Wart Treatment
What is a wart?
A wart (verruca) is a small growth on the skin that develops when the skin is infected by the human papillomavirus (HPV). There are over 150 types of HPV, 10 of which are generally implicated in cutaneous warts affecting the feet.
Viruses can be contagious and spread with contact, mainly through breaks in the skin. Warts can develop anywhere on the foot, but they typically appear on the bottom (plantar side) of the foot. Plantar warts most commonly occur in children, adolescents, older individuals, and those with depressed immune systems.
HPV infects epidermal cells down to the basal cells. Infection is confined to the skin layers and does not penetrate deeper. As the wart grows, it displaces the surrounding skin layers, including the dermis, which can create the illusion that the wart is growing deeply.
The following symptoms may be present with warts on the feet:
Thickened skin. A plantar wart often resembles a callus because of its tough, thick tissue on top. Alternatively, warts can also have a cauliflower or stalk like appearance.
Pain. Pressure on the wart may be painful, such as when walking and standing. Squeezing the sides of the wart may also cause pain.
Tiny black dots. This is often described as pepper staining, like little flecks of ground black pepper embedded on the surface of the wart. The dots are actually dried blood contained in the capillaries (tiny blood vessels). Plantar warts grow deep into the skin. Usually, this growth occurs slowly with the wart starting small and becoming larger over time.
Interrupted Skin Lines. The normal skin lines present throughout the skin, and which make up fingerprints, do not flow through warts.
Solitary. A single wart. This may increase in size and multiply, forming additional satellite lesions.
Mosaic. A cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts.
Warts may go away on their own. About 50% go away within one year, and 66% within two years. During that time however the wart will shed viral particles to nearby tissue which can increase the risk of recurrence and spread.
Over they counter products for wart treatment often include salicylic acid. This acid eats away the viral tissue but will also affect any tissue it comes into contact with. It is important to apply these products only on the wart to avoid irritating the surrounding tissue. Duct tape may be used to cover the salicylic acid, wart, and surrounding tissue. Salicylic acid products usually require 6-8+ weeks of daily treatment to remove a wart. People with diabetes, neuropathy, and peripheral vascular disease generally should not use topical salicylic acid treatments. Cryotherapy can freeze a wart off in 1-3 treatments.
Cryotherapy is the controlled destruction of unwanted cells be precise application of extreme cold (cyronecrosis).
A two-step freeze thaw cycle results in deeper tissue necrosis. While the first freeze causes tiny, spiked chards of extracellular ice, which actually helps preserves cells, the second freeze cause these ice crystals to break through the cell membrane for complete cell destruction. This cell death (apoptosis) of treated wart tissue causes an immune response, recruiting your own body’s immune system to aid in eliminating the wart. Multiple treatments sessions are often necessary.
“Post-thawing, mechanically damaged cells die by necrosis and release their contents into the surrounding milieu. Cells that have undergone exosmosis swell and burst due to osmotic shock. Cells in the utmost periphery of the ablation zone exposed to sub-lethal temperatures undergo apoptosis, releasing apoptotic bodies. Antigens released from necrotic cells upon uptake by antigen presenting cells like DCs [Dendritic Cells] induce co-stimulatory signals that would result in the generation of anti-tumoral T-cell responses. In contrast, antigen uptake by DCs in the form of apoptotic bodies imprints immune tolerance or anergy on T-cells due to the non-induction of co-stimulatory signals on DCs.”
Yakkala, C., Chiang, C. L., Kandalaft, L., Denys, A., & Duran, R. (2019) ‘Cryoablation and Immunotherapy: An Enthralling Synergy to Confront the Tumors’, Frontiers in Immunology, 10, 2283. https://doi.org/10.3389/fimmu.2019.02283
1. Controlled, precise cell destruction of wart tissue. No trauma to healthy tissue.
2. Minimal / low or no pain. No anesthesia or injections are needed.
3. Less scarring or depigmentation.
4. Fast treatments
5. Effective
6. The standard treatment for all HPV lesions.
7. Cryotherapy may also be used on acrochordons (skin tags).
• During treatment, you may feel a sensation similar to a cold ballpoint being pushed onto the skin. During the first few seconds, there is generally little or no discomfort.
• As soon as the ice reaches the bottom edge of the lesion – timing depends on the depth of the lesion – you will start to experience some discomfort. Treatment stops immediately at that moment, as soon as you start to feel discomfort.
• Multiple treatments are generally necessary for successful treatment, particularly on the bottom of the foot where the skin is much thicker. The thickest skin on the body is found on the sole of the foot.
• There may be some mild residual stinging for a few minutes after treatment. Occasionally, a blister may form and last for a few hours. The area may be itchy, and you should avoid scratching it.
• There may be residual stinging for a few minutes after treatment. This is normal.
• Occasionally, a blister may form and last for a few hours/days. If this happens, leave the roof of the blister intact.
• The area may be itchy. Avoid scratching it.
• You may cover the area with a fabric band-aid if desired.
• Schedule a follow up visit in 3-5 weeks to confirm the lesions are gone or determine if repeat treatments are necessary.