WARTS & WART REMOVAL

A wart is generally a small, rough growth, typically on hands or feet, that resembles a cauliflower.

Warts are common, and are caused by a viral infection, specifically by the human papillomavirus (HPV).

Warts typically disappear after a few months but can last for years and can recur. A few papillomaviruses are known to cause cancer.

Types of warts

A range of different types of wart have been identified, which differ in shape and site affected, as well as the type of human papillomavirus involved. These include:

• common wart (verruca vulgaris): a raised wart with roughened surface, most common on hands and knees
• flat wart (verruca plana): a small, smooth flattened wart, tan or flesh coloured, which can occur in large numbers; most common on the face, neck, hands, wrists and knees
• filiform or digitate wart: a thread- or finger-like wart, most common on the face, especially near the eyelids and lips
• plantar wart (verruca, verruca pedis): a hard sometimes painful lump, often with multiple black specks in the center; usually only found on pressure points on the soles of the feet
• mosaic wart: a group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet
• genital wart (venereal wart, condyloma acuminatum, verruca acuminata): wart affecting the genital areas

Treatment for warts

Prescription

Treatments that may be prescribed by a medical professional include:

• Keratolysis, removal of dead surface skin cells usually using salicylic acid, blistering agents, immune system modifiers, or formaldehyde.
• Cryosurgery, which involves freezing the wart (generally with liquid nitrogen), after which the wart and surrounding dead skin falls off by itself. Surgical removal of the wart is sometimes also performed.
• Laser treatment.
• Imiquimod, a topical cream that helps the body's immune system fight the wart virus by encouraging interferon production.
• Candida injections at the site of the wart, which also stimulate the body's immune system.
• Cantharidin, a chemical found naturally in many members of the beetle family Meloidae which causes dermal blistering.

None of these treatments are very effective on single uses except Cryosurgery; the wart often returns after the skin has healed from the treatment, but repeated treatment should get rid of the wart permanently. As they disappear after a few months and maximally a few years, treatment is necessary only if the lesions are painful or are a cosmetic problem.

One review of 52 clinical trials of various cutaneous wart treatments concluded that topical treatments containing salicylic acid were the best supported, with an average cure rate of 75% observed with salicylic acid compared with 48% for placebo in six placebo-controlled trials including a total of 376 participants. The reviewers also concluded that there was little evidence of a significant benefit of cryotherapy over placebo or no treatment.

Over-the-counter

There are also several over-the-counter options. The most common ones involve salicylic acid. These products are readily available at most drugstores and supermarkets. There are typically two types of products: adhesive pads treated with salicylic acid, or a bottle of concentrated salicylic acid. Removing a wart with this method requires a strict regimen of cleaning the area, applying the salicylic acid, and removing the dead skin with a pumice stone or emery board. It may take up to 12 weeks to remove a stubborn wart.

Another over-the-counter product that can aid in wart removal is silver nitrate in the form of a caustic pencil, which is also available at drug stores. This method generally takes three to six daily treatments to be effective. The instructions must be followed to minimize staining of skin and clothing.

Over-the-counter cryosurgery kits are also available, however they can often cost 3 times as much as the previously named products.

Like prescription treatments, over-the-counter treatments usually require multiple applications, and are only necessary if the warts are problematic. Additionally, these treatments are capable of destroying healthy skin as well as warts, so caution must be exercised by those attempting them without medical supervision.