Are Over-The-Counter Wart Treatments Safe?

You can’t damage yourself with these treatments. If you get salicylic acid on normal skin, it can cause burning or redness but never infection or scarring. All you have to do is stop using it on irritated areas, and the skin returns to normal. Still, it’s probably better not to use salicylic acid on sensitive areas like the face or groin, where it’s likely to make nearby skin raw and uncomfortable.

It generally is recommended that salicylic acid not be used in people with diabetes or in areas where there is poor circulation (because of concern about how normally the skin can heal; however, in practice, salicylic acid is withheld only when there are clear signs of ongoing inflammation of the skin).

Likewise, nonprescription freezing products are also safe but must be used carefully and only according to package instructions.

Are wart treatments effective?

Above all, wart treatments require patience. How well wart treatments work is another matter. Warts can appear and disappear without an identifiable cause and may disappear on their own without treatment. Some warts sprout offshoots near the main wart, and others don’t. Some hurt, and others are painless. Certain warts, even of the same type, respond to treatment, while others (even on the same person at the same time) don’t. All treatment methods often require many sessions over weeks, months, or longer to succeed.

Here is a practical approach to the treatment of warts:

• • Plantar warts: Warts on the bottom of the foot feel deep, but they are still within the superficial layer of the skin. Salicylic-acid drops and plasters help remove the thick overlying callus and make the wart feel less like a marble in your shoe. Nonprescription aerosol freezing may be used as well.
  • Common hand warts: These are typically unattractive, although not painful. Salicylic acid can make them smaller and go away in some cases, as can nonprescription freezing.

1. If you can ignore your warts, do so. Eventually, they’ll go away (although eventually can mean a long time — even months or years).

2. If you have an easy case (a single wart on the face or one or a few on the hands), see a doctor for a quick freeze or electrical zap. This method is simple, almost painless, and non-scarring.

3. If you have a hard case, you can start by treating the warts for a few weeks on your own. Examples:

If you have an all-but-impossible case, don’t try too hard. You don’t want to make the treatment worse than the disease. Examples:

• Warts under the nails: These are extremely resistant to treatment. One or two tries by the doctor are worth a shot, but if they fail, putting acid on them yourself just makes them look rough and unattractive.
• “Mosaic” warts: Tiny, so-called “seed warts” can proliferate by the dozens or hundreds all over the sole of the foot. They don’t usually hurt, and they rarely respond to any sort of treatment, although in this case, too, one or two tries at treatment may be in order.
• Flat warts: These are small, flat, flesh-colored pimples and may be numerous on one part of the body (for example on the face, arms, or groin). Getting rid of them by a light application of salicylic acid or other method is easy enough, but they have a tendency to recur.

Wart Treatment by Type of Wart

Treatment will depend in part on the location, the age of the patient, as well as the size and immune status of the individual. The treatment choice will depend in part on previous experience of the patient and the patient’s preference. Many of the treatments can be uncomfortable and therefore difficult to use in children.

Treatments can be either destructive as in the use of liquid nitrogen or most recently there is an immunological approach to boost the patient’s own immune system.

Common Warts

Liquid nitrogen cryotherapy is most commonly used in those who can tolerate the pain. Repeat treatments are frequently required. Excising or scraping off these warts is less desirable as it will scar. The use of pulse dye laser or very occasionally the Co2 laser can be used in resistant lesions. Cantharone can be used particularly in children as it is more easily tolerated. Other treatments involve the use of immune therapy. Substances such as DNCB involve painting the substance on the warts in order to develop an allergic reaction. This immune allergic reaction will be useful for destroying the wart.

Flat Warts

Flat warts frequently occur on the face and on the legs. Care needs to be taken not to use a treatment that will have a high risk of scarring. Very light liquid nitrogen cryotherapy can be used.

It is important that shaving is done very carefully or is stopped for a while as this is known to spread these warts. Treatments such as Aldara have been used. Topical treatments such as vitamin A acids (Tretinoin) can sometimes be of benefit. Efudex cream has also been used.

Plantar Warts

Plantar warts can be stubborn. Because of their location aggressive use of liquid nitrogen cryotherapy is difficult in that it can not only be painful but swelling and soreness can prevent walking for a number of days. Often paring the warts by thinning them down can be helpful. The use of salicylic acid preparations that are applied daily and cover the affected area will eat away at the surface of the wart allowing it to be pared down. This may make it more responsive to liquid nitrogen. The use of duct tape to soften the lesions in some individuals can be in itself curative. It appears that changing the water content and making the skin mushy enhances the patient’s ability to eradicate these warts. Treatments such as surgery and scraping of these warts is discouraged as scars can sometimes be painful on the weight-bearing parts of the foot. The pulse dye laser can be used once the wart has been thinned as it does not produce scarring. Occlusion combining these therapies with Aldara cream in some individuals is helpful.

Genital Warts

Genital warts are usually sexually transmitted. It is important that woman be checked to rule out any atypical changes on the cervix. Small warts can be treated with liquid nitrogen although this is uncomfortable. Podophyllin or podophyllotoxin can be applied every few days and this can be helpful.