Treatment Options

There are many factors considered in choosing an appropriate treatment for verrucae. Determining the best way to treat them usually depends upon such factors as size, number, and location, as well as pain, immunologic status and previous treatments. Studies have shown that approximately 65% of all warts in healthy individuals resolve spontaneously (without treatment) within two years [4, 5]. For this reason some doctors and patients elect to leave asymptomatic warts alone.

The decision to treat a wart, rather than waiting for it to disappear on its own, is often a smart one. Treatment serves three main goals: decrease symptomatology, decrease duration, and decrease further transmission. Doctors have a plethora of treatment choices at their disposal and will work with you to select the most appropriate, and hopefully effective, therapy.

Topical medications such as salicylic acid, 5-flourouracil, and cryogens (freezing agents), generally function to stimulate the patient's immune system by triggering a response at the wart site, and ideally clearing the virus from the skin cells. Some of these topical options (commonly salicylic acid) are available over-the-counter at your local pharmacy. Care should be taken in using these products, since the medication will work on whatever skin it comes in contact with, including healthy skin. For this reason, it is recommended that diabetics and other individuals with decreased sensation not use these products without medical supervision. Topical medications have proven to be anywhere from 45 to 86% effective depending upon the number and location of lesions [6, 7]. Many doctors will use a combination therapy-first freezing the wart with liquid nitrogen or other cryogen, and then applying salicylic acid to the lesion. Patients can then continue to apply the acid as directed between visits.

When topical treatments fail, more aggressive surgical procedures are considered. These procedures, performed under local anesthesia, include sharp excision (cutting off the lesion), hyfercation (burning off the lesion), and laser destruction (zapping off the lesion). These procedures are generally painless (since the affected area is numbed beforehand) and may not limit activity afterward. It should be noted that removing the wart with these more aggressive therapies still cannot guarantee its permanent eradication. Often times the virus will retreat and/or lie dormant in the skin cells surrounding the original lesion, only to return at a later time.