Exams and Tests

Warts are usually diagnosed based only on their appearance.

In rare cases, more testing is done. If the diagnosis of a skin condition is unclear or if you are at high risk for having skin cancer, your doctor may take a sample of the growth and examine it (a skin biopsy). A biopsy is usually done if a skin growth is darker than the skin surrounding it, appears as an irregular patch on the skin, bleeds, or is large and growing rapidly.

Proper diagnosis of plantar warts is important. Some wart treatments can cause scarring.

Treatment Overview

Not all warts need to be treated. They generally go away on their own within months or years. This may be because, with time, your immune system is able to destroy the human papillomavirus that causes warts.

You may decide to treat a wart if it is:

• Painful.
• Embarrassing.
• Easily irritated.
• Growing or spreading to other parts of your body or to other people.

The goal of wart treatment is to destroy or remove the wart without creating scar tissue, which can be more painful than the wart itself. How a wart is treated depends on the type of wart, its location, and its symptoms. Also important is your willingness to follow a weeks- or months-long course of treatment.

Many people first treat warts themselves by using a nonprescription product such as salicylic acid or nonprescription cryotherapy, which freezes the wart. Cryotherapy can also be done in your doctor's office.

Wart treatment is not always successful. Even after a wart shrinks or disappears, warts may return or spread to other parts of the body. This is because most treatments only destroy the wart and do not kill the virus that causes the wart.

For more information, see:

Warts: Should I Treat Warts?

Home treatment

Many people do not treat warts unless they are unsightly or painful. If you choose to treat your wart, home treatment is usually the first treatment tried. It includes:

• Salicylic acid, a nonprescription medicine that softens the skin layers that form a wart so that they can be rubbed off. It is available as a paint, cream, plaster, tape, or patch that you put on the wart. Salicylic acid may take weeks to months to cure a wart. Salicylic acid formulas include Compound W and Occlusal.
• Tape occlusion (duct tape). This treatment uses tape to cover the wart for a period of time.
• Nonprescription cryotherapy. Although cryotherapy can be performed in your doctor's office, a type of this treatment for common warts on the hands and feet can be done at home. You spray a combination of two chemicals into a foam applicator and then hold the applicator to the wart for a few seconds. This treatment should not be used for children younger than 4 or by pregnant or breast-feeding women.

If you are uncertain that a skin growth is a wart, or if you have diabetes, peripheral arterial disease, or other major illnesses that may affect your treatment, it is best to see a doctor.

Treatment by your doctor

Cryotherapy is often used if home treatment is not successful. This procedure uses a very cold liquid to freeze a wart. Cryotherapy poses little risk of scarring, although it can be painful.

Less commonly used treatment by your doctor includes:

• Retinoid cream (Retin-A, Avita), which is a prescription medicine that you apply to the wart at home. It disrupts the wart's skin cell growth.
• Cantharidin (Cantharone, Cantharone Plus), which causes the skin under the wart to blister, lifting the wart off of the skin. This medicine is injected into the wart at your doctor's office.
• Bichloracetic acid (BCA), which kills warts by destroying the proteins in the cells. It is useful for warts on the palms and the soles of the feet. BCA also can destroy normal cells, which is why careful application is needed. A doctor applies BCA once a week.
• Immunotherapy, which triggers your immune system to destroy the virus causing the wart. Because some of the substances used for immunotherapy are expensive, dangerous, or require specialized handling, such treatment is usually considered only after other methods have failed. Immunotherapy options include contact sensitizers (such as squaric acid dibutyl ester or SADBE), imiquimod (Aldara), and interferon. Interferon is an experimental treatment and is used only for severe and treatment-resistant warts. Discuss the benefits and side effects of interferon treatment with your doctor.

Surgery

If home treatment, cryotherapy, or medicine does not eliminate your wart, your doctor may try to surgically remove the wart. Options include:

• Electrosurgery and curettage. Electrosurgery is burning the wart with an electrical current. Curettage is cutting the wart off with a sharp knife or a small, spoon-shaped tool. The two procedures are often used together.
• Laser surgery, which is burning the wart off with an intense beam of light.

For electrosurgery, curettage, and laser surgery, a local anesthetic is used to numb the skin before the procedure.

What To Think About

Nonprescription salicylic acid is as effective as or more effective than other treatments, with minimal risk and pain.¹

Other treatment options include the medicines 5-fluorouracil and cimetidine and using light or lasers (photodynamic therapy).

Factors to consider before treatment

• Cost. Home treatment is often as effective as treatment by a doctor and costs less. But home treatment may take longer. Less expensive home treatments include tape occlusion or nonprescription salicylic acid.
• Ability to tolerate pain. Quicker but more painful methods include some topical medicines (such as cantharidin) or cryotherapy. You may want to pick a slower, less painful method of wart removal. These methods include tape occlusion and salicylic acid treatments.
• Potential for scarring. Scarring is the most important thing to think about when choosing a wart treatment. Scarring from treatment may be permanent and can be as painful as the wart itself. The bottom of the foot is especially sensitive, a consideration in the case of plantar warts. Scarring is also a cosmetic concern. Treatments that are less likely to leave a scar include salicylic acid, cryotherapy, and laser surgery.
• Risk of infection. Treatment can sometimes cause infection. If you have an impaired immune system or a condition such as diabetes or peripheral arterial disease, discuss your increased risk of infection with your doctor. You may need to take special precautions.
• History of recurrent warts. If you have a history of warts that come back, you may want to discuss more aggressive treatment methods with your doctor.
• Location and number of warts. Large areas covered by warts may be better treated with salicylic acid than with more painful, potentially scarring methods.
• Age. Painful treatments, such as cryotherapy, may not be appropriate for young children. If you are older than age 60 and have never had warts, you may want to see a doctor to check any skin growths for skin cancer.
• Time needed for treatment. Topical (putting medicine on the wart) treatment is often slower than surgical treatment. Some treatment methods, such as immunotherapy applied by a health professional, require repeated office visits. In such cases, the expense and inconvenience may outweigh the benefits of therapy.