Wednesday, September 9, 2009

Common Warts

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

I’m sure I don’t see as many patients with common skin warts as my family practice or dermatology colleagues, but these patients still make it to my office.  Sometimes it’s the primary complaint, sometimes it’s an afterthought.  In reviewing the topic, it occurred to me that most patients don’t need to see any of us for this problem.  They mostly need to accept the fact that the treatment takes TIME.  So if you will persist, then you will often be successful without the expense of seeing a doctor.  (photo credit)
Common warts (Verruca vulgaris) are caused by the human papillomavirus (HPV).  Warts on the hands or feet do not carry the same clinical consequences of HPV infection in the genital area.  It is estimated about 10% of children and adolescents have warts at any given time.  As many as 22% of children will contract warts during childhood.
Common warts can occur anywhere on the body, but 70% occur on the hand.  Often they will disappear on their own within a year.  Even with treatment, warts can take up to a year to go away.
Before heading to the doctor, there are treatments you can try at home:  salicylic acid or duct tape.
When using the 17% salicylic acid gel (one brand name: Compound W), it must be applied every day until the wart is gone.  Only apply to the wart, not the skin around the wart.  This treatment is enhanced by covering the wart with an occlusive water-proof band-aid or duct tape after applying the acid.  It can also be enhanced by gently filing the wart with an emery board daily to remove the dead cells prior to applying the salicylic acid.  Treatment can take weeks to months.  Don’t give up early.
Duct Tape can take weeks or months to be effective.   Apply the duct tape to the wart and  keep it in place for six days.  After removing the tape, soak the wart, and pare it down with a filing (emery) board.  Repeat the above until the wart disappears.  Once again, don’t give up early.
The two  treatments (salicylic acid and duct tape) can be combined.  Apply the salicylic acid liquid to the wart before bedtime.  After letting it air dry for a minute or so,  then apply the duct tape over the wart, completely covering the area. Remove the duct tape the following morning. Each time you remove the tape, you will be debriding some of the wart tissue. Repeat the application each night, until there is no remaining wart tissue.  As with using only one treatment, don’t give up early.

If the above don’t work or you just don’t want to take the time, then you may wish to see your physician for removal.  He can use cryotherapy to destroy the wart.   This method may involve repeated treatment over several weeks.  You can do the following to “get the wart ready for removal” and make the cryotherapy more effective:
  1. Every night for 2 weeks, clean the wart with soap and water and put 17% salicylic acid gel (one brand name: Compound W) on it.
  2. After putting on the gel, cover the wart with a piece of 40% salicylic acid pad (one brand name: Mediplast). Cut the pad so that it is a little bit bigger than the wart. The pad has a sticky backing that will help it stay on the wart.
  3. Leave the pad on the wart for 24 hours. If the area becomes very sore or red, stop using the gel and pad and call your doctor's office.
  4. After you take the pad off, clean the area with soap and water, put more gel on the wart and put on another pad. If you are very active during the day and the pad moves off the wart, you can leave the area uncovered during the day and only wear the pad at night.
If none of the above work, then your wart may need to be removed surgically.  Remember the above all take time, so give them time to work.  Even if the wart disappears with any of the above treatments, it may recur later.

Treatment of Warts; Medscape Article, May 27, 2005: W. Steven Pray, PhD, DPh; Joshua J. Pray, PharmD
What Can Be Done About a Hand Wart That Keeps Reappearing After Removal?; Medscape Article, May 31, 2007; Richard S. Ferri, PhD, ANP, ACRN, FAAN
Duct tape and moleskin equally effective in treating common warts; Medscape Article 2007; Barclay L.
Duct Tape More Effective than Cryotherapy for Warts; AAFP, Feb 1, 2003; Karl E. Miller, M.D.


Dreaming again said...

around age 3 Samuel developed warts (plural) on his nose. I don't remember how long it took us to get rid of them ..but during the 5th grade he was bullied for having them on his face.
(monthly treatment w/ the derm!)

They moved to his knee, and we didn't try as hard ... then he got a severe cut (45 stitches!) and ..the cut ...evidently excised the wart virus from his leg and no more warts.

Not a treatment I'd recommend!

Anonymous said...

Dr - I love your blog and normally would recommend all treatments you describe.

However,not this one! The cutting of the wart & appying more Compound W (which is the worst of the products out thee, btw) is a terrible thing for a diabetic to do! They run into infections of digits & plantar areas just because of this.

As a pharmacist, I prefer the plasters - not just the liquid Compound W (which you can't control at all!). The plasters can be applied for 48 hours at a time, removed & reapplied. The packaging clearly states it takes 12 weeks for treatment.

The bonus is it requires the patient to seek out medical care if the area becomes inflamed, reddened, or if the pt develops constitutional sx (fever, etc).

Compound W is difficult to apply, doesn't stay in place, is difficult to keep at the site & is just messy (plus - it makes permanent discoloration of fabric it touches).

Just my opinion as a pharmacist......

rlbates said...

Anonymous, thank you for the very useful input.

Anonymous said...

Pediatric Annals had a nice article in the July 2009 issue about immunotherapy for warts. Among the list of treatments (with references included) were cimetidine (Zantac), topical sensitizers like diphenylcyclopropenone (DCB) & squaric acid (SADBE), intralesional skin test antigens (ouch!) and 5% imiquimod (Aldara) cream ($$$$$). Have used Zantac for a while - have seen an occasional cure. We've also used some sensitizing agents because our Derm use them, too. No quick cure for warts or their cousins, molluscum, but these do ok.