Warts | Wart Removal

A wart is a bump on the skin that is caused by a virus.

It’s a thickening of the skin. The skin cells are infected with viral particles and the particles make the skin cells grow abnormally.

The skin cells that are infected by the virus grow weirdly.

Yes, it’s a virus, so it’s contagious.

Usually from physical contact. If you touch someone else’s wart you have the potential of contracting the virus.

Usually what happens is, when you are first exposed to the virus and you get infected you have a cutaneous manifestation (the bump on your skin) within a few weeks. But it can be delayed. You can have it within a few weeks or there’s a latency period of up to 12 months. This means that your body may not show signs of infection during that period.

So, you can be exposed to someone with a wart, get infected by the virus, and not develop a wart for up to a year which makes it really hard to figure out how you were infected.

Once you have the virus, it’s in your system forever. Most people are exposed to warts as kids and they can have a wart that shows up on their skin lasting months or years potentially. Eventually what happens is, if you were to do nothing and not treat it, they go away on their own. The wart might go away but it’s only a symptom of the virus. You still have the virus and the potential for more warts to form.

Your immune system realizes that there’s a problem there and it recognizes that it needs to eliminate the wart. Your immune system attacks the virally infected cells and kills them. But the virus isn’t eliminated, it’s suppressed.

Yes. If your immune system isn’t optimal for any reason you can end up with another wart. Some people who, for example, are taking immunosuppressive medication can all of a sudden start getting warts again.

The virus that causes warts is the Human Papilloma Virus which causes a lot of different kinds of warts; genital, plantar, etc.

Well, there are different strains of the virus like HPV-7 or HPV-16. There’s over a hundred different strains and depending on which one you’re exposed to; you may get a different type of wart.

No, not for warts.

Mostly, we freeze warts with liquid nitrogen. It kills the infected cells by essentially giving them frostbite.

That’s the most common way that we treat them, but no. We also use something called cantharidin, which we call beetle juice. It’s a caustic chemical that is applied directly to the wart and causes a chemical burn that kills the infected cells. Sometimes we’ll numb them and burn them off using electrocautery. But I think freezing is the easiest and best method.

We’re not great at getting rid of viruses in medicine. Meaning, we can damage the infected cells and it doesn’t necessarily eliminate the infection. If the patient’s immune system doesn’t suppress the virus, it will continue to make abnormal cells and the wart may resurface. To get rid of warts completely, it takes a concerted effort of the patient’s immune system and whatever we are doing to treat them.

I don’t really use lasers to treat warts so much anymore. But there are a couple of different types of lasers you can use. One is a destructive laser and it destroys the infected cells like the electrocautery (burning) would. The other targets the blood vessels in the wart.

Warts have a higher concentration of blood vessels because of the way they grow. Most blood vessels in the skin grow horizontally across the surface of the skin. When warts grow, they cause a kind of upfolding of the skin, which then causes the blood vessels to distort vertically similar to a pleat in your pants. So, when you look at a wart and see the dark dots, those are blood vessels. Some people call them wart seeds but they are actually just blood vessels on end that you’re seeing.

The main reason is that it doesn’t feel good; it hurts! Another reason is that it creates a smoke plume and the viral particles could theoretically be in that smoke plume. Which, if you breathe in that smoke, you could potentially inhale the viral particles and develop warts in your respiratory system. You can take precautions against that scenario but freezing is easier. And, the lasers aren’t necessarily more effective.

There’s a yeast antigen treatment called Candida that we used for a time but I didn’t find it to be that effective. There are also some chemotherapies that you can inject into the wart. I tried one once (bleomycin) but it was so incredibly painful for the patient that I never used it again. I don’t like to do things that hurt that much. Warts are tough to get rid of so I’ve tried a bunch of different things over the years.

There’s something called Compound W gel, a concentration of salicylic acid, which essentially dissolves the skin. It can work on superficial warts but may not work for the bigger more stubborn ones like plantar warts. I don’t recommend the freezing kits because they don’t get cold enough to do anything other than hurt.

Warts are one of the toughest things we treat. Most of the treatments are painful and you have to do multiple treatments consistently. If you treat it and it improves a little bit but there’s a little bit left, then it can regrow. It can be very frustrating for the patient because there’s no certain way to get rid of them. On top of that, the more aggressively you try to treat a wart, the more likely you are to end up with a scar. But if you let your body take care of it, you wouldn’t have a scar. The problem is that people don’t want to wait for them to be gone.