electro Surgery (Cautery) Treatment
Using a magnifying lamp, a minute, sterile needle is introduced either alongside or into the area to be treated. When in position, a tiny energy current is discharged precisely at the relevant point to have the maximum effect. Local or general anesthesia is usually required. The total cure rate is 20 to 65 per cent. It is a safe, comfortable and effective treatment, which is becoming increasingly popular for treating skin problems in both women and men. These treatments are indicated for large or stubborn lesions.
Upton’s paste: This specialty paste consists of six parts salicylic acid and one part trichloroacetic acid in glycerine, mixed to a stiff paste (ordered by script). A piece of thick adhesive tape (eg, ‘Leukoplast’), with a hole cut in the middle for the wart is applied. The Upton’s paste is applied to the wart and the whole area occluded with a second piece of tape. This is kept dry and intact for one week. The wart is then pared and the paste reapplied until clearance occurs.
Aldara: This prescriptive cream, 5% imiquimod, is an immunomodulator. This cream should be applied three times a week and applied after the wart has been debrided. While it may help clear the lesions, it is also more expensive than other conventional treatments.
Efudex: This immunotherapeutic modality is 5-fluorouracil (5-FU) 5% cream, which has been found to be effective in treating plantar warts in a randomized controlled clinical study. In this study, patients applied 5-FU twice daily with tape occlusion and regular debridement.
Unless warts are very large and uncomfortable, surgical removal is generally avoided. Since warts are caused by a virus, they may recur following attempts at surgical removal or any other modality of therapy. Excision is also not recommended as it may leave a painful scar and wart recurrence in the scar is common, and more difficult to treat.
Carbon dioxide laser is occasionally used for resistant warts. Local anaesthetic is necessary and healing may be prolonged. Complications include scarring, hyperpigmentation and hypopigmentation. Local recurrence of warts may occur.