August 30, 2010

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

Warts are very difficult to treat and most patients are unable to successfully remove their warts using just the over the counter Freeze Off Spray or Compound W.  The HPV virus is very resilient and multiple destructive modalities are usually needed to remove warts.  My typical treatment plan involves shaving down the dead skin of a wart with a double edged razor blade.  This is usually painless as the wart produces an overlying callused type of skin.  Once the callus is removed, I treat the wart with liquid nitrogen, which is sprayed directly onto the wart.  The wart appears white like an ice cube.  I allow it to thaw and then repeat the freezing.  Two cycles of freezing/thawing is usually sufficient to cause the wart to blister over the following three days.  The wart will become black, crusty, and blistered which are all good signs as a large portion of the wart has been destroyed.  After the wart has settled down over several days, I recommend that my patients begin treating their warts nightly with an Emery board/nail file, which is used to shave the dead skin of the wart down.  The Emery board/nail file should never be used on nails or other skin areas as it is contaminated with HPV virus and can spread warts to other body sites.  After filing the wart, Compound W bandages can be applied to the wart over night.  These Compound W bandaids contain salicylic acid, which dissolves a portion of the wart.  Typically, I have my patients follow up every six weeks for in office liquid nitrogen treatments, as any longer can result in the wart recovering and starting to re-grow.  The Freeze Off Spray sold over the counter is usually ineffective since it consists of Freon, which is -30 degrees Celcius, whereas the liquid nitrogen I use is much colder at -197 degrees Celcius.  Hand and foot warts are much more difficult to treat as they are deeper in the skin as the acral skin (hand/foot skin) is much thicker than other areas on the body.  Some patients may have to follow up 7-8 times before a wart is completely treated.  Most patients are finished after 2-3 in office treatments.  Treatment is complete once dermatoglyphics (skin lines) are present where the wart had once resided.