Written by Dr. Ringpfeil
Common warts, or “verruca vulgaris,” are caused by certain strains of the human papilloma virus.
A wart forms when the immune system cannot fight off this virus in the skin. Warts can be transmitted through skin to skin contact or by touching an object or surface infected with the virus, such as a public shower floor. Warts can occur on any area of the body. They are often skin-colored and rough-surfaced, but sometimes are darker in color and smooth to the touch.
Warts are benign and most will resolve without treatment after several years. Treatment is only recommended when warts are actively growing, spreading, or causing symptoms, such as pain or itching.
To date, there is no cure for warts. All at-home and in-office treatments are designed to stimulate the immune system to fight the human papilloma virus from the inside. Many treatments are typically needed to remove warts, especially those in areas of thickened skin such as on the fingers, toes, palms, soles, elbows, and knees. Our medical providers perform and educate our patients about the following at-home and in-office treatment options.
Daily use of immune-boosting vitamin supplements can help the immune system to fight off the wart virus. We recommend Vitamin C 1000 IU, Zinc 50 mg, and 1 tablet of echinacea daily.
Occlusion with duct tape is an easy and inexpensive at-home treatment to remove warts. Although the exact mechanism behind this method is not well understood, studies have shown it to be effective. We recommend a 12 week course of applying duct tape to each wart, changing the tape every 24-48 hours and washing the warts in between tape applications.
When applied topically, salicylic acid, cantharidin, and MCA (monochloroacetic acid) have been shown to improve warts. Salicylic acid slowly destroys affected skin cells and sometimes stimulates the immune system to help destroy the wart virus.
It is widely available over the counter as a gel, liquid, or pad, and comes in a variety of strengths and brands. Cantharidin and MCA are only available in-office. Cantharidin, also called “blister beetle juice,” is a chemical substance that is applied to a wart, then covered with tape. It destroys the wart by forming a blister in the affected skin. MCA is another chemical that can be applied to warts in-office. It is often used in combination with cryosurgery for better efficacy. All of these substances usually require weeks of treatment for best results.
Cryosurgery, or treatment with liquid nitrogen, is one of the most common in-office treatments for warts. Liquid nitrogen is delivered to the wart through a pressurized spray canister. The reaction it creates in the skin stimulates an immune response that can help to fight the wart virus. The treatment may also directly destroy some of the wart growth. The treatment can be uncomfortable, but only lasts a few seconds. It can also cause lightening of the skin in darker complexions. Cryosurgery is performed every 3-4 weeks and often takes several months for warts to completely resolve.
Pulsed dye laser (PDL) treatments can be performed in-office for warts that thrive on feeder blood vessels. When PDL treatment is directed to the wart, it closes off these dilated blood vessels and subsequently starves the wart of its blood supply. Usually several treatments are needed every 3-4 weeks for complete resolution of warts.
Warts can be completely removed in one office visit by shave removal or electrocautery. The characteristics of the wart determines which of these methods is most appropriate. Shave removal “scoops” the wart off of the skin with a blade. This procedure leaves a flat scar on the skin. Electrocautery destroys the wart through burning. Both procedures are performed under local anesthesia, so they are painless. With both removal methods, there is a chance of recurrence of the wart.
The wart virus thrives in moist environments and is most easily contracted through open skin. Therefore, the best ways to prevent warts are to cover open wounds, avoid contact with wet surfaces, keep prone skin dry, and never pick at warts.
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