Wart Removal surgery specialist Singapore

Wart Removal Surgery

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. Treatment options depend on the site, size and type of wart.

viral warts diagram

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 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. 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.

How Do I Get Warts?

Warts can enter in the skin when there is a breach in the skin barrier. For example, a wound, a scratch, nail biting or even picking on your acne can potentially create a portal of entry for the wart viruses.

Warts can spread directly from an infected person to another, or to even the same person (auto-inoculated warts). Warts are also found in contaminated surfaces such as gyms and swimming pools. 

Warts are more common with individuals with hyperhidrosis of the feet, and individuals who are in certain professions such as butchers and fishmongers.

What Are The Different Types of Warts?

Flat warts
Filiform warts
Plantar Warts
Common 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.

How Are Warts Diagnosed?

Most warts can be diagnosed based of their clinical appearance. Similar skin lesions such as seborrhoeic keratoses and skin tags may need a closer examination. In rare and unusual cases, a skin biopsy may be needed for confirm the diagnosis.

Treatment of Viral 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 Viral 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 degree 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

  1. Electrosurgery is a procedure using alternating electric current to generate heat to burn the warty tissue. This procedure is painful and likely to cause scarring.
  2. CO2 (Carbon Dioxide) laser surgery for wart removal is a destructive treatment option that is usually reserved for stubborn warts. The CO2 laser has a wavelength of 10600nm, which has a high absorption capacity of water. 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.

Case Example: Facial Wart Removal

facial wart removal Singapore
Filiform Facial Warts
face wart laser removal Singapore
Flat Facial Warts
best facial wart removal clinic Singapore
Laser wart removal

Facial warts are common in the general population. The 2 most common types encountered are the flat and filiform facial warts. Facial warts grow and spread slowly in most cases, but rapid spread can occur in cases of low immunity states. Facial wart removal presents unique challenges. Topical salicylic acid treatments cannot be used on facial skin because it is far too harsh, and has a high risk of post-inflammatory hyper pigmentation. Cryotherapy on the on hand, is very painful on facial skin and may cause blisters, swelling and hyperpigmentation.

Facial Carbon Dioxide laser wart removal is effective at precisely removing the warts with little downtime, no bleeding and gives excellent cosmetic results.

The affected area is numbed either with a topical or local anaesthetic. The laser wart removal procedure is virtually painless.

Depending on the size of the wart, most individuals recover within 7-10 days.

As with most procedures, there is a small risk of bleeding, infection, hyperpigmentation, hypopigmentation, scarring and recurrence. With careful planning and selection, the risks are minimal.

Electrosurgery is associated with a higher risk of scarring. Laser surgery is more precise and healing is excellent in most individuals. Also, the smaller the wart, the less obvious the scar will be.

 Warts are known to recur regardless of the treatment modality. Multiple treatments may be necessary for recurrent warts.

Dr Moses Ng dermatologist

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

Where can I get more information?

  • British Association of Dermatologists for Plantar Warts.
  • Medscape resource for Non-genital warts. Click here.
  • New Zealand HPV Project. Click here.

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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.