Doctors’ Notes

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Warts

Warts are small, firm bumps on the skin. They can have a rough appearance and can also have yellow, tan, black or brown pigmentation.

The medical term for wart is verruca vulgaris, or verruca plantaris, for warts located specifically on the feet. This Note will answer the most frequently asked questions about these bothersome little bumps…

What Causes Warts?

They’re caused by viruses from the human papillomavirus (HPV) family.

How Do You Get Warts?

You get infected with the virus that causes warts — which means warts are contagious. They spread through contact, ho touching a wart can spread it elsewhere on the body or infect someone else. Warts can also be spread by touching an inanimate object that has the virus on it. For example, it’s common for someone to “catch” the virus while walking barefoot at a public pool or in a gym or locker room.

Where Do Warts Occur?

Warts can occur anywhere on the body, but most often on fingers, hands, elbows, knees, and feet. They may occur as single lesions or in groups of multiple lesions in close proximity to each other (at times coalescing).

Who Gets Warts?

Warts rarely occur before the age of 2 but are common in school-aged children. They affect approximately 20% of children. People with eczema or conditions with decreased cell-mediated immunity may be at higher risk of developing them.

How are Warts Diagnosed?

Warts are diagnosed clinically, which means the diagnosis is based on history and physical exam.

How Long Do Warts Last?

Most warts will go away on their own, eventually! This can take up to two years, though,  and recurrence is common.

How Do You Treat Warts?

There are several options for the treatment of warts, and some can even be done at home! We also treat warts in the office. (See below.)

The earlier treatment is started, the better the response! It’s important to note that wart treatment typically require prolonged time (several months) and possibly multiple office visits. All treatments have inconsistent rates of success, which means that a treatment may work for one person may not work for someone else, or even somewhere else on their own body.

We do NOT recommend treating warts on the face, warts directly related to the nail bed, or warts in the genital regions at home. These need to be addressed in the office and may require the expertise of a Dermatologist. For warts that can be treated at home, here are some good options…

Salicylic Acid

This is a topical, painless treatment that can be used at home. Formulations for treatment are produced as liquid, ointment pads, and patches, all of which can typically be found at your pharmacy. We suggest whichever formulation is easiest for you to apply. (There’s no evidence demonstrating one formulation to be better than another.)

For warts on the body, we recommend using 17-40% Salicylic Acid concentration. For warts specifically on the palms and soles, higher concentrations of 40-50% may be necessary. The treatment should be applied directly to the dry wart on a daily basis. The wart should then be covered with duct tape or a band aid. After about 24 hours, take the duct tape/bandaid off, and trim off the excess dead skin (it will look white). Doing this removes the layers of extra skin and allows you eventually to treat the wart itself.

The wart should be examined in the office if greater than 12 weeks of daily therapy is needed. Salicylic acid can be combined with other treatments, such as Cryotherapy — which is completed in the office, to improve its therapeutic response. Local skin irritation can occur with treatment. If this occurs, simply decrease the frequency with which you  administer salicylic acid — typically going to every other day.

Liquid Nitrogen

This treatment, commonly referred to as Cryotheray, freezes the wart. This treatment is recommended for children ages four and older.

We don’t recommend this treatment at home for lesions which involve the nails as this can cause permanent damage to the nails. Each at-home kit is administered slightly differently, so please follow the instructions on the package. The treatment can be repeated once every two weeks.

We don’t advise administer more than six treatments. If the wart is still present after six treatments, the patient should be seen in the office. Side effects of this treatment can include pain at the site as well as redness, blistering, and decreased pigmentation. If these occur, stop the at-home treatment.

Please use as directed by the package, as each at home kit is different. The best results occur combining this treatment with salicylic acid treatment. As always, if you have any questions, please don’t hesitate to ask.

Duct Tape

Some studies have found silver colored duct tape to provide benefit. Other studies have not demonstrated any additional benefit to using duct tape. Duct tape can be used in conjunction with salicylic acid treatment as long as it doesn’t cause additional irritation or pain.

When Should You Come to the Office?

We’re always happy to help when you have questions or concerns about anything. Regarding warts specifically, we recommend coming to the office if:

• You’re unsure if your child has a wart

• The wart doesn’t go away with home treatment

• You don’t feel comfortable with administering home treatment

• There’s pain/numbness tingling associated with the wart

• The wart is red, swollen, or has pus associated with it.

How Do We Treat Warts in the Office?

Our first line is typically Liquid Nitrogen, which is a higher concentration than can be purchased over-the-counter. We may use a topical treatment in the office called Cantharidin, which causes blistering of the lesions within two to twenty-four hours. We may also prescribe topical treatments such as Imiquimod or Fluorouracil. Finally, we may refer to Dermatology if more advanced or invasive treatments are necessary. Some warts need to be surgically removed or shaved, while others may require cauterization or laser therapy. We don’t perform these procedures at Kids Plus.

Can You Prevent Warts?

Because warts are caused by viruses and are contagious through contact, good hygiene (washing hands with soap and water for 60 seconds and using hand sanitizer) can help prevent the spread of lesions to other places on the body as well as to other individuals.

Please do not deliberately manipulate the warts, as this can lead to their spread.

Patients can also avoid possible exposure by wearing their own footwear in public areas — particularly at pools, gyms, locker rooms and showers.

If you are treating a wart at home with a nail file or board, it should NOT be shared with other individuals.

What About the HPV Vaccine?

Human papillomavirus (HPV) vaccines are available for the prevention of genital warts and HPV-related anogenital cancers. This incredible vaccine PREVENTS CANCER!

We HIGHLY recommend starting the vaccine series (2 or 3 vaccines are needed depending on the age when the series is started) between ages 9 and 11 for BOTH boys and girls.

Dr. Kate Belser has been a Kids Plus Provider since 2019.