Publications
Partners
Skin cancer is a possibility that must always be kept in mind. When a lesion changes in colour or size, especially in older people, a medical practitioner should assess it. Malignancy arising in a common wart is extremely uncommon. When your child has warts, you should visit the doctor with him or her to provide an accurate history. Know which treatments have been tried already. Ideally the person should be seen by the same doctor for follow-up, or at least by someone from the same practice. Continuity of care can help speed up recovery by avoiding repetition.
Treatment depends on the duration, type and extent of the lesions, your age, your immune status and your desire for treatment. 66% of common warts disappear within two years due to the immune response, and 20% of warts disappear within six months.
Home
Warts can initially be treated at home without your seeing a doctor. Non-prescription drugs come in liquid, gel and ointment form. Most preparations contain salicylic acid, which can soften the warts and dissolve them. This treatment doesn’t cause scarring.
The affected area should first be soaked in warm water to soften the skin so that medication can penetrate it. Dead skin can be gently rubbed off with a washcloth or pumice stone. However, don’t traumatise the wart, as this may spread the virus and cause new warts. It is a good idea to apply Vaseline gel around the affected part to prevent the agent getting onto healthy skin.
Alternatively, use zinc oxide plaster to cover the unaffected skin. Then apply the preparation onto the affected part and leave it there for as long as possible.
Medication
Podophyllin is the treatment of choice for anogenital warts. It works similar to the salicylate-based medications, but has a fairly corrosive effect on normal skin. Zinc oxide plaster can be used to protect the normal skin.
Flat warts can often be treated successfully with daily applications of tretinoin (as used in acne). If sufficient peeling does not occur for wart removal, another irritant such as benzoyl peroxide or salicylic acid cream can be applied sequentially with tretinoin.
Injection of bleomycin into the lesions has been tried, but complications may occur. Your doctor would therefore use this medication with caution. Only specialists with experience should use this method.
Surgery
Cryotherapy is highly efficient, but painful. Liquid nitrogen (which is at a very low temperature) is applied with a cotton wool stick or a fine nozzle to freeze the wart and kill it. It subsequently is replaced by healthy skin and peels away. Sometimes frequent applications may be required for stubborn warts. In fact, often up to five visits, at monthly intervals, are needed. This treatment rarely leaves scars, but this also depends on the size of the wart. Hypopigmentation, following treatment is a major problem, especially in dark skin.
Warts can also be treated with laser. This can be very efficient, but may be very expensive.
Some lesions can be excised under local anaesthetic. This has the advantage of microscopic examination for diagnostic reasons. The major disadvantage is scarring. It should only be used when necessary.
Sometimes warts can recur at the wound edge where a wart has been treated, requiring further treatment.
Reviewed by Prof H.F. Jordaan, MBChB, MMed (Derm).
