Why should we Treat Warts?

There are many reasons to treat warts. These include, but are not limited to:

1. Cosmetic considerations: the patient's desire for therapy
2. The psychosocial stigma: the belief that warts are a lack of cleanliness
3. To decrease the spread or transmission of this virus
4. To relieve the symptoms of itching, pain, bleeding and/or burning
5. To restore function (hard to use fingers that are covered with warts, for example)
6. The possible progression to cancer (NOT all warts have this potential to change)

The ideal treatment:

1. Would eliminate warts in nearly all patients that are treated.
2. Would be painless and not cause scars
3. Would require few treatment sessions
4. Would provide a lifelong immunity (i.e.: could never get another wart)
5. Be easily obtained and at low cost
6. The ideal treatment does NOT exist!

Treatment options available to us today:

1. Duct tape: this needs to be applied to the warts for 6 days and then removed. The affected area has to be soaked in warm water and then the wart has to be gently debrided (rubbed) with an emery board to remove the dead tissue. The duct tape needs to be reapplied and the entire process repeated for at least 2 months. The entire review article can be found in Arch Pediatr Adol Med 156:971-4 (2002). This study found that the majority of warts cleared in the first month, but it was a small study (few patients), comparing duct tape to liquid nitrogen.
   
   
2. Aldara: this is an immunomodulator that has been approved by the FDA to treat genital warts only, but DOES work for most warts. It needs to be applied twice daily to the warts. It is very expensive and requires a long course of therapy to totally eradicate the warts.
   
   
3. Occlusal-HP and Tinamed are 2 examples of over-the-counter products that are applied twice daily to the warts, after they are soaked and mildly debrided. This is a relatively inexpensive treatment, but it time-consuming and needs to be done for a long time.
   
   
4. Liquid Nitrogen (Cryotherapy) is applied to the warts with the intention of causing a blister. The blister elevates the wart virus from the blood supply, thus causing death. This can be painful, scarring can result, and multiple treatments are required.
   
   
5. Cantharidine (from the blister beetle) needs to be applied to the warts in the doctor's office and covered with an occlusive dressing, which is removed anywhere from 2 to 8 hours after it is applied. The Cantharidine is then washed off with alcohol, and a blister results. This elevates the wart from the blood supply, hastening the death of the wart. This is usually painless, though can be unsightly. Repeated treatments may be necessary.

NO single modality is uniformly superior to the other alternatives.

NO single modality will always work for every wart.

Treatment involves some degree of trial and error and many times multiple treatments and multiple modalities are required.

This information should not take the place of a consultation with the dermatologist to see what treatment is best for you.