Wart
Removal.
Treatment options for non-genital warts include freezing, topicals & surgery.
Wart
What are Warts?
Warts are a very common non-cancerous lesion that is caused by the human papillomavirus (HPV). HPV is better known for types 16 & 18 that may cause cervical cancer. Types 4 & 11 may cause genital warts. The HPV vaccine given to Queensland kids at school in year 8 covers these HPV types – and more.
Simple warts are usually caused by HPV types 1,2,4, 60 & 63 and these are not included in HPV vaccinations.
Who gets them?
Although warts can strike anyone, school-aged children are especially prone to them.
Warts are also more likely to appear in people with dermatitis, drug-induced immunosuppression, or human immunodeficiency virus (HIV).
What are the clinical features?
Simple warts may occur anywhere on the body but most commonly appear on hands, feet or knees. Warts that appear on the soles of the feet are also called verrucae.
They present as rough cauliflower-like growths that can range in size from 1mm to 1cm or more.
Warts are ‘caught’ by direct or indirect contact with HPV-infected skin scales found on surfaces such as the tiles around a swimming pool or changing rooms. The virus enters the skin through tiny breaks in the skin surface. Moisture and maceration of the skin on the feet facilitate the spread of warts.
A wart may develop within 1-6 months of exposure to a virus (the incubation period).
The bottom line is that you cannot prevent yourself from getting simple warts.
Gallery of Warts
Please click on the images for details.
What is the significance?
- Viral warts are infectious to the person and others.
- A cutaneous wart can adversely affect one’s psychosocial well-being, including being teased at school, embarrassing, and having permission denied for swimming lessons.
- A periungual wart can cause nails to decay and be destroyed.
- The pain caused by plantar warts (Myrmecia type) interferes with walking and sports, resulting in knee or hip pain.
- The specific HPV types involved in epidermodysplasia verruciformis can cause cutaneous squamous cell carcinomas.
Treatment for Warts
Treating a Wart Yourself
Eventually, most warts disappear on their own. A study conducted in kids showed that two-thirds of warts disappeared within two years of being left untreated.
A reasonable home treatment is with a commercial preparation that contains salicylic acid, a chemical that helps remove the wart’s hard outer layer. Wart-off ® paint is one example. Treatment should be used every night as follows:
- Soak the wart in warm water for at least 5 minutes. This will soften the wart and help the salicylic acid to penetrate the skin.
- A thick and scaly wart should be pared down or filed with sandpaper or an emery board.
- Mask the area around the wart with Nail Varnish or vaseline.
- Use the applicator to apply a very small amount of Wart-Off on the top of the wart only. Avoid contact with the surrounding skin.
- Allow the Wart-Off paint to dry, and cover the wart with occlusive material. You can use a waterproof bandaid or cut off a piece of micropore® tape.
- Wash your hands thoroughly after applying the Wart-Off.
- Remove the bandaid or tape the following morning.
- Repeat once daily for 12 weeks, or until the wart has completely cleared.
The aim of this treatment is to get rid of the wart without causing you or your child any pain. Some warts are already tender, in which case you won’t be able to file down the wart at all. Kids are unlikely to put up with much of this treatment, and your child may only tolerate the application of the product every couple of days. The treatment may make the wart sore, in which case it’s best to leave it a few days.
Mosaic warts may respond to a gel containing formaldehyde. Verrucae that have clustered together are particularly hard to treat. Try soaking the whole area for 10 minutes daily in a diluted formaldehyde solution.
Why you might want your Warts Treated at a Clinic?
- They have been present a long time.
- They have resisted home treatment.
- They are unsightly.
- Concern about spreading them.
- You just don’t like them!
How can I help stop the warts from spreading?
- Wear comfortable shoes. You can purchase special pads to relieve pressure on plantar warts from a chemist.
- Do not share your shoes or socks with anyone else.
- Keep your feet clean and dry, and change your socks daily. Do not go barefoot in public places. Plantar warts should be covered with waterproof plasters or a rubber ‘verruca sock’ if you go swimming.
- Do not pick at your plantar warts.
- When paring or filing down warts, take care not to damage the surrounding skin, as doing so might result in the warts spreading. Dispose of the dead skin carefully. Remember that the sand paper or emery board will probably be contaminated with The HPV virus.
- Check your children’s feet periodically for warts.
Freezing Warts
Cryotherapy is the most common clinic treatment.
Methods available through The Wart Clinic also include Medical-Grade topical treatment, Electrocautery, and Surgery.
Freezing warts may be attempted at home using over the counter products, but they are nowhere near as effective as Freezing using liquid nitrogen in a GP clinic¹. Freezing using over the counter products will freeze at temperatures of up to -70°C, whereas liquid nitrogen freezes at -176°C.
Cryotherapy involves freezing the wart with a 2mm margin of normal skin included in the treated area so as to kill the virus in and around the wart. A thick wart may be pared down before freezing. Cryotherapy is reasonably effective. However, more than one session is usually required to clear the wart. Treatment is performed at 2 to 3-week intervals.
The greater the freeze time, the more effective the treatment but with a greater risk of pain and blistering.
Side effects can include lightening or darkening of the skin in the treated area, which may persist.
How about kids? Children will definitely not appreciate a deep freeze and may hate doctors for years to come! A light freeze may be performed but is probably not going to be effective. Whether you want the wart treated or not depends on your child’s age, their tolerance to potential pain, and their attitude to the wart.
Medical-grade Topical Therapy
Medical grade topical therapy is also available. The application of the product is completely painless although any subsequent blistering may be uncomfortable. The treatment may need to be repeated.
Who do we see at our clinic?
Let’s start with an important point – you don’t have to treat a wart at all. Our patients most often attend our clinic for one of these reasons:
- The wart is located on a visible part of the body
- Concern over the transmission of the (non-genital) HPV Virus to a partner
- Verrucas cause discomfort when walking
- The wart is on the genital area
- The psychological effect
Children do not tolerate intensive treatment, although they do generally tolerate topical therapy. It would be best if you started with home therapies before considering further treatment.
What treatments do you offer?
Warts can be very challenging to treat, and every treatment has its pros and cons.
Treatment options at our clinic include:
- Medical-Grade Topical treatment.
- Cryotherapy
- Surgery using curettage or cautery – although recurrences occur in up to 30% of cases.
Our Doctor at South East Skin Clinic is very experienced at treating warts with various treatment methods, including a combination of the above. However, you may require several visits, and success is not guaranteed.
Treatment can be difficult for persistent warts on the soles of the feet. How do you know which treatment is most likely to work? Treatments that are more intensive increase the probability of treatment success but also lengthen the healing time.
Don’t believe the headline that says ‘simple effective wart treatment’ – there is no such thing.
REFERENCES
- Management of Cutaneous Warts, BMJ, M.Lynch et al, 2014.
- Topical treatments for skin warts, cochrane, 2012.
- Use of Cantharadin for Verruca, podiatry institute, 2012
©South East Skin Clinic, All rights reserved
©South East Skin Clinic, All rights reserved
