Treatment of warts

Dermatology and Laser Institute of Colorado, P.C.
9695 S Yosemite St, Ste 120
Lone Tree CO 80124-2888
Warts are benign growths caused by the human papilloma virus. Because warts are caused by a virus, they may spread on your skin or to someone else. Do not pick at your warts with your fingernails, as they may spread to your fingers or under your nails. Warts are notoriously stubborn and difficult to treat. No matter what treatment is chosen for your warts, you should understand that multiple treatments may be required. There is no guarantee of response to a particular type of treatment. Rarely after treatment, a larger doughnut-shaped wart may form, which is clear of wart in the center but has wart tissue present at the edges. Treatment of warts is considered a procedure by most insurance companies and may be applied toward your deductible or co-insurance. Pare the Wart
No matter what treatment you have done, it is very helpful if you pare your wart at home every few days with a blade, pocket
knife, pumice stone, or nail file. The best time is after showering or bathing, when the skin is soft. This will significantly
enhance the ability of any cream or treatment to penetrate to the “roots” of the wart.
Liquid nitrogen
(-196°C). Freezing with liquid nitrogen is the most common treatment. It is safe and nontoxic but somewhat
painful. Young children may not tolerate it. Usually, a scab or blister forms after a wart is frozen.
Cantharidin (extract of blister beetle, or “beetle juice”). This is not FDA-approved, but has been used safely for many years. It
is particularly useful in children since it is not painful to apply. Other medicines that may be applied together with cantharidin
are salicylic acid and podophyllin.
Pulsed dye laser treatment. Often successful, but high energies are used and treatment is painful. We usually numb the skin
first with injected anesthetic. The treated area will be sore and scabby for a few days afterwards. Aggressive treatment with the
laser is usual y required for wart resolution and this can leave a permanent scar.
Candida antigen (yeast extract). This is typically used by allergists during skin testing. It is not FDA-approved for warts, but
can be injected into the wart to try to stimulate an immune reaction in the area. The area may get red, swollen, and tender after
Aldara cream (imiquimod) is FDA approved only for the treatment of genital warts in adults and children age 12 and older, but it
is widely used for all warts. It works by stimulating your body to local y produce interferon, which has antiviral activity. For genital
warts, it is used three times a week. For warts on the palms, soles, or digits, it is used nightly and covered with tape (duct tape
is recommended for the feet). Aldara cream does not penetrate wel through thick skin. You should try to pare down your warts
as directed above. Aldara packets can be reused if they are not empty. Poke a small hole in the packet with a safety pin,
squeeze out the cream, and then fold the packet on itself, seal with a paper clip, and place in a small Zip-loc bag to prevent
evaporation. You may need to continue Aldara for several months. Aldara cream can cause symptoms of local irritation such
as redness, flaking, or burning. If this occurs, use less cream or use it less frequently. Do not use if pregnant.
Dinitrochlorobenzene (DNCB) is a potent topical sensitizer for warts. It is not FDA-approved but has been studied and
appears to be safe. First the patient can be made al ergic to it and then it can be placed on the warts themselves, so that they
are attacked by the body’s immune system. There is a risk of getting a severe local or widespread allergic reaction on the skin.
You must avoid getting the DNCB anywhere else on your skin. Do not use if pregnant.
Bleomycin is a chemotherapeutic agent and a powerful inhibitor of DNA synthesis. Persistent warts resistant to other therapy
can be treated by injection of bleomycin into the wart with a needle. Cure rates of up to 92% have been reported with this
method. Although uncommon, Raynaud’s phenomenon and nail loss or nail dystrophy have been reported after treatment with
intralesional bleomycin. Do not use if pregnant.
Copyright, 2009-2014, Dermatology & Laser Institute of Colorado, Richard J. Ort, M.D., All Rights Reserved Dermatology and Laser Institute of Colorado, P.C.
9695 S Yosemite St, Ste 120
Lone Tree CO 80124-2888
Efudex (5-flourouracil) is another topical medication. It is FDA-approved, but used off-label for warts. It can
be applied twice a day and covered with a bandage or duct tape. Caution should be used around the nails, as it has been
reported to cause abnormal nail growth or nail dystrophy. Efudex is a strong cream with significant potential to cause irritation.
You should not apply Efudex anywhere else on your skin and should wash your fingers after applying it, or use a Q-tip to apply
it. Do not use if pregnant.
Tagamet (cimetidine) is an over-the-counter oral medication that can be used off-label for the treatment of severe warts.
Tagamet is primarily used to treat heartburn and prevent stomach ulcers. There is some evidence that it can stimulate the
immune system to fight the wart virus. It is generally safe, but some possible side effects include headache and diarrhea.
Over-the-counter medications are available. These generally have salicylic acid as the active ingredient .They are somewhat
effective if used on a daily basis for an extended period of time. You can also try wearing duct tape on the wart for an extended
period of time. It is important to pare the wart (see above).
Copyright, 2009-2014, Dermatology & Laser Institute of Colorado, Richard J. Ort, M.D., All Rights Reserved


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