Wart Removal Surgery

General Facts about Warts

  • Warts are very common skin infections in the general population.
  • Affecting 10-12% of the population, warts can occur at virtually any age group.
  • Any breach in the skin barrier can increase the chance of a wart infection, whether by director indirect contact.
  • Warts can potentially infect any body site, but are found commonly on the feet, fingers, face and genital region.
  • Treatment success depends on the location of the wart, the size and your natural healing capacity.
  • Treatment options include topical agents, cryotherapy and laser wart removal surgery.
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What are Warts?

Warts are caused by the human papilloma virus (HPV) and affect most of us at some point of our lives. There are over a hundred types of human papilloma viruses, and some high-risk HPV viruses are associated with cancer development. Most notably, there are vaccines now available to protect young girls from cervical cancer, as studies have shown that HPV 16 and 18 account for about 70% of cervical cancers. 

The wart viruses are incredibly resilient creatures, and can survive in extremely dry conditions, freezing temperatures and in the external environment for protracted periods of time. Due to the infective nature of warts, it is not surprising to learn that they can spread from one site of the body to another. This means that if you are picking on your wart, you can transfer the virus to other parts of your skin.

Warts take on a different appearance depending on the site where it infects. Warts typically have a rough surface, and can look flat or have tiny projections sticking out from the skin. In certain areas such as the soles and around the fingernails, the wart virus tends to grow deeply, causing pain and the surrounding skin to be thickened in texture. Certain jobs increases your risk of getting warts, for example, meat handlers have a higher risk of warts on their hands that are affectionately termed Butcher’s Warts. Warts are also more common and more difficult to treat if you have a weakened immune system such as diabetes, cancer and HIV.

Treatment of Warts

You might be surprised to know that warts will eventually clear spontaneously as your immune system decides to act on it, although it may take years. About 60% of warts may clear on it own within 2 years, however we do understand that many patients may experience pain from the warts, or the warts may be spreading around the skin, therefore motivating many patients to seek professional help to find a solution to treat their warts.

There are various home remedies that may help with the warts with varying degrees of success. Although these alternative treatments are unsubstantiated, they remain popular and widespread. One rather painless and inexpensive method involves applying duct tape over the wart for a couple of days before removing it. There are also reports of people treating their warts by immersing the affected area under hot water several times a week. Some individuals have used raw garlic and Tea tree oil in an attempt to treat their warts at home. Interestingly, there are reports of some individuals resorting to hypnotherapy to address their warty problem.

Non surgical wart treatments

There are multiple medical treatment options available for warts. However, there is no single treatment that is universally effective, and recurrence rate remains significant despite treatment. As warts are very resilient creatures, patience and perseverance is essential.

Generally, we start off treatments that are the least painful and least costly, reserving more sophisticated treatments for stubborn warts.

The topical treatments for warts are a good first line treatment for warts, they contain a variety of active agents. Salicylic acid preparations are a common treatment option for warts and work by actively removing the top layers of the skin infected by warty tissue. Multiple applications are needed, and while it is suitable for warts of the soles and hands, it cannot be used to treat sensitive areas such as the face or genitalia due to the increased risk of skin hyperpigmentation and skin irritation. Infants, and patients with impaired circulation and diabetes are also not suitable for salicylic acid topical treatments. Other topical agents include Podophyllotoxin, Trichloroacetic acid and Cantharidin. A recent combination formulation of salicylic acid and 5-Fluorouracil (which is a chemotherapeutic agent) has shown to be an effective treatment for warts.

Injection therapy for warts is another option, but can be painful and recurrences are common.

For genital warts, the Imiquimod cream has been shown to be effective, and works by stimulating your body’s immune system to fight off the wart virus.

Cryotherapy or Liquid nitrogen treatment of warts is commonly used in medical practice and works by using freezing temperatures of up to -196 degrees celsius to destroy the warty tissues. It’s a rather painful procedure, and you may blister after liquid nitrogen treatment. Definitely not a recommended treatment option for young children! Multiple sessions are required and side effects from liquid nitrogen treatment include scarring, blisters, ulceration and colour changes to the skin.

When warts recur or become resistant to standard treatments, wart removal surgery is considered.

Wart removal surgery

Carbon dioxide laser surgery for warts is a destructive treatment option that is usually reserved for stubborn warts. The carbon dioxide laser is able to selectively remove the warty tissue while minimizing bleeding. The procedure is carried out under local anaesthesia, and wound aftercare is essential post treatment. Although lasers are a sophisticated treatment for warts, the recurrence rate remains significant.

Laser wart removal surgery is considered when the warts are large, and resistant to treatments. The other techniques vary from formal excision, to the destruction of the warts using electrosurgery.

 

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Summary

Warts are very common viral infections in the general population. When people seek treatments, it is usually when the warts are causing pain, discomfort, irritation or may be cosmetically unacceptable. Whatever you reasons, you should know that there are many treatment options available, whether topical, cryotherapy or by wart removal surgery. The treatment of warts must take into consideration the risk and benefits to the patient, the costs involved and amount of downtime that is acceptable to the patient.

References:

  1.  Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, Handfield-Jones SE. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. Br J Dermatol. 2014 Oct. 171(4):696-712.
  2. Kwok CS, Gibbs S, Bennett C, Holland R, Abbott R. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2012 Sep 12. 9:CD001781.
  3. Sloan K, Haberman H, Lynde CW. Carbon dioxide laser-treatment of resistant verrucae vulgaris: retrospective analysis. J Cutan Med Surg. 1998 Jan. 2(3):142-5.