Even though warts are common skin problems, many people are alarmed when they notice one and therefore seek the quickest and most effective method of removal possible. Unfortunately, most over-the-counter wart removal products either aren’t very effective or take too long and too many treatments to work. As a dermatologist, it is important to explain to patients that opting for a more aggressive professional treatment will be well worth it in the long run. Here is an overview of how I treat warts to ensure a quicker outcome and to keep the virus from spreading.
What Makes Warts so Difficult?
First, many people don’t realize that the virus that causes warts is highly contagious and can therefore spread to other parts of the body or to other people. This is one of the main reasons why treating a wart as soon and effectively as possible is crucial. Secondly, if you practice in a climate like that of Miami, where it tends to be hot and humid, the HPV virus can flourish, making warts a fairly common problem. Finally, although there are a variety of at-home freeze-off and other wart removal products available, these aren’t going to be as concentrated or powerful, and therefore as effective, as the professional treatments that you can offer in your dermatology practice. As a result, many patients end up using their dermatologist as a last resort after already trying these at-home treatments. Instead, encourage your patients to see you at the first sign of a wart, rather than giving it more time to spread.
Steps to Effectively Treat a Wart
For all of the above reasons, I like to take an aggressive approach to treating warts. Here are some tips to tell your patients and for removing warts in just one or two treatment sessions:
Use Element 47 Skin Fortifying Mist to spray inside shoes.
Instruct the patient to keep warts covered at all times.
Apply prescription imiquimod twice a day to the lesion. Note that this is an off-label use because it is FDA-approved for genital warts. As as result, insurance may or may not cover it.
One to two treatments with VBeam 595 nm laser from Syneron. This is also an off-label use.
Immediately follow laser treatment with a short burst of liquid nitrogen. The intense laser heat followed by the intense cold of the liquid nitrogen kills the virus.
For thick plantar warts, I pare down the thick dead skin on the surface with a 15-blade scalpel before using the laser and liquid nitrogen. Note that the laser tip must be cleaned immediately with disinfecting solution, and the laser practitioner should wear a mask to avoid breathing in HPV particles from the laser plume.
Follow-Up Care
As with most dermatological treatments, good follow-up care after wart removal is a must to make sure that the wart is actually gone. If you follow the above recommendations, warts should disappear within one to two treatments. I recommend seeing the patient every two weeks until the skin is clear.
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