Cause
Warts are viral infections. Since this is actually an infection, the warts are contagious and can spread from person to person or can spread on a person. Often all it takes is to touch someone with warts to get them. Some people never seem to get warts, while others have them often. We frequently see swimmers getting warts on their hands and feet. Swimmers must swim barefoot. When the swimmer’s feet rub against the cement or diving board, the rough surface scrapes the wart and releases some of the contaminated tissue. When the next swimmer has a similar abrasion and steps on the infected tissue, then they can get the warts too.
Usual course
Most warts go away without treatment. The problem is that they may take years to go away, and may spread before they do. Most warts go way in 18 months or so. Since the warts may resolve on their own, many wives tales or weird methods to get them to go away have cropped up. My favorite is: take a raw egg, rub it on a pregnant women’s belly, rub the egg on the wart, put the egg in a brown paper bag, and either bury it in the back yard, or put it in the closet. There are several variations of this method. The method might actually work in that it takes the child’s mind off of the wart, and that may help the immune system fight the viral infection.
If the above doesn’t work, then you have to decide whether you want the wart treated, or just want to let it go. In general, I would recommend removal if: the wart hurts, is spreading, is disfiguring, affects some body function, or if you just want it removed.
Treatment Options
Over the counter (OTC = no prescription necessary) methods are basically limited to salicylic acid (Compound W and others) and maybe Cimetadine, depending on the child’s weight. At our office we can prescribe a non-burning cream called Aldara, freeze the wart off with liquid nitrogen, or refer you to a specialist who can electrocute, or cut the wart off. The following are detailed descriptions of each.
Salicylic Acid / Duct Tape
This is over the counter Compound W and others. Buy the one with the strongest % available (up to 20%). To use, soak the wart in warm water until the skin becomes water logged; use a pumice stone, file or sandpaper to remove the top dead layer of tissue; apply the medicine with the brush / applicator; do this 3 times a day until the wart resolves in 3 to 12 weeks. The patch version of these medicines is not very effective. The salicylic acid may sting intensely when it gets on the normal surrounding skin. Since the salicylic acid causes a break in the skin, there is a risk of infection if the wound is allowed to get dirty.
DUCT TAPE: This method works much better with duct tape. The type and brand does not matter. I am sure you have seen a bandaid left on your skin a long time and how that changes the appearance of the skin temporarily. That occlusive effect appears to help kill warts. Leave the acid covered with duct tape on 24 hours a day. Once a day, have a precut piece of duct tape ready (it should completely cover the wart by about 1/4 inch). Remove the old duct tape, put new acid on, and cover with new duct tape. If you do this for 4-6 weeks and its not working, then keep doing it and schedule for us to freeze it. The freezing will work much better after the duct tape and acid method.
Cimetadine
Cimetadine is an acid blocker used for ulcers and heart burn, and goes by the trade name Tagamet. For some unknown reason, it also helps remove warts. The treatment takes a long time to work, generally 2 to 6 months. We will have to calculate the dosage based on weight. There is an over the counter pill, but this may not fit the weight of your child. There is a liquid available, but it requires a prescription.
Aldara
Aldara (imiquimod) is an prescription antiviral drug initially used for genital warts. It has been studied in regular warts and found to be pretty effective. Aldara is not an acid, it actually kills the virus that causes the wart. It is applied 3 times per week for a maximum of 15 weeks. It generally takes about 1 month to see any difference and takes 2 to 4 months to cure. If the medicine is not working by the 2nd month, then it probably is not going to work.
Liquid Nitrogen
This must be performed in the office. We apply liquid nitrogen to the wart with a q-tip and freeze the wart to below 300 degrees below zero. This kills the wart and gives the skin a mild case of frostbite. You will not see any difference in the skin for 2 to 3 days, then a blue-black callous will form (like frostbite) and this will fall off in 2 to 3 weeks. If there is anything left at 3 weeks, the freezing didn’t work. The longer you wait to retreat, the bigger the warts get, and the less chance of success; therefore, if any warts remain after 3 weeks, then return as soon as possible for a second treatment. The freezing numbs the skin as its applied, but still hurts for about 30-45 seconds, and feels like a hard pinch. The freezing extends deep in the skin like a half circle like a melon baler. About 5% of the time, the roots of the wart are deeper than we freeze, and the wart will return.
HOME OVER THE COUNTER FREEZING: There are a number of over the counter freezing options. They only freeze to 20-60 degrees below zero. They do work, but they require you to follow directions exactly and are not as effective as us applying liquid nitrogen. There are a few reasons for this. First, we have decades of experience freezing warts exactly the right time and as quickly as possible. Freezing hurts and therefore many parents do not freeze the wart long enough. Liquid nitrogen, being very much colder that the over the counter method, freezes quicker and deeper. This makes the pain a little less due to the time required to freeze. And it makes it more effective. Parent’s don’t typically tell me when something over the counter works as there is no reason to. But I could not count how many times someone came to me to treat a wart after the home method failed. Please understand it does work somewhat as good as liquid nitrogen, but its hard to cause pain to your child and do it long enough to be effective. Also most children can’t stand to have more than about 8 warts frozen off at one time depending on the size.
Electrodessication
This is done at the dermatologist’s office with a local anesthetic. Electrodessication is essentially electrocuting the wart away. Since the warts have roots sometimes and we don’t want to destroy too much normal tissue, there is a small failure rate. Also, since this method does damage some normal skin and leave an open wound, there is a risk of infection.
A version of this uses a laser to burn away the wart. There is a concern with the laser than some of the wart tissue that is vaporized is not sterile and if that tissue lands on other skin, then a wart can start there. If you see a surgeon or dermatologist, then they can tell you more about the laser.
Surgical Removal
This is also done at the dermatologist’s office under a local anesthetic (depending on the ability of the patient to remain still). As with electrodessication, there is a small failure rate and risk of infection.
