Verruga vulgar

SKIN WART TREATMENT — Treatment of warts depends upon where the wart is located and how much it bothers you. Treatment is not necessary in all cases because about two-thirds of skin warts will resolve on their own within two years, without treatment. However, during this time, the wart may enlarge or new warts may appear. In addition, a few small warts are usually easier to treat than multiple larger warts. For these reasons, most people choose to treat skin warts.

There are many ways to treat warts, and the "best" treatment depends upon your and your healthcare provider's preferences and any underlying medical problems. Most treatments take several weeks or even months to work, and warts can come back after treatment.

Treatment of skin warts is also discussed in more detail in a separate article. (See "Cutaneous warts".)

Treatments you can use at home

Salicylic acid — Salicylic acid is a type of acid that is applied directly to the wart. It comes in different forms, such as a liquid or patch. Some forms of salicylic acid can be applied at home, while others must be applied by a healthcare provider.

Salicylic acid is useful for most types of skin warts and can be used in children. You may choose to combine salicylic acid treatment with duct tape. (See 'Duct tape' below.)

If you decide to try salicylic acid treatment at home, you should first soak the area in warm water for 10 to 20 minutes (to soften the skin) and dry the skin completely. Apply the liquid or patch to the wart at bedtime and leave it in place overnight. Between treatments, you should use a nail file or pumice stone to gently slough off dead skin from the surface of the wart. It is normal to have some skin irritation or light bleeding during treatment; this is a sign that the treatment is working.

You should continue treatment for one to two weeks after the wart is gone to be sure that the virus is gone.

If you have neuropathy (nerve damage that causes numbness), you should not use salicylic acid. In people with neuropathy, salicylic acid could potentially injure the skin without the person being aware of the injury.

Duct tape — Duct tape, a sticky tape available at most home improvement stores, has been used to treat skin warts. It is not clear how duct tape works or if it is an effective treatment. Some studies have shown success while others have not.

If you choose to try duct tape, silver duct tape is preferred over clear tape because it sticks to the skin better. You should cover the skin wart with tape and leave it in place for six days. You then remove the tape, soak the skin in warm water for 10 to 20 minutes, and use and emery board or pumice stone to gently slough off dead skin. Leave the skin uncovered for one night, then reapply the tape for another six nights.

Most people who find duct tape an effective treatment have resolution of their skin warts within four weeks. Warts are unlikely to respond if you do not see any improvement within two weeks.

Duct tape treatment is not recommended if you have diabetes, nerve damage (neuropathy), peripheral artery disease, or any condition that causes the skin to be irritated. In these people, duct tape may cause complications, such as skin sores or infection.

Prescription treatments

Liquid nitrogen — Liquid nitrogen is a very cold liquid that destroys warts by freezing the skin (also called cryotherapy). Liquid nitrogen must be applied by a healthcare provider, and multiple treatments are often needed to eliminate the wart.

Liquid nitrogen may be recommended for skin wart treatment in older children and adults, but it is not usually recommended for younger children because it can be painful. You may be given local anesthesia before treatment with liquid nitrogen to decrease pain.

After treatment, most people heal within four to seven days. Home treatment with salicylic acid is usually recommended for at least one week after the skin heals to reduce the chances of the wart coming back.

People with dark skin can develop permanent loss of skin color in areas treated with liquid nitrogen. If you have concerns about how your skin will appear after treatment with liquid nitrogen, talk to your healthcare provider.

Cantharidin — Cantharidin is a liquid that is applied by a healthcare provider to treat skin warts. It may be particularly useful for young children because it causes no pain initially. However, some people (although not all) develop pain, blisters, and swelling 2 to 24 hours after the treatment.

The skin usually heals within 5 to 10 days after treatment. Most providers recommend treatment with salicylic acid for at least one week after the skin heals to reduce the chances of the wart coming back.

Shave excision — Shave excision is a procedure that involves removing a skin wart with a blade. A healthcare provider performs the procedure, usually after injecting local anesthesia to numb the skin.

5-Fluorouracil — 5-Fluorouracil is a prescription cream that can be used to treat flat warts. You apply the cream to the affected area twice a day for three to five weeks. During treatment, it is important to protect the treated area from the sun because sun exposure can worsen skin irritation. (See "Patient information: Sunburn prevention (Beyond the Basics)".)

Imiquimod — Imiquimod cream (Aldara®) is a prescription cream that works by stimulating the immune system to eliminate the wart. You apply the cream at bedtime several times per week. It is normal to develop some skin irritation during treatment.

Imiquimod is more expensive than other wart treatments, but may be recommended in certain situations (for children, if other treatments are not effective, or if scarring is a concern).

Immunotherapy — Immunotherapy involves injecting a substance directly into the wart to trigger an immune response. Your clinician may repeat the injection every three weeks (up to five injections) until the wart completely clears up. Salicylic acid and/or duct tape may be used in addition to immunotherapy.

The advantage of this type of treatment is that it does not leave scars and is less expensive than imiquimod.

Other treatments — Other wart treatments are available, and may be recommended if you do not respond to one of the treatments discussed above. (See "Cutaneous warts".