I was motivated to write this article after a down-vote by a patient who was suggested laser removal of warts and wanted to try alternate therapy. While I believe that a patient must get cured of their ailment by any therapy that offers them a resolution of their problem, I hope to educate people about what warts are and how I approach a case with warts.

Have you ever noticed an annoying growth on your body that you cannot get rid of? Your friend might have told you that these are warts. They bleed when you pluck them and seem to vanish, only to grow back in a couple of weeks.

What are warts?

Warts, or viral warts are an infection of the skin by Human Papilloma Virus (HPV). They infect areas of the skin that have small injuries and make the skin cells to grow out rapidly in the infected area. They spread from an infected person to a non infected person. The HPV virus can survive on wet surfaces for prolonged periods and infect people who touch or walk on that surface (swimming pools, bathroom floors, public toilets etc.). Like most skin problems, warts are treated by several so called experts, from the neighborhood barber, to the man dispensing sweet pills to charm them away. Like any infection, your body's immunity can take care of warts in most cases, the success of which is claimed by the various "pathies". 

What are the different types of warts

1. Common warts

Common Warts

2. Genital Warts (sexually transmitted, can be seen on genital area, around the genital area, anal area, mouth; can cause cervical cancer, penile cancer or anogenital cancer)

3. Palmoplantar warts (found on hands and feet, mistaken for corns very often)

4.Flat warts/ Plane warts (Found on face most commonly)

5. Periungual warts

Peri-ungual Wart

6. Genetic disorders - A rare type of genetic disease called epidermodysplasia verruciformis (EDV) presents with multiple wart like growth on limbs and trunk of the body. Tree man Syndrome is a severe form of this disease.

Tree Man ' src="https://www.practostatic.com/fit/55e8333519c330e55de904a25126f686f8f33d0c">
Tree Man 

Myths vs Facts

Warts were believed to be a curse from the Gods. People with multiple warts were thought to be witches and thought to practice black magic. 

Due to this belief the Godmen started claiming that they could "charm a wart" by lifting the curse. Several plant extracts, acids and other therapies.

1. Myth: Warts are sexually transmitted

Fact: Genital warts are sexually transmitted, common warts are transmitted by contact with an infected person or a surface containing the virus

2. Myth: Warts are harmless

Fact: While most common warts are harmless and in many cases taken care of by the body's immunity, certain types of HPV that cause genital warts can cause cervical cancer. Cervical cancer vaccines are available which can protect you from the HPV subtypes that cause cancer, but they cannot prevent other types of warts. In rare cases, patients have been diagnosed with blood cancers (leukemia and lymphoma) after getting a blood checkup for recurrent warts. A simple test like Complete blood count and peripheral smear maybe suggested by your doctor to rule out these dangerous diseases.

3. Myth: Modern medicine cannot treat warts

Fact: Many treatment options exist that can completely get rid of warts. However like any other disease in a small percentage of patients, it may recur. Most treatment success claimed by alternate medicine relies on body's immunity to get rid of warts. 

Can they be cured?

Since warts are only on the surface of the skin, antiviral tablets are not effective. they have to be destroyed by antiviral creams, acidic lotions or burnt using as laser or electric current. 

What treatment options does modern medicine provide?

1. Antiviral Creams - effective for very small and genital warts. Can cause burning sensation and dermatitits when used incorrectly

2. Acid Lotions - These make the warts loose and peel off from the skin in layers. These can also peel the surrounding normal skin and cause infection if used incorrectly.

3. Electric Cautery - Burning the warts using electric current has been used by dermatologists to treat warts for decades. A local anaesthesia is used to make the procedure pain free. In case of very large warts a dressing may be needed till the wound heals. 

4. Radiofrequency Ablation - Warts are burnt using a radiofrequency device instead of electric current. Similar to electric cautery. Radiofrequency causes lesser damage to surrounding skin than electric current.

5. Laser Ablation - Warts are burnt using a Carbon-dioxide LASER machine. Laser causes lesser damage to surrounding skin than both electric current and radiofrequency and is useful on visible areas like the face where scars may develop if radiofrequency or electric current are used. It requires specialized equipment and special laser operating setup not found in all clinics.

6. Cryotherapy - A cold gas is sprayed onto the wart damaging it by freezing the cells. It requires multiple sessions. Side effects may include burning sensation during and after the procedure and blister formation. It also requires specialized equipment not found in all clinics.

7. Intra-lesional therapy - Certain medicines are injected into the wart to make it fall off. This is done only the wart recurs in spite of above treatments as it is painful and may cause a reaction and pus formation at the site of the wart. However this is the best therapy for recurrent warts when done by an experienced dermatologist trained in such procedures.

8. Other medical therapy - medical therapy with tablets is effective only for plane warts

9. Supplementary treatment - Supplements like Zinc and Vitamin C may be added to your treatment as they are believed to improve your body's immunity to warts.

Do warts recur?

In spite of the best efforts by a doctor warts may recur. Recurrence rates vary from as low as 1% to as high as 50% depending on the type of procedure and type of warts. Warts around the finger nails or toe nails called as peri-ungual warts may recur. These can be successfully treated by intra-lesional therapy. 

Warts in the beard area may recur due to shaving and may need multiple sessions of wart removal and avoiding shaving during treatment period.

Underlying problems which can affect the immune system, like cancers and HIV must be ruled out if you have recurrent warts and may require blood tests.

About the author

Dr. Rajdeep Mysore is a dermatologist practicing in Bangalore, with a special interest in disorders of general dermatology and Dermatosurgery (skin surgeries). You can reach the author by email, facebook or book an appointment for a consultation for any queries.