Medical Treatment

Doctors may choose from several different techniques for removing plantar warts.

• Acid: One of the most common methods is to burn warts off with a mild acid applied topically to the wart. This disintegrates the viral cells and allows normal healthy skin to replace them. Many applications may be required over the course of several weeks to achieve this, but the technique is highly successful. Salicylic acid, cantharidin, and dichloroacetic (or trichloroacetic) acid are useful.
  
  
  • Other acid methods may be used.
    
    
    • Upton's paste: A piece of thick adhesive tape (such as Leukoplast), with a hole cut in the middle for the wart, is applied to the sole to isolate the wart. Upton's paste is applied to the wart, and the whole area is covered with a second piece of tape. This is kept dry and intact for 1 week. The wart is then pared (shaved down) and the paste reapplied until clearance occurs. Upton's paste consists of 6 parts salicylic acid and 1 part trichloroacetic acid in glycerin, mixed to a stiff paste (ordered by prescription).
      
      
    • Salicylic acid in white soft paraffin: A mixture of 40-60% salicylic acid in white soft paraffin is applied daily after showering and covered with waterproof tape. You pare the wart once a week with a sharp blade.
      
      
    • Formalin soaks: The doctor prescribes Formalin BP solution 37% and instructs you to make up a 3% solution on a daily basis. This is done by adding 2 teaspoons of the solution to 1 cup of water. Soak the affected area in a shallow dish for 20 minutes daily. Before treatment, Vaseline is applied between the toes and the normal skin surrounding the wart. Once a week the wart is pared with a sharp blade.
      
      
    • Efudex (5-fluorouracil), although not an acid, is another topical ointment that can destroy wart tissue in a manner similar to chemotherapy for skin cancer.

• Laser treatment: New technology has enabled doctors to use lasers to kill the virus in warts. The procedure, sometimes performed in the physician's office, is effective, clean, and accurate. It is also expensive. Some doctors shy away from laser treatment for warts because the benefits are not dramatic enough to warrant the cost.

• Cryotherapy: Freezing warts with a very cold solution such as sodium nitride can kill the virus. This causes the wart to turn black and eventually fall off within a few days. Cryotherapy works well on many parts of the body, but it is sometimes ineffective on plantar warts because they tend to run deep, and the cold may not penetrate far enough to kill the virus completely.

• Debridement: In this technique, the physician uses a scalpel to cut the warts off under anesthetic. It is often the procedure of choice when many small warts are present in a particular area. It can also be used in combination with acid to make sure the virus is killed and to prevent the warts from regrowing.

  Note: Cutting the warts out is generally not recommended for plantar warts because the surgery may leave a painful scar. It is common for warts to return in the scar tissue.

• Oral medication: No oral medication has proven effective.

• Immunotherapy: For plantar warts that are resisting treatment, you may be referred to a dermatologist for immunotherapy in which your body is taught to reject foreign substances.