At Alpine Dermatology we offer numerous effective treatment options for warts. We treat patients of all ages for warts and our Physician Assistant, Steve Anderson has been specially trained by Dr. Eberting to treat even the most difficult cases.
What is a wart and who gets them?
Warts are caused by the Human Papilloma virus (HPV). There are over one-hundred different strains of HPV and different strains tend to cause different types of warts. All warts are contagious and some warts can cause cancer; cancer of the cervix, the throat, around the fingers or toes, and a type of skin cancer called squamous cell carcinoma (in some cases, but not all cases). This is why it is important and necessary to treat warts. Both men and women get warts and all ages of people are susceptible to them.
Warts exist and thrive on our bodies when our immune systems to not recognize them as “foreign”. Instead of mounting an attack against the wart, often the immune system allows them to go on replicating on our skin. This is how people can end up with many warts. Approximately 50% of warts will go away within two years on their own…so if yours are not going away, or if they are spreading or growing, it is time to have them treated.
What are the different types of warts?
1. Flat warts: these are tiny little warts that have a flat top—thus the name. They are very common on legs (and are spread by shaving), faces, lips, and hands. This type of wart is often one of the easiest to cure, but it does take some time and dedication.
2. Plantar warts: warts that are found on the sole of the foot. These are treatable and usually require a series of treatments to clear them. One thing that is important here is to make sure you do not have a melanoma on the bottom of the foot that looks like a wart. Any unusual wart in this area may need to be biopsied (again, this is extremely rare).
3. Periungual warts: warts that are found around the finger or toe nail. These warts tend to be among the most difficult to treat. Very rarely, this type of wart can progress into a type of skin cancer. This is extremely rare, but if you have a wart in this area and it has been recalcitrant to treatment for several years, your doctor may determine to do a biopsy on it to rule this out. Remember, if you have this type of wart…DO NOT BITE YOUR NAILS! Or you may end up with warts in and on your mouth. Yuck!
4. Genital warts: warts found on the penis, vagina and peri-anal skin. Genital warts are considered to be sexually transmitted by skin-to-skin touch. Many of these warts also have the strains of HPV in them that cause cervical cancer, penile cancer, SCC of the anus. It is very important to treat genital warts. There are a few vaccines available now to prevent several of the dangerous strains of genital warts. This vaccine is recommended for both girls and boys.
5. Other warts: warts on your elbow, forehead, cheek…wherever: warts can be found anywhere on the body and can spread to anywhere on the body.
How are warts treated at Alpine Dermatology?
We offer many different treatments for warts. What treatment we use depends on your particular case. For example; where are your warts, how many do you have, how big are they, how old are you, and are you immune-suppressed? These questions and more need to be answered in order to determine the right treatment for your case.
Our treatment options include:
1. Cryotherapy (Liquid nitrogen) and prescription strength salicylic acid:
This treatment is one of the most convenient and most effective. The wart virus has a gene in it that makes the skin it infects grow more rapidly than the skin around it, so you use the salicylic acid to soften the wart and to pare it down every day. Then, every two weeks, we will freeze the warts. This acts to cut off the blood supply to the wart. Between these two modalities, most warts can be cleared. It is important to return for your follow-up appointments until the warts are COMPLETELY gone. If the wart is small or partially there, it can replicate, grow, and make more warts.
2. Cantheridin:
This is a chemical from the blistering beetle that is painted onto warts and causes a blister to form. It is among the less effective, but most painless option…so it is often used on children when more effective, but more painful treatments aren’t an option. This is not an FDA-approved use of cantheridin.
3. Immunotherapy:
Alpine Dermatology offers two forms of immunotherapy:
a. SADBE (squaric acid dibutyl ester): SADBE is a very potent allergen. This means that almost everyone will become allergic to it if they have it painted onto their skin at a concentration that is strong enough. By painting this chemical onto your warts, we make you allergic to SADBE and you will get a little eczema in the area. Somehow, this immune reaction gets your immune system to start “seeing” the wart virus as a foreign bad guy and will start killing it. This is a great way to get your own immune system to treat the warts. This treatment requires some dedication and is used when more convenient options don’t work or when you have numerous warts, or when you are immune-suppressed. This option is a little inconvenient because you must keep the entire treated area covered for approximately 12-16 hours every time you get it treated. Sometimes this may mean wearing a glove on your hand overnight.
Note: Dr. Eberting does not use DNCB as may be found in many other
offices. DNCB is a known mutagen; meaning it is known to cause
mutations in bacteria when subjected to a test called the Ames test.
SADBE is NOT a known mutagen and is probably safer. SADBE is not
FDA-approved for the treatment of warts.
b. Candida Antigen: This is a protein from the yeast Candida that is
purified and injected into and around the wart. This acts in a similar way
as SADBE, but most people are already allergic to it and so it tends to
work on most people. This is a treatment that sometimes is tricky to get
insurance to pay for, but when we need to use it, we feel grateful that we
can! Candida Antigen is not FDA-approved for the treatment of warts.
4. Aldara: Aldara was originally approved for the treatment of genital warts. Now, it is often used to treat many different kinds of warts. Depending on where, how many and how big the warts are, we use this medication differently. There are some tricks we can teach you to get this treatment to work when it may not have worked in the past. Aldara is also extremely expensive ($500 to $800 a box!)
5. Veregen: a new botanical medication. Veregen is an extract from green tea leaves that is FDA approved for the treatment of genital warts. It probably works in a similar way as the immunotherapy that is discussed above. VEREGEN® Ointment, 15% is a medicine for skin use only (topical) for the treatment of warts on the outside of the genitals and around the outside of the anus. It causes complete clearance in about 53% of people and around 6-7% of those will have a recurrence. This medication is also fairly expensive.
6. Laser: In extremely resistant cases, we can use a laser to treat a wart. Because the wart virus can be aerosolized when we do this, it tends to be a treatment of last resort.
7. Other topical medications: there are a few other prescription topical medications that can be used to treat warts as well. If your case is one that is determined to be effectively treated this way than your provider will let you know.
