Wart Removal Surgery

What are Viral 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 long 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 are likely to transfer the virus to other parts of your skin.

Wart removal treatment therefore is recommended to get rid of the virus and to prevent further spread.

What Do Warts Look Like?

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. Warts on the bottom of your feet are called plantar warts. 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.

Although warts are common, they are unsightly and can cause discomfort. It is therefore understandable that many would seek wart removal treatments for this common condition.

Wart risk factors

• Weakened Immune System: Individuals with weakened immune systems, such as those with HIV/AIDS or who are on immunosuppressive medications, are more susceptible to HPV infections and thus more likely to develop warts.
• Skin-to-Skin Contact: Direct contact with warts, either on someone else’s body or on the person’s own body (autoinoculation), increases the risk of developing warts.
• Exposure to Contaminated Surfaces: Walking barefoot in public places like pools, locker rooms, or communal showers can increase the risk of contracting HPV and developing plantar warts.
• Skin Injuries or Broken Skin: Having cuts, scratches, or other breaks in the skin can provide an entry point for HPV, making it easier for the virus to infect the skin and cause warts.
• Age: Children and teenagers are more likely to develop warts because their immune systems have not yet fully developed immunity against the various types of HPV.
• Personal Habits: Certain habits, such as nail-biting or shaving, can spread the virus to other parts of the body, leading to the development of warts.

Warts are abnormal growths on the skin caused by the human papilloma virus (HPV). Affecting about 10-12% of the population, warts can occur in any age group. Wart removal treatment depend on the site, size and type of wart.

What Are The Different Types of Warts?

Warts take on distinct appearances depending on the site of infection.

1. Flat warts are commonly found on the face or neck. They are usually multiple and often of varying size.
2. Filiform warts have finger-like projections. These are often found on facial areas and co-exist with flat warts.
3. Plantar warts are common warts found on the sole of the feet. They may cause pain when you walk or stand.
4. Common warts have a cauliflower like appearance. They are founds mostly on the fingers, elbows and knees.
5. Genital Warts: Small, flesh-colored or grayish growths that may cluster together, sometimes resembling a cauliflower. They are generally softer and may be flat or raised.

How Are Warts Diagnosed?

Most warts can be diagnosed based of their clinical appearance. It may mimic some dermatological conditions such as:

• Seborhoeic keratosis
• Squamous cell carcinoma (a type of skin cancer)
• Corns and Callus

In rare and unusual cases, a skin biopsy may be needed for confirm the diagnosis.

Can warts be left alone?

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 motivating many to seek professional help to find a solution to treat their warts.

Why do i need to treat wart early?

Common Viral Wart Treatments

Over-the-Counter Treatments

1. Salicylic Acid: Available in various forms such as liquids, gels, and patches. When applied directly to the wart, it helps peel away the infected skin.
2. Cryotherapy Kits: These use a freezing agent, often dimethyl ether and propane (DMEP), to freeze and destroy wart tissue.

Prescription Treatments

1. Topical Medications: These can include stronger concentrations of salicylic acid, imiquimod (which stimulates the immune system), and Verrumal creams.
2. Cantharidin: Applied by a healthcare provider, this causes a blister to form under the wart, lifting it off the skin.

Different wart removal treatments in Singapore

Electrosurgery

A procedure using alternating electric current to generate heat to burn the warty tissue. This procedure is painful and likely to cause scarring.

CO2 (Carbon Dioxide) laser surgery

CO2 laser for wart removal is a destructive treatment option that is usually reserved for stubborn warts. It is able to target skin lesions with a high degree of precision and low reflection and scattering of the laser beam. The CO2 laser selectively vaporizes the warty tissue while minimising 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.

Cryotherapy: 

Liquid nitrogen is used to freeze the warts. Multiple treatments may be required. 

Excision: 

Surgical removal of warts, especially larger and stubborn ones. However, this is associated with more scarring.

Immunotherapy:

Intralesional immunotherapy are an option for warts resistant to conventional forms of treatment. Intralesional injection of vaccines (mumps, measles, rubella virus or MMR vaccine, and Bacille Calmette-Guerin or BCG vaccine) helps to stimulate your immune system against different antigens to clear cells infected by the HPV virus. For patients with multiple warts, intralesional immunotherapy can lead to clearance of targeted and even distant warts. An average of 3-5 treatment sessions are done over fortnightly sessions. The procedure is associated with a low risk of serious adverse events, with redness and pain on injection being the most commonly reported events.

Wart removal treatment comparison

When considering wart removal treatments, several factors should be taken into account to determine the most effective and appropriate approach. These considerations include the type and location of the wart, the patient’s age and overall health, the potential for pain or scarring, and the likelihood of recurrence.

Procedure	Electrosurgery	Cryotherapy	Laser	Excision
Mechanism	Electric current	Liquid nitrogen	Vaporization	Surgical removal
Limitations	Scarring	Hypopigmentation, Blistering	Specialized equipment	Longer healing time
Pain level	Minimal to Moderate	Moderate to High	Minimal	Minimal
Recovery	7-10 days	7-10 days	7-10 days	10-14 days
Scarring	++	++	+	+++

Wart removal cost Singapore

TREATMENT	PRICE
Topical treatment	from $50
Electrosurgery	from $380
Laser wart removal	from $380
Surgical excision	from $499

Frequently Asked Questions About Wart Removal

Wart removal surgery

Viral warts are very common 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. Wart removal must take into consideration the risk and benefits to the patient, the costs involved and amount of downtime that is acceptable to the individual.

Dr. Moses Ng

Schedule a consultation for Wart Removal in Singapore

Are you suffering from stubborn warts and have tried over-the-counter treatments that do not work? Contact us today to schedule a consultation, so that Dr. Ng can develop a personalized treatment approach for resolving your skin concerns and helping you to achieve long-term improvements in the appearance of your skin.

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. Oganesyan A, Sivesind T, Dellavalle R. From the Cochrane library: topical treatments for cutaneous warts. JMIR dermatology. 2021 Dec 14;4(2):e33900.
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.
4. Fields JR, Saikaly SK, Schoch JJ. Intralesional immunotherapy for pediatric warts: a review. Pediatric dermatology. 2020 Mar;37(2):265-71.
5. Kaur A, Brar BK, Kumar S, Brar SK, Boparai AS, Puri N. A randomized comparative study of MIP and MMR vaccine for the treatment of cutaneous warts. Indian Journal of Dermatology. 2021 Mar 1;66(2):151-8.