One of my old dermatology professors once said, “If you have a huge variety of treatments for a single condition, it means there is no one good treatment for that condition”. He was either talking about warts or rosacea…I can’t quite remember which. However, I am going to address warts.

I see warts each and every day in my office. They are not hard to treat. They are just very difficult to cure. In fact, because warts come from a virus that infects a small opening in the skin (sometimes microscopic), we cannot technically ever cure a virus. Antiviral therapy is really only effective in dramatically slowing the replication of the virus while it is attached to its host. The only way to truly kill a virus is to kill the host. And since we in the business of first doing no harm, that is not really a feasible treatment choice for the common wart.

Warts can occur anywhere on the body, but the most common areas include hands and feet. These areas are the hardest as well to treat. I usually advise patients that it may take anywhere from 5-8 treatments with traditional therapies such as liquid nitrogen cryotherapy for warts on hands and on feet. I have treated some patients with warts on feet (plantar warts) for upwards of 20 treatments! I advise that using topical medications such over-the-counter salicylic acid in concentrations around 40%, or prescription wart medications containing things like imiquimod, urea, salicylic acid or cimetidine can speed the process up, allowing for fewer in-office visits and treatments.

Most therapy for warts has the same general purpose – to irritate the patient’s immune system to the point of recognition that the body will fight the virus that is causing the wart. Some do so in a destructive fashion such as liquid nitrogen cryotherapy, laser destruction, cantherone blistering solution or topical irritants to the skin (salicylic acid and urea) but others work in a more elegant fashion allowing for the immune system to better recognize viral particles and “attack” the viral particles, as is the case with imiquimod. Newer therapies including extracts from green tea leaves such as Veregen, a prescription topical cream that is applied to the warts 3 times daily, but this can typically take up to 16 weeks in order to work! In other words, there is not really a great treatment for the common wart.

Depending on the patient’s insurance, many times it becomes quite costly to have to perform multiple treatments such as liquid nitrogen cryotherapy, cantherone or even the laser destruction. Unfortunately, such as the nature of warts, and they don’t even care that they are costing the patient lots of copays and out of pockets! The nerve!

Regardless if the difficulties with the elimination of the common wart, I always recommend treatment because just as any other virus, it can infect any part of the skin and can spread causing even more warts to form if left untreated. Warts? See a dermatologist!