WHAT CAUSES WARTS?
Warts are a very common problem. It is estimated that 10% of children and young adults are infected. These harmless skin growths can develop on any part of the body. On the hands, warts are most often raised. Flat warts commonly occur on the face, arms and legs. Lesions on the soles of the feet are often compressed or appear flat because of the pressure exerted on this site during walking.
Although warts are generally not a risk to one’s overall health, they can be a nuisance. They may bleed if injured, interfere with walking, and cause pain or embarrassment. Since a virus causes warts, they may spread on the body or to other children. However, despite exposure, some people never get warts while others develop many. This may be immune related, but we don’t know exactly how. There is currently no reliable way to prevent warts, although avoidance of certain activities or behavior such as not picking or not shaving over them, may prevent further spread.
People have been trying to cure warts for thousands of years. Warts frequently resolve spontaneously. The average common wart, if left untreated, will usually disappear within a 2 year time period. This spontaneous disappearance is less common in older children and adults.
There is no single perfect treatment of warts. Because salicylic acid is the only FDA-approved treatment for nongenital warts, the most commonly used treatments are considered “off-label”. The ideal treatment depends on the number, location, and size of warts, as well as your skin type and the judgment of the provider. Treatment is not always indicated. Because the virus that causes warts may be present in the skin for several weeks before producing a visible wart, new warts frequently appear while existing ones are being treated. Multiple office visits may be required. Warts may return weeks or months after an apparent cure. Unfortunately, no matter what treatments are used, some warts occasionally fail to resolve.
Treatments are generally targeted either at destroying the tissue where the wart resides (“destructive methods”), or stimulating the body’s immune system to recognize and eliminate the infection (“immunotherapy”). Destruction can be achieved with chemicals like salicylic acid, freezing with liquid nitrogen, creams containing 5-fluorouracil (Efudex), or with laser surgery. Immunotherapies include imiquimod (Aldara), a cream that stimulates skin cells to produce virus fighting molecules, and injection of a purified form of yeast (“candida antigen”) into the wart to alert the immune system to fight off the virus. With the latter treatment, repeated “booster” injections are typically administered every 4-6 weeks in clinic. In younger patients, the use of oral cimitidine (Tagamet) is sometimes successful at stimulating the immune system to fight off warts. However, it must be taken for 4-6 weeks before an effect can be seen, and treatment is often continued for 3-4 months.
LIQUID NITROGEN TREATMENT
Liquid nitrogen is a cold, liquefied gas with a temperature of 196 degrees below zero Celsius (-321 Fahrenheit). It is used to destroy superficial skin growths like warts. Liquid nitrogen causes stinging and mild pain while the growth is being frozen and then thaws. The discomfort usually lasts only a few minutes. A scar can sometimes result from this treatment, but not usually. After liquid nitrogen application, the treated site may become swollen and red. The skin may blister and form a blood blister. A scab or crust subsequently forms. It will fall off by itself in one to three weeks. No special care is needed after liquid nitrogen treatment. You may wash your skin as usual. If clothing causes irritation, cover the area with a small bandage (Band-Aid) and double antibiotic ointment.
Because one liquid nitrogen treatment often does not completely remove the wart, we often recommend at-home topical treatments following in-office therapy. However, you should not start these treatments until the treatment site has recovered. Wait at least 3 days after liquid nitrogen therapy has been used, or wait until the blister has completely healed (often 5-7 days).
Potential adverse effects of treatment with liquid nitrogen are usually minor and temporary, but include pigmentation change and rarely, scarring.
HOME CARE INSTRUCTIONS
Please follow instructions closely and do not skip days of treatment.
1) Soak warts for 10 minutes in warm water (this can be while bathing or showering). Pat area dry with a towel.
2) Gently remove any whitish dead skin from the surface of the warts. Stop if it becomes painful or starts to bleed. Nailfiles or pumice stones can be used, but should not be reused on normal skin.
3) Apply Dr. Scholl’s, Compound W, DuoFilm, Wart-off or other 17% salicylic acid-containing product to cover each wart. Wait for area to turn white before proceeding. Tapes impregnated with salicylic acid, like Mediplast or transversal, should be placed on top of the dried medicine. Do not apply to normal surrounding skin.
4) Cover warts with white cloth surgical tape or duct tape.
5) Repeat the steps daily if possible. When the tape is removed, it may pull off dead layers of skin from the wart and surrounding normal skin. Stop treatment if skin becomes too irritated.
Questions or concerns? Schedule an appointment with our dermatologist in Mission Viejo at (949) 545-6600.
DermaBare Aesthetics & Laser Center