Why Should We Treat Warts?
There are many reasons to treat warts. These include:
- Cosmetic considerations: the patient's desire for therapy
- The psychosocial stigma: the belief that warts show a lack of cleanliness
- To decrease the spread or transmission of this virus
- To relieve the symptoms of itching, pain, bleeding, or burning
- To restore function (e.g., hard to use fingers that are covered with warts)
- The possible progression to cancer, which a risk for only some warts
The ideal treatment, which does not yet exist, would achieve these goals:
- Eliminate warts in nearly all patients who are treated.
- Be painless and not cause scars
- Require few treatment sessions
- Provide a lifelong immunity to contracting warts again
- Be easily obtained and at low cost
Treatment options available to us today:
Duct tape: The tape must be applied to the warts for 6 days and then removed. The affected area must then be soaked in warm water and the wart gently debrided (rubbed) with an emery board to remove the dead tissue. The duct tape must be reapplied and the entire process repeated for at least 2 months. For details, see the article in Archives of Pediatric and Adolescent Medicine, 156:971-4 (2002). This study found that the majority of warts cleared in the first month, but it was a small study with few patients, comparing the effectiveness of duct tape and liquid nitrogen.
Aldara®: This immunomodulator has been approved by the FDA to treat genital warts only, but does work for most warts. It must be applied twice daily to the warts, is very expensive, and requires a long course of therapy to totally eradicate the warts.
Occlusal-HP® and Tinamed®: These over-the-counter products must be applied twice daily, after the warts are soaked and mildly debrided. This is a relatively inexpensive treatment, but it is time-consuming and must be done for a long time.
Liquid Nitrogen (Cryotherapy): This treatment is applied to the warts to cause a blister. The blister elevates the wart virus away from the blood supply, causing the wart tissue to die. This can be painful, scarring can result, and multiple treatments are required.
Cantharidin (an extract from the blister beetle): This product must be applied to the warts in the doctor's office and covered with an occlusive dressing, which can be removed from 2 to 8 hours after it is applied. The Cantharidin 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 it 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.
