Wart Treatment by Type of Drug and Procedure

The new advance in treatment of genital warts has been imiquimod (Aldara). This encourages the patient’s autoimmune system to attack the wart. This is particularly helpful in the moist areas of the skin or mucosal surfaces.

Salicylic acid
Salicylic acid can be applied either in the form of plasters or as liquid on to the warts. This will break down the thickened skin on the surface. It is more effective if the area is covered. These are useful for warts on the hands, knees and feet. They do turn the skin white. They can be used in combination with paring of the warts. Treatment with these at nighttime and covering with duct tape can be effective although slow.

Podophyllin

Podophyllin has a long history of use. It is useful mostly in genital warts. It should be applied very carefully on the warts, trying to prevent spread on to normal skin. It should be washed off after a few hours. There is irritation usually for a few days. Repeat treatments are usually required. A more purified form of podophyllin called podophyllotoxin is available for patient use. It can be used once or twice daily for a few days in succession. This produces some irritation. It has the advantage of not being as irritating as podophyllin and can be applied by the patients themselves.

Vitamin Acid

Vitamin acid (Tretinoin) is a vitamin A preparation. It is used in the treatment of acne and photo damage. Vitamin A products tend to regulate the surface of the skin, generally trying to keep the epidermis behaving normally. It may also cause some inflammation. In some individuals it can help reduce or even eliminate warts.

Cantharone

Cantharone (cantharidin) is derived from an insect. It can be very helpful in children but the application is painful. Inflammation and
blistering usually occurs later in the day, after application. Multiple treatments may be required. There are two concentrations. The
stronger version combines Cantharone with podophyllin and salicylic acid. Very occasionally the blistering reaction can be quite severe
and associated with swelling and pain. It is often very effective even in resistant warts.

Cryotherapy

Cryotherapy is the use of liquid nitrogen. This can be applied either with a Q-Tip or it can be sprayed on to the skin. It causes destruction by freezing water inside the cells. This damages the cell causing death. It is painful to apply and there is blistering associated with this. Multiple treatments may be required. Thawing and freezing again makes this therapy more effective. It can be a problem in dark skin in that it can either increase or decrease pigmentation, which can be permanent. This treatment can be used in combination with other therapies.

Electrodesiccation

Electrodesiccation is the use of an electric needle to burn warts. It usually requires a local anesthetic. It does have a potential risk of scarring. Very large warts can sometimes be scraped off before they are cauterized.

CO2 Laser

The CO2 laser has been used for many years. It essentially vaporizes water in the skin and causes destruction. It leaves a hole in the skin which will heal. There is often scarring with this technique. Other lasers such as the pulse dye laser are easier to use. The yellow light is absorbed by blood in the vessels that feed the warts. This is a similar laser used in the treatment of red birthmarks. The pulse dye laser at a high power setting can be effective particularly if multiple pulses are used in succession.

Aldara

Aldara is an immune response modulator. It boosts the patient’s immune response to viruses. It can also encourage the production of a
lasting immune memory. It has been available in Canada since 1999. It works best in the genital area as penetration into the skin is easier. When it is used elsewhere it often has to be covered to help with penetration into the skin. It has been shown to work well particularly in women. It is applied three times weekly. There will be some inflammation associated with this. The results may be enhanced by combining this with liquid nitrogen. This drug has added a very significant tool in treating genital warts.

Chemical Peels and Aging

Chemical peeling is emerging as one of the most effective ways to combat skin aging. Chemical peels are one of the most frequently performed aesthetic procedures in North America. Its popularity continues to grow because of the versatility of conditions where chemical peels are of significant benefit. In addition to the topical preparations such as over-the-counter and prescription creams, chemical peels are one of the earliest forms of treatment adopted by many patients. At the same time, there is much confusion and misunderstanding surrounding chemical peels that prevents more of us from enjoying their undeniable benefits. Let’s go through the important facts about chemical peels and their uses in modern skin care regimens.

Categories of Chemical Peels:

1. Superficial chemical peels:

Broadly speaking, chemical peels can be divided into several categories based on the depth of penetration in the skin. Superficial chemical peels create an injury to the epidermis - the outermost layer of the skin. As such, they are recommended for the treatment of skin conditions that primarily affect the epidermis. Conditions such as acne, actinic keratosis, superficial (epidermal) melasma, mottled skin pigmentation, superficial wrinkling as well as mild photo-damage can greatly benefit from properly selected and applied superficial chemical peels.

* AHAs

Some of the most common examples of superficial chemical peels include a variety of alpha-hydroxy acids
(AHA,) salicylic acid as well as low concentration trichloroacetic acid (10% - 25%.) The most commonly used superficial chemical peels are members of AHA. Alpha-hydroxy acids is a group of compounds derived from food products including glycolic (from sugar cane,) lactic (from sour milk,) malic (from apples,) citric (from fruits) and tartaric acid (from grape wine.) Glycolic acid (GA) is a clear winner amongst the AHA as its small molecular weight allows it to penetrate into the skin and exert its influence on living and non-living (outermost layer) cells. These properties account for the popularity of this product in both cosmetic as well as medical preparations.

In low concentrations, 5 - 10%, GA reduces cell adhesion in the top layer of the skin. This action promotes exfoliation of the outermost layer of the skin accounting for smother texture following regular use of topical GA. This relatively low concentration of GA lends itself to daily personal use as a monotherapy or a part of a broader skin care management for such conditions as acne, photodamage, wrinkling as well as selected cases of melasma.

In higher concentrations, between 10 and 50%, the benefits of GA are more pronounced but are limited to temporary skin smoothing without much long lasting results. This is still a useful concentration to use as it can prepare the skin for more efficacious GA concentrations (50 - 70%) as well as prime the skin for deeper chemical peels such as higher concentration trichloroacetic acid.

At higher concentrations, 50 - 70% applied for 3 to 8 minutes under the supervision of a physician, GA promotes separation between the cells and can be used to treat acne, photodamage (such as mottled dyspigmentation, superficial melasma or fine wrinkles) as well as superficial scars. The benefits from such short contact application depend on the pH of the solution (the more acidic the product [lower pH,] the more pronounced the results,) the concentration of GA (higher concentrations produce more vigorous response,) the length of application and prior skin conditioning such as prior use of topical vitamin A acid products. Although single application of 50 - 70% GA will produce beneficial results, multiple treatments every 2 to 4 weeks are required for optimal results.

* Salicylic Acid

Salicylic acid is a member of beta-hydroxy acid group. Because of its improved lipid solubility compared to the AG, it is particularly effective in the treatment of acne. In addition, it is not as inflammatory and some physicians use it extensively for the treatment of melasma. Low concentration trichloroacetic acid (10% - 25%) can also be used to treat the conditions affecting superficial epidermis but its use is limited to experienced physicians as more detailed patient selection and application care is required. As such, physician supervision is required for all peels except low concentration glycolic acid (up to 35%) and salicylic acid peels (below 20%.) This precaution is necessary to prevent inadvertent worsening of the skin condition as well as scarring.

Although in some instances only one superficial peel can accomplish desired effects, in most cases a series of peels is recommended to achieve optimal results. Superficial peels are an excellent way to introduce oneself to the rejuvenating power of these common aesthetic procedures. Done properly and with care, superficial peels are very safe treatment options for some of the most common conditions affecting facial skin.

It is important to understand that superficial chemical peels are peels with similar risks and side effects as other peels. Some of the side effects of superficial chemical peeling can include hyper- or hypo-pigmentation, persistent redness, scaring as well as flare up of facial herpes infections (”cold sores”). Caution needs to be exercised with some patients, particularly those suffering from rosacea or eczema. These patients are prone to skin irritation and even the mildest peels can cause injury to the skin. Fortunately, in most instances, such injury can resolve with time and optimal skin care. In cases of melasma, extreme caution needs to be taken, as it is possible to worsen this common and unforgiving skin condition. Any significant redness of the skin must be avoided.

Author: Mariusz J.A. Sapijaszko, MD FRCPC (Dermatology)