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Warts – how to treat

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Warts/Papillomas/Veruccas

Warts are benign tumours seen at any age but most commonly in children. Common warts usually occur on the hands, feet and extensor surfaces. Facial warts often take the form of multiple tiny plane lesions. Warts adjacent to mucosal surfaces are frequently filiform. There is no specific or reliably effective treatment for warts. In children, warts frequently resolve spontaneously within 2 years, making aggressive therapy inappropriate.

How to treat warts

There is a considerable lack of evidence on which to base the rational use of topical treatments for common warts. Therapy does take a while, particularly on foot warts, as localised therapy is aimed at evoking an immune response in the skin so that the wart virus is eliminated. Therapies include:

Topical keratolytics (eg over-the-counter preparations of salicylic acid alone, or in combination with lactic acid, trichloroacetic acid [Upton’s paste] or podophyllum resin), antivirals (eg podophyllum resin).

Examples of product to be used include wart-Off Paint which contains Salicylic acid 20% w/v; Lactic acid 12.5 % w/v; Podophyllum resin 10% w/v. Or duofilm is another useful product available in pharmacies.

 

It is important to soak the area in water, and pare/debride  the wart with an emery board or pumice stone so that the protective hard skin covering the wart is removed.

Paint normal skin with nail polish or cover with adhesive elastic plaster with a hole left for the wart, and apply the substance to the wart. Apply more tape over the top to increase occlusion. Remove tape the following day, and pare the wart with a scalpel, or file with a pumice stone or emery board. When using Upton’s paste on plantar warts, the tape should be left in place for a week. See manufacturer’s instructions for information on frequency of application and duration of therapy.

Cryotherapy (liquid nitrogen)  can be used to freeze lesions where topical therapy has failed, in adults and in children who are able to cope with the discomfort of the procedure. Liquid nitrogen is the preferred cryogen and is applied with a cotton-tipped applicator or spray device until ice ball formation. The treatment can be repeated once thawing is complete (double freeze-thaw cycle). Cryotherapy should be applied to each wart every 2 to 4 weeks until resolved. This can only be done at a medical clinic. EMC charges a small fee for this therapy which we stock.

Duct tape Occlusion

  • A piece of duct tape cut as close to the size of the wart as possible, and applied to the area.
  • The tape is left on for 6 days and replaced with new duct tape if it fell off.
  • After 6 days, the tape is removed, the area soaked in water, and the wart debrided with an emery board or pumice stone.
  • The tape is left off overnight and reapplied the following morning.
  • This process continued for up to 2 months or until the wart is resolved, whichever occurrs first.

 

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