August 31, 2010

| perri dermatology
Medically reviewed by Anthony J. Perri, M.D.

There are many different treatments that exist for warts.  In the past, most warts were excised as an office surgery.  However, this occasionally left a scar that could be more troublesome than the wart.  The recurrence rate of the warts is relatively high using this treatment modality as the HPV virus lives in the surrounding skin of the wart.  Thus, the surgical margin usually does not include the virus affected skin.  Lasering of warts with a CO2 laser had gained popularity in recent years but the HPV virus can be aerosolized and inhalation results in warts arising in the mouth and trachea.  Bleomycin is a chemotherapy agent that can be directly injected into a wart.  Although effective, this method can be excruciatingly painful and can occasionally cause necrosis of normal skin.  Trichloroacetic acid is a treatment that can be used to destroy warts.  The trichloracetic acid denatures the proteins in warts and can be very effective in treating genital and anal condylomas.  Cantharidin is another treatment that can be used.  It is a liquid extracted from the blister beetle.  It is painless when applied to the wart and over several hours it causes a blister to form in the wart.  Unfortunately, it cannot be used on plantar warts as it causes a chemical lymphangitis on the feet as they become very irritated from the cantharidin and can form painful red streaks on the soles of the feet.  Aldara is an immunomodulator cream that has some efficacy in genital/anal warts but I find it to be rather ineffective in treating palmar/plantar warts.  Topical retinoids are also used in the treatment of warts.  They are applied to the warts nightly and eventually cause skin irritation on the warts.  The immune system may now recognize the wart as a foreign invader once it is irritated and mount an inflammatory response that destroys the wart.