Warts: Treatment

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Many of the nonprescription wart remedies available at drug stores will remove simple warts from hands and fingers. These medications may be lotions, ointments, or plasters and work by chemically removing the skin that was affected by the wart virus. The chemicals are strong, however, and should be used with care since they can remove healthy as well as infected skin. These solutions should be avoided by diabetics and those with cardiovascular or other circulatory disorders whose skin may be insensitive and not appreciate irritation.

Flat warts are best treated with topical retinoides (retinoic acid) or a gel containing salicylic acid. The acid doesn't actually kill the wart virus, but waterlogs the skin so that the surface layer, with the virus, peels off. These products can take up to three months of treatment depending on the size and depth of the wart. Patches are also good to use. Rather than applying drops, a small pad is placed on the wart and left for 48 hours and then replaced with a new one. The patch usually contains a higher concentration of salicylic acid and may irritate the surrounding skin. If this occurs, patients should switch to a gel or stop medication for a period. To help the healing process for flat facial warts, men should shave with an electric shaver or temporarily grow a beard. Women with flat warts on areas that are shaved should use other methods to remove hair such as depilatory cream or wax.

Physicians should be consulted if there are no signs of progress after a month of self treatment. Doctors have many ways of removing warts, including using stronger topically applied chemicals than those available in drugstores. Some of these solutions include podofilox, topical podophyllum, and trichloracetic acid (TCA). Some burning and discomfort for one or more days following treatment can be expected. Although these chemicals are effective, they may not destroy all warts completely. A second method of removal is freezing or cryosurgery on the wart using liquid nitrogen. Cryotherapy is relatively inexpensive, does not require anesthesia, and usually does not result in scarring. Although temporarily uncomfortable, it provides an effective and safe way to deliver freezing temperatures to a particular area on the skin, and healing is usually quick. Physicians may also choose to burn the wart with liquid nitrogen or numb the skin and then scrape off the wart. Another removal process is electrocautery (electric burning), destroying the wart by burning it with an electric needle. Laser surgery is also becoming a more common option for removing warts.

Genital warts are the most difficult to treat. They can be removed, but the viral infection itself cannot be cured. Often, because the warts are so small, more than one treatment may be needed. The virus continues to live in the deeper skin, which is why warts often return after they have been removed. Strong chemicals may be applied as well as surgical excision with or without electrocautery. This therapy requires a small operative procedure and a local anesthetic. Laser therapy, although more expensive, is often used for treating venereal warts that are more extensive. The use of lasers which vaporize the lesion can theoretically transmit the HPV. It is not at all clear, however, if this occurs.

There is no one recommended method for eliminating plantar warts. If detected early, cryotherapy is usually enough. However, they can be very resilient, requiring treatment over several months. Treatment ranges from the conservative approach of applying chemical solutions to the more aggressive option of surgery. Patients with diabetes or vascular disease are usually treated with the more conservative methods.

— Ruthan Brodsky