Ask the Pharmacist

Q) I am so sick and tired of these warts. Why do I keep getting them and how can I get rid of them?

A) While almost all warts are harmless, they are not aesthetically pleasing and can occasionally be painful depending on where they reside. They are also somewhat contagious meaning that ignoring them puts your family and friends at risk of contacting them from you.

Warts have been around forever. They have been discovered on 3,000 year old mommies & referenced in literature throughout the ages.

Warts are a by-product of the human papillomavirus (HPV) which can enter into the outer layer of our skin via small lesions or cuts in our skin. Once there, the virus infects our keratinocytes (these are the most common cells that make up our epidermis, the outermost layer of our skin) causing a thickening of the epidermis and hyperkeratinization. The most common locations for warts to grow are on the hands and feet. There are a number of types of common warts each located on a different area of the body and each with a unique presentation.

Common warts are usually found on fingers and toes although they can appear elsewhere. They tend to be slightly greyish in colour, have a rough, grainy appearance and a top that is slightly rounded.

Plantar warts grow into the soles of your feet which make them unique (other warts grow out of your skin so that they appear as a “bump”). They can be mistaken for a callous or they can look like a small hole in the bottom of your foot that is surrounded by thicker, hardened skin. They may appear in a cluster and some may have a black dot within it. These warts can be painful if, when walked upon, they push up into some nerve cells.

Flat warts (also known as plane warts) usually grow on the face, arms or thighs or other sun exposed areas. They tend to be small with a flat top making them not as noticeable as most other types of warts. Their colour can vary from pink to brown to slightly yellowish. They often appear in large numbers (like 20 to 100) but thankfully are the most likely to disappear on their own.

Filiform warts can grow around your mouth, nose, eyelids, armpits, neck or under your chin. They are small and look very much like a skin tag (i.e. a hanging flap of skin). They tend to be the same colour as your skin.

Periungual warts grow under and around your finger and toenails. These can be painful and affect future nail growth. This brings us to our sixth and most important type of wart, the genital ones. While these are not always visible to our eyes, when you do see them they tend to be very small and take on the colour of your skin or a tone just slightly darker. The tops may resemble a cauliflower and it may feel either smooth or slightly bumpy to the touch. Genital warts are considered a sexually transmitted disease and should always be looked at by a doctor as some types of HPV infections (remember, a wart is a by-product of the HPV virus) can predispose a female to cancer of the cervix and vulva or males to cancer of the glans penis or anus. For our discussion today, we will not be referring to genital warts from here on out.

One acquires a wart just like you get any other virus, from other people. It can be passed by skin-to–skin contact or through contact with infected surfaces such as towels, shoes or a wet shower floor. You can also spread it to other parts of your body such as by shaving one on your face or legs and continuing to use the blade or by scratching or biting a wart.

The risk of acquiring a wart from another person is quite low but there is a reason, other than a highly tuned sense of style, that many of us where flip-flops at the community pool.

Warts can go away on their own, just often not as quickly as we would like them to. They tend to last a shorter time in children. Most resolve on their own in a few months to 2 years, which is a blessing considering that children are far more likely to have them then adults (almost 1 in3 kids will have warts whereas the incidence in adults is closer to 3 to 5%).

Warts in adults tend to persist longer, in some cases 5 to 10 years. As such, many adults seek treatment which can often be done at home on your own but can involve a doctor as well or even a combination of strategies. The treatment with the most evidence that it works is the application of salicylic acid (SA) to the wart. Commercial products range from 17 to 40% of SA which is quite a range. For thicker skin areas, such as the soles of your feet, it’s go big or go home and as such I tend to favour a 40% compound. In fact, for better results, most pharmacies will make you a 60% product for a very reasonable price.

For sensitive areas of the skin like the neck, obviously a lower strength cream would be more appropriate. Application frequency can vary from twice a day to every other day depending on the formulation.

All products work best however if you follow a few simple rules. The first is to soak the area in warm water prior to application of the cream for 5 to 10 minutes so as to soften the skin. Next, gently file away the wart with a pumice stone, emery board or piece of sand paper to remove the dead skin. This will help the medicine better penetrate the wart. Note, do not reuse the same object as the virus will now be on it and be capable of spreading elsewhere (like your fingers!). Apply the SA to the entire surface of the wart but do not let it touch the normal skin around it. Some people protect the surrounding skin from irritation by applying Vaseline to it. Lastly, wash your hands.

Once again, it is a transmittable virus. The SA peels away the wart, in layers, so persistence will be a key. It may take months for this, or any other type of treatment to work, and if you do not get the entire wart removed, it is likely to follow the example of a weed and be back before you know it.

There are a number of other treatments available as well but they all work by the same principal, which is surprisingly, a natural process of sorts. Basically, the various treatments all irritate the skin, and in doing so, trigger your body’s immune system to attack and help clear the virus/ wart.

The other main treatments you can try on your own are freezing agents and, of course, duct tape. Freezing agents such as the one made by Dr. Scholl’s are designed to freeze the wart and thereby kill it, attempting to duplicate cryotherapy in which doctors use liquid nitrogen during an office visit. While this is more convenient, it is regrettably not as effective as cryotherapy and the general feedback I have had from patients has been one of disappointment. It is more expensive than the various creams and patches, but is less work and could, in theory, work much quicker.

Duct tape is actually now considered to be a legitimate therapy. It is applied over the wart, or even over a wart already covered with SA, and left on for 3 to 6 days if used alone or changed whenever the SA should be reapplied. It raises the temperature of the skin in the area once again stimulating your immune system to respond.

Therapies your physician may try other than cryotherapy which can be effective but require prescriptions include a number of creams (Efudex and Aldara) or a liquid called cantharone (which is extracted from the aptly named blister beetle!). Other, in office, surgical procedures which can be painful and require multiple sessions include cautery (burning it away), curettage (scraping) or excision (cutting it out). Yes, warts can be embarrassing but they’re not dangerous usually, are treatable and are not an indication of poor hygiene, morals or anything else. It’s just the end result of a virus you were unlucky enough to encounter. For more information about this or any other health related questions, contact your pharmacist.