Warts

What are warts?

Warts are benign (non-cancerous) growths in the top layer of the skin.  They are caused by a viral infection of the Human Papilloma Virus (HPV).  Warts are usually rough and skin-colored, but may be red or brown or even flat.  They may look different depending on the type and where they are located.  Multiple warts can be common in people with compromised immune systems, but most people with warts are generally in good health. 

Common warts are most often found on the hands, but can be found almost anywhere on the body.  Knees and elbows are other common sites for these warts.  They can spread more easily if skin is damaged.  This is common around the fingernails in people who bite their nails or pick at their hangnails.

Plantar warts are found on the soles of the feet and be single or in large clusters.  Because of pressure, they flatten and press into the feet where they can be very painful.

Flat warts tend to be smaller and smoother than other types of warts and tend to be present in large numbers.  These are commonly seen on the face, arms and legs and can be spread by irritation such as shaving.

How can they be treated?

Because warts are caused by a virus, they can be very difficult to treat.  Some warts will disappear with one treatment, while others may be treated for months without clearing.  Warts may also clear on their own with no treatment (this is more common in children than adults).  There is no guaranteed cure for a wart.  Dermatologists might even try a combination of the following treatments:

Cryotherapy:

The wart is frozen with liquid nitrogen which causes a blister and causes the wart and surrounding dead skin to fall off.  The treatment itself just lasts for a few seconds, but the blister may take 2 weeks to heal.  Repeat treatments every 10-14 days are typically recommended until the wart is gone.

Cantharidin:

This is a chemical which is applied to the wart.  The area is kept dry for 24 hours and then washed off.  This also causes a blister.  The application of the chemical is painless (though the resulting blister can be painful) and many children and even adults prefer this method.   Repeat treatments every 10-14 days are also recommended with this treatment.

Curettage:

The area around the wart is numbed with an anesthetic and the wart is scraped out using a tool called a curette.  Sometimes Cantharidin is applied 2 days before to create a blister before the curettage.  This method is typically used only for resistant warts.

Aldara (Imiquimod):

This is a cream which helps the immune system fight the virus without the pain of the more destructive treatments.  It is indicated for the treatment of genital warts, but has been used effectively to treat other types of warts.  It doesn’t absorb as well into thicker skin and so a second medication may be prescribed to help soften the skin.

Tagamet (cimetidine):

This oral medication is usually taken to help with ulcers or reflux, but may help fight warts by stimulating the immune system to attack the wart virus.  This typically works better in children than in adults and is typically used with other methods of treatment.

Other treatments:

These may include burning, laser treatment, immunotherapy, and injections with Bleomycin, an anti-cancer drug.

Treatment with chemical compounds: containing salicylic acid, blistering agents, immune system modifiers, or Formaldehyde.

Laser treatments:

"Burning" the warts off with a high-powered laser is very futuristic, but overall only as effective as cryotherapy.

Household treatments

(will only work for you if you do NOT read the last paragraph)

Salicyclic acid:

This is applied in a gel, liquid, or plaster form to the wart daily under a bandage and gradually removes layers of skin.  This is usually not painful, but can take several months to clear a wart.  It typically works better if applied after soaking the skin in water to soften it and removing any dead skin before application of the salicyclic acid.

Duct tape:

People have used this to remove warts for years, and a recent small study showed that it was just as effective as cryotherapy.  A piece of duct tape is applied over the wart and left on for a week.  The tape is then removed and replaced with a new piece.  The main problem with this treatment is that the duct tape sometimes doesn’t stick well.  We’re not sure why this clears warts.

Other treatments:

Hypnosis, suggestion, application of banana peels, etc.  Warts may clear when these treatments are used, especially in children.  It is difficult to know if these treatments actually work, or (more likely) if the warts disappear because the immune system responds to the wart virus augmented by a placebo effect.

Do NOT attempt to cut or burn away the warts, as some Asian practitioners propose: it is very painful, and can lead to infection and/or permanent scarring.

Why do these Household treatments sometimes work?

Without controlled studies for most household remedies, it is difficult to know whether the warts disappear because the remedies work, or if (as is more likely) they disappear due to the individual’s own immune system response to the virus, augmented by a placebo effect. The success of hypnosis in curing warts suggests that the condition may be cured by belief in a remedy, which is why these treatments work best for children.