What is one of the most difficult skin conditions to treat in a single visit? Most are surprised to hear that it’s warts. These benign growths typically need multiple visits but don’t despair, it is possible to treat them over time.

Warts are benign growths that are often flesh-colored, gray, or brown with black dots and commonly found on hands, elbows, knees, and feet. Warts are caused by the human papillomavirus (HPV) for which we do not have a cure, but we can manage them.

Types of Warts

There are different types of warts. The type is determined by what it looks like and where it grows on the body.

• Common Warts are most often found on the hands and around fingernails. They commonly develop where the skin is broken, such as from biting nails or picking cuticles.
• Flat Warts are small pink or brown slightly elevated bumps more commonly found on the face of children (brows) or young adults (beard areas). Flat warts can also be found on dorsal hands and lower legs (women). They are often grouped or in a line as a result of scratching, waxing, or shaving.
• Plantar Warts are typically the most difficult to treat. They grow on the soles of the feet and can be painful to walk on.
• Filiform Warts are small finger-like projections that often grow quickly on the face.

Warts are harmless and may go away without treatment. Some warts may even respond to over-the-counter treatment. There are a number of topical over-the-counter products you can try. We recommend using one with salicylic acid (Mediplast, DuoFilm or Compound W) and combining it with duct tape occlusion. Yes, you read that correctly. After applying the salicylic acid, cover the wart with a piece of duct tape cut as close to the size of the wart as possible. Repeat this process every 6 days for 8-12 weeks or until resolved.

You can also try one of the various cryotherapy options for the home. While not as strong as in-office cryotherapy, it is an over-the-counter treatment that can be an initial attempt.

For any of the over-the-counter solutions, we highly recommend using caution and following the directions closely to avoid damaging the surrounding skin and causing a permanent scar.

If warts remain and especially if they are painful and spreading, then you may need to see a dermatologist. Dermatology treatment for warts often involves a destructive modality that can cause discomfort and blistering.

Treatment Options

A dermatology provider may use one of the following treatments:

• Liquid Nitrogen (cryotherapy) is the most common and often first-line treatment. It is a quick cold spray but feels like a burn and is not too painful. A blister will often develop and it may cause hyperpigmentation (dark spots) on the surrounding skin.
• Cantharidin (“beetle juice”) is a blistering agent that is often “painted” on a wart and a favorite among younger patients as it is not painful when applied. It will cause a blister under the wart and surrounding skin irritation.
• Candida Antigen is injected into the wart with a small needle. This also may cause a blister, surrounding skin irritation, and possibly hyperpigmentation. It is often recommended to inject every month for a few months.
• Immunotherapy Cream such as Aldara (Imiquimod) cream can stimulate the immune system to fight warts. This is a prescription cream that is applied at home three to five times a week and may cause surrounding skin irritation.
• Laser Treatment may be offered if a wart is not responding to other therapies. It can be painful and require multiple treatments. We offer laser wart treatment in our Briargate and Northgate offices.
• Excision (cut out) is an option if all other therapies are unsuccessful but this will result in a permanent scar and the wart may still recur.

As mentioned before, there is no cure for the wart virus. Therefore, you may need multiple treatments to treat a single wart. Even after a wart goes away, it may recur in the same spot or you may develop a new wart in different locations. With continued treatment, however, you can manage the appearance and spread of warts.

Vanguard Skin Specialists began as a Colorado Springs dermatology practice and now has additional offices in Canon City, Pueblo, and Woodland Park. Vanguard specializes in the diagnosis and treatment of skin cancer, and also offers general dermatology, plastic surgery, and aesthetic medicine.

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