Frequently I encounter patients who are concerned with small, unsightly bumps that appear on various parts of the body. It’s usually a case of them noticing something that looks like skin growing from the body over a few months but without causing them significant duress. More often than not, these turn out to be warts.
What are warts?
To put it simply, warts are benign tumours often caused by infection with Human papillomavirus (HPV). As mentioned before, they can appear virtually anywhere and generally do not cause many problems.
The appearance of warts can vary, ranging from a slightly raised bump to a very conspicuous looking lumpy skin tag. Most of the time, warts are a cosmetic concern, unless their location causes mechanical problems. An example of this is plantar warts (warts on the heel of the foot) that make it difficult to walk.
Warts can sometimes just disappear after a period of time and have been seen to often resolve spontaneously in otherwise healthy patients, which brings us to the question, why see a doctor for this?
Why see a doctor for this?
The primary reason to see a doctor when you have skin lumps and bumps is to determine what it is exactly. In this day and age of googling your symptoms, it’s easy to underestimate a medical condition or scare yourself silly with an overdiagnosis. Why put yourself through all that unnecessary anxiety when you can see a doctor who will help identify once and for all what is it you have? In addition to that, a doctor can discuss your treatment options depending on the diagnosis.
In the event you are absolutely sure you have warts, it’s still advisable to see a doctor instead of treating it at home. I’ve heard of a myriad of home remedies like peeling off warts with duct tape or scraping it off with a pumice stone. Such “treatments” are risky as there is always a high possibility of bleeding and re-infection. At the doctors, sterility and care will be taken to make sure the procedure is done as safely as possible.
Why see a doctor at all if it can go away by itself?
The fact of the matter is, spontaneous resolution may take months to years, in interim warts can grow and spread, causing pain and emotional distress due to their appearance.
The good news is, while the virus that causes warts cannot be eradicated, warts themselves can be removed with various methods.
I’ll go on to explain a few methods I use here for the treatment/removal of warts. We’ll cover radiofrequency therapy, acid film painting, using creams at home as well as surgical excision. As with previous articles on the subject matter, please do not discount the importance of the HPV vaccination in all people aged 9 to 45.
Basically, RF is a removal technique employed here where we use radio waves to cut the skin. We also use a thermal (heat) component to lightly burn the skin around the cutting point to stop bleeding as well.
This keeps the surgery site clean and reduces the risk of infection. We also do not have to bring a knife/scalpel to your skin when we’re doing the removal. When we reduce the risk of bleeding, overall the process is cleaner, safer and neater as well.
You will be left with a raw area of skin at the site of the removal though. This would look like a typical abrasion (fall/scrape) wound. This can take about one week to ten days to heal up but once it does, and the scabs fall off; the underlying skin will be healthy and nearly normal looking.
There is minimal downtime to RF surgery removal of warts. It is a process that is typically done under local anaesthesia (where we inject numbing agents into the skin around the part that needs to be removed). We will also apply a generous amount of numbing cream to the area.
Once that has absorbed, we will proceed with the RF removal procedure. I like to do this under a magnifying lamp to see the extent of bumps or tissues that need to be removed.
The entire process can take a few minutes or longer depending on the amount and location of the warts that need to be removed.
Once this is done, we’ll snip the ends of the warts, try our best to make sure the skin is left nice and flat and assess the situation. If necessary, we’ll prescribe you a course of painkillers and/or antibiotics to prevent a secondary infection to the area.
At home, we’d expect that you keep the area clean and dry and apply an antibiotic or soothing cream on the surgical site at least twice a day. We expect that within a week or so after the procedure, the scabs will start to form on the skin and once that has completely dried up, it will fall off revealing new, non warty skin beneath it.
In about two weeks or sometimes longer than that, it should look like there is a minimal scar but with no warts in the area.
We’d typically re-assess the situation within a month and review progress of the skin and the area around it. If necessary, we can do a revision surgery to get the area looking more prim and proper. Otherwise, we’ll let that be that and review this only if there is a further warty growth or something similar in the area.
Acid Film Painting (Duo/Podofilm)
This is an acid gel treatment that we use in the clinic. There are different names to the medications but it typically contains two different acid groups (salicylic and lactic acid) to kill the wart’s growth.
It does this by getting absorbed into the wart and breaking the skin from the inside out. This is a procedure usually only done in the clinic setting and rarely advised at home. The acid itself is abrasive and must be applied on with care so as to not affect the surrounding skin.
This procedure is usually done ad-hoc and takes just minutes. First, the area is cleaned and dried then a layer of the acid is applied via a brush film. Once the acid gets absorbed into the skin, the wart will turn a pearly white colour. This is where it might start to get uncomfortable for the patient. There can be a burning/tingling sensation that might be unsettling.
These sensations usually last between 10-30 minutes. Once it has settled down, there is usually no sequelae of this.
The area will remain white for a few days (even with regular showers). Once the white part has completely dried up, you’ll notice the wart itself is either smaller or falling off. If it is falling off, you may help the process along by applying firm but gentle pressure on it.
If the wart has reduced in size but is still present, you can always come back to the clinic to have a repeat procedure done. We typically advise multiple sessions for this in similar scenarios. You may need one, or sometimes multiple sessions depending on the extent of the warty growths seen.
As with most abrasive treatment options, once the wart has been treated (ie acid applied onto it), it is recommended that you care for the area with soothing creams or moisturisers so as to not injure the surrounding skin.
There are home remedies for this offered in pharmacies and medicinal stores but we usually do not recommend this until we assess the situation and the product you intend to use.
Please take caution that this medicational therapy works by effectively killing skin cells and thus great care should be taken into maintaining the health of the surrounding skin.
People with diabetes, poor blood circulation such as peripheral vascular disease, or nerve damage to the hands or feet should only use such treatment under a doctor’s supervision.
Warts that are larger than 5cm² may require a different treatment.
This is a wonderfully useful but still somewhat dangerous cream to use for the treatment of warts. Imiquimod basically improves the immune system reaction against warts and also functions similar to the acid painting where it kills the surface skin cells.
You should use this sort of cream twice a week only, not too regularly. Each sachet is a small amount and should be used sparingly. Similar to other cream applications, after a shower, clean and dry the area before using something like a cotton bud to dip into the sachet and apply on the area of the wart. Try your best to avoid the skin surrounding it.
Once applied, leave it on for at least four hours at a time before washing it off. Using this cream usually has no burning sensation effect like using the acids mentioned earlier.
Also similar to the acid painting, we’d like to review the progress of this in a few weeks to a month and assess the situation. If necessary, we can proceed with radiofrequency removal of warts then. This is ideal because if warts have been significantly reduced, it is much safer to proceed with the removal. The area that needs to be cauterised (burnt) is less in these situations and that makes you a better candidate for the surgical procedure.
If you are treating the genital or rectal area with imiquimod topical, avoid sexual activity while the medicine is on your skin. Imiquimod topical can weaken the rubber that condoms or diaphragms are made out of.
Visible genital warts on the penis or vagina or around the anus are removed by excision, which means cutting warts off with a surgical knife (scalpel). Performing surgical removal of warts is one of the oldest forms of destructive therapy we’ve been using.
The downside of this is that it may cause a scar and may also lead to the propagation of the condition if not done under absolutely sterile conditions.
It is, however, an immediate result. Unlike acid painting, undergoing a surgical removal procedure will ensure that the wart is removed from the body immediately.
Some practices use a scalpel, some go about it using further technological advancements such as electrosurgery or loop excisions.
Electrosurgery is a method that burns off warts using high-frequency electric current. As the electric charge passes through the tissue it dries out the wart and burns it away
The procedure is usually done in a doctor’s office or clinic or an outpatient surgery centre. You receive medicine that numbs the area around warts (local anaesthetic) before the surgery is performed.
Recovery time depends on the location and number of warts removed.
Most people will be able to return to normal activities within 1 to 3 days.
Healing takes 2 to 4 weeks. Within this time though, we do not recommend close physical contact or sexual activities with a partner. More to err on the side of caution and to aid recovery than anything else.
Scarring may occur but this entirely depends on the individual as to how prominent the scar will be. If you are prone to keloid formations, I would advise against this form of therapy for you. Won’t be too pleased to see those growths especially in the genital/anal area post-treatment.
Cryotherapy basically means freezing a wart. The idea behind it is that once frozen, the outermost skin layer will be devoid of nutrition and therefore the wart will die from the outside in. This is similar to acid painting ideology.
Cryotherapy has been used successfully for years on end as a treatment for warts. Its success is variable, with some patients having minimal pain during the procedure and also minimal scarring after therapy. Cryotherapy is usually almost always only done in the doctors’ office and is a much quicker process than say surgical removal. This is because it does not involve separate anaesthesia processes.
The freezing agent is usually liquid nitrogen. When it is sprayed onto the wart, it has a slight numbing effect. This can make the process less painful. It usually takes less than 5 seconds to spray a wart fully. The application will be then left to dry for a bit.
When your doctor places the instrument on your skin to freeze the wart, it will feel like an ice cube is stuck to your skin. Afterwards, you may feel a burning sensation as your skin thaws out.
Most warts require 1 to 4 treatments, with 1 to 3 weeks between each treatment.
Healing is generally quick (7 to 14 days) with little or no scarring. Unlike surgical removal or RF removal, usually there will be no raw area to deal with post-therapy but this depends on the site, and size of the wart is removed.
So, in conclusion, please understand that having a wart is usually not life threatening but it is still an infection of an active virus. This should alert you to get this investigated and treated as best as you can. There are home remedies for this, but always proceed with caution when it comes to these things.
As for medications and therapies, we are gifted to be in an age of technology where we have so many advancements at our disposal. Coming in to see a doctor and getting the appropriate treatment plan laid out for you is definitely advisable. Please also remember to perform regular checks at home and follow up with your doctor on these symptoms if there are any recurrences. Lastly, do not feel dejected if the treatment process takes some time. With a comprehensive review of the body systems, we should be able to tackle issues like warts and keep them away from the body well enough.