WARTS: INFORMATION FOR PATIENTS

This leaflet gives advice about common warts and verrucas (warts on the sole of the foot) but does not include facial or genital warts, which require different treatments. If you have eczema, diabetes or poor circulation you will need to take extra care and should see your doctor before starting treatments.

Warts are common, harmless growths, which occur mainly on the hands and feet, particularly in children. They are caused by infection with the human papilloma virus. 2/3rds of them will disappear within 2 years without any treatment.

Warts do not necessarily need treatment. Wart treatments take time and patience and sometimes cause discomfort. If your warts are not painful or do not bother you too much, it is worth waiting for them to go on their own. This is particularly the case in children who often do not cope with treatments so well.

What to expect if you decide on treatment. If your warts trouble you and you decide to start treatment it is important to be aware that no treatments are 100% effective and all require perseverance and usually take at least 3 months to work. The main treatments used are wart paints which can be bought from the chemist, duct tape bought from a hardware store and cryotherapy (freezing treatment) which is performed at the surgery.

Wart paints are the first choice of treatment because they are effective if used properly, and have fewer unwanted effects than cryotherapy. Most contain salicylic and lactic acids, and work by helping to remove the dead layers of infected skin and by causing inflammation which stimulates the immune system to attack the wart virus. There is no single product that is better than others in every case, the choice is personal : your pharmacist can help you choose. You may already have tried wart paint and not found it helpful. The commonest reason for this is that you haven’t used it regularly or for long enough.

Tips for successful treatment.  Treat the wart daily following the same thorough plan.  Soften it in warm water for 5 minutes.  Dry, and then scrape off the top layer and the old treatment with a pumice stone or emery board.  Protect the surrounding skin with petroleum jelly, as treatments may irritate normal skin.  Apply the preparation carefully to the wart.  Covering with a plaster can enhance the effects of the treatment.  If the area becomes sore stop treatment for two days and continue every other day.  Do not stop treatment too soon: it is best to continue for a week after the wart appears to have gone.  Restart treatment early if the wart comes back. Verrucas can be particularly difficult. If they are proving resistant it may be worth trying a different wart paint such as gluteraldehyde, formaldehyde or podophyllum. Ask the pharmacist for advice.

An alternative treatment that has also been proven to be effective in some cases is the use of the duct tape and this may be worth a try particularly for verrucas. Tips for success:  Cover the wart with duct tape and leave it on for 6 days. If the tape falls off during this time, apply a fresh piece of tape.

 After 6 days, remove the tape and soak the wart in warm water for 5 minutes. After drying, remove the dead skin by gently rubbing with an emery board or pumice stone

 Leave the wart uncovered overnight and apply a new piece of duct tape again the next day.

 Continue treatment for up to two months.

If you have followed these instructions carefully for 12 weeks and you still have troublesome warts cryotherapy may be worth trying.

Important things to know about cryotherapy. The wart is treated by freezing with liquid nitrogen for about 15 seconds: this is painful and children often cannot tolerate it. Longer freeze times are needed for verrucas and treatment is generally less effective. Afterwards the area is likely to become inflamed and some swelling and discomfort should be expected. Blistering is common and can occasionally be severe. This can cause discomfort on walking in the case of verrucas. The wound that follows can take about 2 weeks to heal. Further treatments are usually required: often 4 or 5 treatments 2-3 weeks apart are needed and success is not guaranteed. Complications of cryotherapy include:  Permanent loss of skin colour in the treated area: so cryotherapy is less suitable for dark skinned people.  Delayed healing especially on the leg.  Rarely, scarring, infection, or nerve or tendon damage can occur.

If these treatments fail, which is uncommon, there are other options, but they have more unwanted effects and most require referral to a specialist. Local specialists do not generally accept referrals for viral warts on the NHS any longer, unless there are exceptional circumstances.