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May 29, 2013 at 9:36 PMComments: 0 Faves: 0

Options For Treating Warts

By Jeffrey VanWingen M.D. More Blogs by This Author

Most people would agree that warts are icky. They're lumps of tissue that aren't supposed to be on our skin. Warts are contagious, and this leads to a self-consciousness about harboring a pestilence. On the bottom of the feet they hurt, giving painful reminders of their presence with each step. On the genitalia, they are emotionally painful, carrying reminders and regrets.

Warts are common, and people who have them want to be rid of them. This desperation has yielded plenty of solutions to rid the body of warts.

Understanding warts

To best combat an enemy, it's first important to understand how they work, where they come from, their movements, and their motivations. With our enemy, warts, things are well understood. Warts are a viral infection on the skin. The virus thrives in the living tissue of the skin, recruiting a blood supply for nourishment and using the skin to wall itself away from the body's immune system - ingenious, really.

Many different wart-causing viral strains exist. The strains causing genital warts, for instance, are different than those which cause plantar (foot) warts. The concept, however, is very much the same.

Principals in Treatment

In order for warts to go away, it's essential that the body's immune system recognizes that there is a foreign invader to mount a defense. This is the one common denominator in successful treatment regimens. Though it sounds simple, finding success can be tricky.

Options

Cryotherapy: Cryotherapy, or freezing, is probably the most popular method for treating warts. Warts in all areas of the body (feet, genitalia, and skin) are susceptible to cryotherapy. The freezing is generally accomplished using liquid nitrogen. In freezing the tissue in and around the wart, viral particles can be destroyed and the agitation caused can stimulate an immune response. 

While some pain may occur with the treatment, there is also a numbing effect with the cold. A blister may form where the treatment took place, but it will eventually dry up, and the wart tissue may flake away or fall off. Scarring is generally not a problem with cryotherapy. Repeat treatment may be needed after 2-3 weeks. If 3 treatment cycles do not work, I usually pursue other means of treatment. 

Home kits for cryotherapy are available at most pharmacies. They freeze the tissue using alcohol-based chemicals. This method is fairly efficient for superficial warts, but it's probably a better idea to have larger warts treated in a doctor's office with liquid nitrogen.

Salacylic Acid: Acid treatment, in the form of pads or drops is a popular method to treat skin and plantar warts, but is not indicated for genital warts. All forms of salacylic are available at pharmacies. Over weeks, the acid slowly destroys and agitates wart tissue, destroying virus and waking up the immune system, much like cryotherapy. Treatments may be required for up to 12 weeks. Regimens are different among the different brands of pads and drops. Acid treatment may be more likely to cause scaring than cryotherapy.

Bleomycin: The potent medicine, bleomycin, has been used in the past as an antibiotic and as chemotherapy for cancer. Recently, however, it has been used successfully in eradicating warts. It is not indicated for genital warts and is usually used when another treatment fails. A small amount of the medicine is injected directly into the wart. The goal in therapy is to disrupt growth and kill the virus within the tissue. Like cryotherapy, subsequent injections may be required for ultimate success. 

Imiquimod (Aldara): The branded drug,Aldara, is a cream that is indicated for the treatment of genital warts, but not warts found elsewhere. The medication stimulates the immune system to form a response against the virus causing the warts. It does not cause disruption or agitation of the tissue. The cream is used a few times per week, applied at night. The typical course is 6 weeks. While a nice option for genital warts, many insurance companies require failure of cryotherapy before they will pay the high price for the drug.

Cimetidine: This medication had been used for years as a therapy for heartburn and ulcers. It was serendipitously discovered that some people experienced disappearance of their warts on the medication. Research was done that showed bona fide results in its use as a therapy for non-genital warts. The medication is taken as a pill for several weeks. There is some dispute as to whether the dose should be 300 mg or 600 mg taken twice per day.

In my practice, I use the medication primarily when warts are plentiful, making cryotherapy a daunting task, or in conjunction with other therapy as a "boost." Though not known for sure, it is thought that cimetidine stimulates the body's immune response to the virus causing the warts. 

Duct Tape: Yes, studies have shown that duct tape works. The protocol that showed most success in studies involved covering the wart with gray duct tape for 6 days, followed by soaking the wart with water, then removing the dead tissue with a pumice stone or emory board. The process is generally repeated until the wart is gone or therapy is deemed futile. Theoretically, the resin in the duct tape causes breakdown of the skin and prevents light and oxygen from reaching the tissue. The agitation may stimulate the body's immune response. Obviously, this remedy is economical, and most people have a roll laying around to fix everything else that goes awry. 

Apple Cider Vinegar: Vinegar is an acetic acid to be more accurate. Though not very potent as an acid, it seems to get the job done when it comes to the dead skin cells of a wart. The protocol that I recommend involves first paring the dead skin atop the wart with a pumice stone or emory board. Then, apply petroleum jelly to the healthy skin around the wart for protection from the acid. Finally, apply a cotton ball soaked in the vinegar with a band-aid. Repeat the treatment cycle until the wart falls off or is deemed futile.

Podophylium: A plant extract, podophylium is sold as an ointment for warts under various names such as Himalayan mayapple, American mandrake, or devil's apple. The ointment is toxic to cells it comes into contact with, causing irritation. This destroys cells with virus and may stimulate the immune system. The ointment causes irritation over any skin it comes into contact with. Please bear in mind that this treatment should not be used during pregnancy.

Laser Therapy: Pulse dye laser therapy is used to burn off warty tissue and coagulate its blood supply. It destroys the tissue, killing off the areas infected with the virus. Pain and scarring are common with this treatment. Because of this, and the lack of availability, laser treatment is usually reserved for large, difficult to treat, plantar warts.

Efficacy

No head-to-head comparison studies are available pitting the different options against one another. As such, I can't say for sure that one therapy works best, or better, than others. I tell patients to be persistent with wart treatment. It takes time, and sometimes it takes more than one treatment and/or more than one therapy. 

Prevention

An ounce of prevention is worth a pound of cure when it comes to warts. To that end, avoiding skin contact with warts is an important first defense. Using sandals in public showers can help guard against plantar warts, while prudent sexual practices can prevent genital warts.

In Conclusion

Warts are common place, but plenty of remedies exist to rid this tenacious viral infection from the skin. The primary common factor in therapy is an agitation or a disruption that destroys virus-containing cells and wakes up the body's immune system to recognize that there is a virus living in the skin. The remedies, however, take some patience and persistence, but this perseverance will eventually result in wart-free skin.

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