The Skin Center 26081 Merit Circle Suite #109
Laguna Hills, CA 92653
(949- 582-7699
(949) 582-SKIN
Fax (949) 582-7691
Warts
Warts are pesky bumps caused by a virus called HPV. They are quite contagious and often difficult to treat. No matter what therapy is used, warts generally require multiple treatments to get better. It is not possible to predict how many times a particular wart has to be treated before it completely goes away. Some warts seem to be “friendlier” than others and may go away with very few treatments. Other times, a wart may still not go away even after lots of treatments and different medications.
Overall, warts tend to resolve at some time even without any treatment. The problem with leaving them without treatment is that they may spread to other body parts or other people. There are many ways to treat warts and we are committed to finding the best therapy designed for your wart. It is very important to keep your follow up appointments for best results.
Please check with your own Dermatologist for your personalized wart medication. This is a sample treatment and not intended to serve as medical advice.
PERSONALIZED WART TREATMENT:
1. It is important to remove the thick skin overlying the wart. This is much easier after soaking the wart, or after a shower or bath. You may file down the wart with a coarse emery board or callus peeler (from drugstore).
2. Apply the following each morning under a piece of tape ( electrical or silver duct tape or Band-aid.: : ( if too irritating, stop the tape or use every other day)
40% salicylic acid patch
3. Apply the following each evening: ( if too irritating, stop tape or decrease use to every other night)
Aldara cream or Efudex cream
5. If your skin gets red, raw or too sore, please stop the medications and call us at 949-582-7699 to return for a re- check. If you have any allergic reaction, stop the medication and call our office.
6. Return to the doctor in 2-3 weeks for your follow up check.
WARTS
“20+ ways to lose a wart”
The Skin Center at Laguna
Assistant Clinical Professor of Dermatology, University of California, Irvine
Board- Certified , American Board of Dermatology
Warts, officially called verrucae , are extremely common. There are several types: the common wart ( verruca vulgaris), flat warts ( verruca plana), foot sole warts (verruca plantaris), and genital warts (condylomata accuminata). About 7-10% of the population is affected at some time by these pesky warts. They pose a cosmetic and treatment concern. The highest incidence of warts is in children ages 10-19. They can incubate anywhere from 1-9 months before they become apparent. Warts can last anywhere from as little as 2-3 months and up to more than 5-10 years. Fortunately, even without any treatment at all, about 25% disappear by 3-6 months. Another 50-65% may disappear by 2 years spontaneously.
Warts are most common on locations like fingers, hands & elbows. This may be because of more local trauma and contact with these areas. Warts can also spread in scratched areas or spread in areas of trauma. Any small breaks or abrasions in the skin create a nice open door and can cause the warts to spread there.
All Warts are caused by a virus. They are quite contagious and in general, very challenging and difficult to treat. The virus is called Human Papilloma Virus ( HPV) and there are many different kinds of these viruses. Some of these virus types are “ friendlier’ than others, meaning that they aren’t as pesky and somewhat easier to treat. There is absolutely no unanimously single effective treatment for a wart. They are at best unpredictable and generally require multiple treatments regardless of the therapy used. Even after they go away, there is a 5-10% chance that they recur.
Overall warts are hard to treat. Some of the even more difficult areas are around the nails, under the nails, and plantar ( sole of the foot) warts.
It is very important to complement any physician applied in-office treatments with home maintenance. Good at-home treatments include strong 40% salicylic acid patches ( available without prescription) and filing / gently shaving down the wart . With treatment, we can expect some improvement over 2-4 weeks. However, there is never any guarantee with warts and they are somewhat unpredictable. With continuous treatment, they can resolve as soon as 4-12 weeks. Overall, the best treatments for warts combine several therapies all at the same time for maximum clearing.
Not everything that looks like a wart is always a wart. What other things can look like a wart? Benign irritated barnacles ( seborrheic keratosis), soft corn, callus, Molluscum ( another viral condition common in children), irritated moles, “picker’s wart” , or an irritated skin tag.
WART TREATMENT MENU:
1. Salicylic acid preparations- available at the pharmacy, over the counter without a prescription
Some names include Tenamed, Mediplast , Duofilm, Occlusal HP, Trans Ver sal.
Apply these directly to the wart daily.
PROs- Not painful, can be self applied, inexpensive, overall good treatment
CONs- needs repeated daily application, can irritate surrounding skin, may be slow
2. Liquid nitrogen (freezing)- doctor applied therapy
For best results, need to repeat every 2-4 weeks
PROs- quick/ fast application, physician supervised
CONs- May be very uncomfortable in some areas ( fingers) and some patients, painful for some children, causes blister, requires cost and time of doctor visit every few weeks until gone
3. No treatment- remember that even without any treatment, some warts spontaneously clear
PROs- Free
CONs- warts may spread to other sites, may not go away, and may spread to other people
4. Scraping off and burning (Currettage and dessication)- doctor’s office procedure using local anesthesia
For resistant or recurrent warts.
5. Power of suggestion “ charming of warts”
Distant Healing, hypnosis
6. Acupuncture / Acupressure
7. Duct Tape applications
8. Condylox 0.5% topical solution- prescription product applied by patient at home
Best for moist warts
9. Cantharidin- “ beetle juice”- physician applied in-office to warts
Potent blistering agent. Comes from the blister beetle.
10. Formalin (4ml of 40% formaldehyde in Aquaphor) apply daily by patient at home
11. Lasers-
More for resistant or recurrent warts.
Not a fast cure-all. Still may need multiple treatments.
12. Interferon therapy
Topical and injected interferon alpha and beta
13. Aldara cream- presciption product
Helps body’s own immune system recognize the wart and remove it
Need to apply 3 times a week or daily for up to 16 weeks
14. Podophyllin resin 20-25%
Physician applied in office with cotton tip applicator
Patient will wash off at home in 4-6 hours
15. Retin A or Tretinoin cream
Mild treatment, no scarring, and good for numerous flat warts, facial or neck lesions
16. Efudex 5% cream- prescription cream
Applied at home by patient
17. cimetidine ( Tagamet) – pills taken by mouth
Off label use of a well known stomach ulcer medication
Best for patients with numerous warts, particularly in pediatrics
18. Bleomycin- chemotherapy medication injected directly into the wart
19. Trichloracetic acid ( saturated solution) 50-90%- Physician applied in office every 1-3 weeks
20. Hot water immersion ( Hyperthermia)
for 30-45 minutes 2-3x/week , about 16 trts
CAUTION- do not burn skin
21. Squaric acid sensitization- physician applied initially, then patient resumes at home
22. Cidofovir – new antiviral ( not yet widely available)
23. Photodynamic therapy with 5- Aminolaevulinic acid ( PDT with 5-ALA)
24. Smallpox vaccine
Not recommended
30-60% remission, but risk of scar
25. Surgical removal or excision
More for very resistant or recurrent warts. Recurrence still is possible and no guarantee of cure.
Call to Schedule an appointment at (949) 582-SKIN
Dr. Gary Cole and Dr. Nili Alai are Board-Certified Dermatologists.
For more information, please call (949) 582-7699 or visit the practice website at www.lagunaskincenter.com.
Information in this publication and site is not intended to serve as medical advice. Individuals may use the information as a guide to discuss their treatments with their own physicians. This site does not promote nor endorse the unauthorized practice of medicine by non-physicians or state licensed health care providers.
Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of these artciles have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert.
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