Warts/Verruca

Warts (or verrucae) are benign growths of the skin that are very common, especially amongst children and adolescents. Symptoms are usually minimal, unless located on sensitive sites such as the feet (i.e. “plantar warts”). They are considered harmless, though stubborn and often difficult to treat.

The wart virus (HPV) is very common and can spread by direct contact to other parts of the body, or to others. The HPV virus enters the skin through a small scratch or wound. This explains why warts often appear around fingernails and other frequently traumatized areas (ie knees or elbows). Most people who are exposed to the virus do not develop warts. This is because their body’s immune system recognizes the HPV virus and attacks it before it can trigger a growth. 

For those who do become infected, the virus will trigger skin cells to begin reproducing more rapidly. This creates small bumps where the skin becomes a bit thicker than the surrounding areas. The infected skin may also have a slightly different color, and you may notice black dots or blood vessels commonly referred to as “seeds.” The process tends to be quite gradual, with most cases taking 12 months after infection for the growths to fully appear.

The majority of warts will resolve on their own within a 1-2 year period. However, treatment often helps hasten or initiate resolution. Though there are numerous treatments available both over-the-counter and in-office, none have been able to provide reliable cure rates (not even surgical removal!). Unfortunately, the virus can be notoriously resistant, and you should expect to need multiple “rounds” or treatment attempts (usually 4-6 weeks apart). To improve treatment response, your provider may suggest combining in-office procedures with over-the-counter topicals (ie salicylic acid). Additionally, it may be helpful to prevent skin thickening and callus formation by using creams (ie urea), soaks (ie vinegar-water), or physical exfoliation (ie pumice stone).

TREATMENTS 

• Salicylic Acid: Best over-the-counter remedy. Prefer medicated strips/bandages replaced daily.
• Liquid Nitrogen (‘Freezing’): Gold standard in-office procedure. Do NOT attempt over-the-counter  products, as they do not achieve cold enough temperatures (often worsen the lesion).
• Cantharadin (‘Beetle Juice’): Painless in-office application that leads to irritation over the following several  days. Should be covered prior to leaving clinic, with tape/bandage left in place 1-4 hours before washing.
• Candida Antigen: Injection (in-office) with subsequent irritation over the following several days.  Particularly useful for plantar warts or otherwise resistant lesions.
• Surgical Excision: Often not the first choice due to associated scarring that is typically not seen with other  treatments. Also has similar recurrence rates and increased risk of infection.

Other: occlusion (‘duct tape’), electrosurgery (‘burning’), laser, prescription topicals, injectables.