Diagnosis and Treatment

Only a physician can confirm whether or not you have warts, so if you experience any wart-related signs or symptoms, visit your doctor. Some skin growths that may resemble warts are actually moles, corns, calluses, skin tags, or even skin cancer. It is particularly important to seek help if you suspect that you have genital warts because they are sometimes linked to cancer.

Your physician will perform a physical examination that consists of a visual inspection, sometimes with a special magnifying instrument called a dermatoscope. Occasionally, a biopsy of the lesion will be performed if the physician is uncertain of the diagnosis. Women with genital warts may also undergo a Pap test to make sure they have no signs of cervical cancer.

Although warts can sometimes disappear without treatment, many people choose to treat their warts if they are unsightly, start to spread, or make them feel uncomfortable. Talk to your doctor about whether treatment is appropriate and, if so, which treatment is right for you.

Lifestyle Changes and Skin-care Strategies

Non-genital Warts

If you develop warts, you can make several lifestyle changes to help them heal properly and prevent them from spreading:

Genital Warts

You can change your lifestyle to prevent the spread of genital warts once they occur:

Medical Treatments

Most wart treatments are topical. Some treatments can be carried out at home, and some must be applied by a doctor. They each use a different chemical to achieve the same thing; to kill the wart cells, causing them to peel and fall off. Treatments are also available to help your body’s immune system attack the wart cells. The type of wart treatment you will use depends on what type of warts you have.

Cantharidin and cantharidin combination products cause skin to blister and peel off. They are used by doctors to remove external genital warts (i.e., warts on the penis or the vulva). They are available alone and in combination with other wart-removing agents (salicylic acid and podophyllin). These products can damage healthy tissue if not applied properly. These and most other topical treatments for warts cause some local pain or blistering where they are applied.

Imiquimod is a prescription immune-response modifier that causes your body’s normal immune defences to attack the wart. It is provided as a prescription cream and can be used to treat external genital warts (i.e., warts on the penis or the vulva) and warts near the anus. It is also used for other kinds of skin conditions (cancerous and pre-cancerous skin growths). For genital and perianal warts, imiquimod is usually applied at bedtime and used three times per week for up to 16 weeks, while other formulations of it are applied every night until clear. You should not apply a bandage over the cream, but you may apply a cotton gauze pad to the area. Some people experience long-term changes in skin colour (lightening or darkening) in the treated area. If you experience serious irritation following treatment, you can discontinue imiquimod for a few days and then resume treatment when the reaction subsides. Most people experience some inflammation, reddening and irritation in the treated area. Uncommonly, some women have difficulty urinating as a result of the inflammation.

Liquid nitrogen (cryotherapy) is one of the most common treatments for warts. Extremely cold liquid nitrogen is used to “freeze off” or “freeze burn” the wart, causing the cells in the wart to die and the wart to peel off. Liquid nitrogen is extremely dangerous to handle, and it must be applied only by a doctor. You may require regular repeated treatments to remove the wart completely, and occasionally treatment may cause some scarring after the wart is removed.

Podophyllin and podofilox (podophyllotoxin) cause skin cells, including those in the wart, to die and peel off. These preparations are used by doctors to remove external genital warts (i.e., warts on the penis or the vulva). Podophyllin is available alone and in combination with other wart-removing agents (salicylic acid and cantharidin).Your doctor will apply the first dose of podophyllin and will instruct you on how to apply the later doses, usually once or twice a day for up to three days, followed by at least four days of no treatment. If necessary, you may repeat this course of treatment (three days of treatment followed by four days of no treatment) for up to four weeks, on the advice of your doctor. When using podophyllin, apply it directly to the genital warts, using a layer of petroleum jelly to protect the surrounding skin. It will dry to form a film surrounding the wart.You should not use podophyllin if you are pregnant. This and other topical products for warts can damage healthy tissue if not applied properly.

Salicylic acid is one of several strong acids used to “burn off” warts. To use, first soak the affected area in warm water for five minutes and remove softened wart tissue with a washcloth or emery board. Apply the gel directly to the wart and allow it to dry and form a barrier around the wart. Treat once a day until the wart is cleared; if you develop any discomfort, take a break, and then restart as needed. This product and other strong acids must not be used near the eyes or mucous membranes. Salicylic acid can damage healthy tissue if not applied properly. If you have diabetes or any other condition that impairs your circulation, check with a doctor before using. In addition, salicylic acid is flammable and should be kept tightly capped and away from open flames.

Other strong acids (bichloroacetic acid/trichloroacetic acid) can be used to spot-treat warts. Bichloroacetic acid and trichloroacetic acid are used for several kinds of warts, including genital and plantar warts. To avoid risk of damaging your healthy skin, these treatments must be applied by your doctor. You may require repeated treatments to remove the wart completely.

Systemic Treatments

Human papilloma virus vaccine prevents infection from certain strains of human papilloma virus (HPV) that cause genital warts. HPV infection can eventually lead to cancers of the cervix, the vagina and the vulva. The vaccine is given to girls and women, ages 9 to 26 and more recently has also been approved in males. Vaccination requires three injections into the muscle of the upper arm or thigh: an initial dose and boosters after two months and six months. The vaccine can only be used to prevent HPV infection, not to cure it. Because it is not 100 per cent effective and only works on certain strains of the HPV virus, it is still important to avoid unsafe sexual contact. Women should continue to have regular gynecological exams and Pap tests, whether or not they have been vaccinated.

Other Treatments

Some medications are officially approved for treating other conditions/diseases, not warts, but they have been tried in the treatment of warts with variable success. Some alternative treatments and home remedies have also been studied in the treatment of warts, but evidence is limited or mixed. These treatments are included here for information only.

• Prescription: Cimetidine, intralesional immunotherapy (e.g., interferon, bleomycin), 5-fluorouracil, epinephrine
• Other: Laser therapy, aminolevulinic acid with photodynamic therapy infrared coagulation, duct tape coverage, surgical therapies (e.g., surgical excision)

Footnotes:

*All information on medical treatments on this site is provided as an overview only. For a complete and up-to-date list of side effects, warnings and precautions, read the product’s package insert and consult your doctor or pharmacist.
**If you are considering an alternative or complementary therapy, discuss it with your doctor first, and always be sure to keep your doctor up to date about any vitamins, supplements, or other forms of alternative treatment you are taking. Like any medication, alternative therapies can interact with other medications/treatments and, in some cases, have side effects of their own. Remember that “natural” does not necessarily mean “safe.”