How to Get Rid of Warts: Which Treatments Are Truly Worth Your Dime and Time?

Warts are stubborn lesions that can cause disability or emotional distress. Various treatments are available, even home remedies, but they may fail or produce complications if not done properly.

Many people jump through hoops trying to figure out how to get rid of warts without consulting a medical professional. But this skin condition is more complicated than it looks, and only a skin specialist can guarantee that your wart removal attempts will not be futile or leave a scar.

This article explains various at-home and office-based wart treatments, identifying those that work and those that don’t. We also give tips on how you can stay wart-free after receiving therapy.

But first, you need to understand…

Where Do Warts Come From, and Why Are They Hard to Get Rid Of?

Most people associate skin infections with redness, pus and tenderness. Warts look different and don’t usually cause pain unless they get hit or stepped on. So people may not regard them as infectious even though they are.

Warts result from human papillomavirus (HPV) infection. Skin breaks, such as abrasions and cracked heels, allow the entry of the virus. From there, they move to the inner skin layers and invade younger cells. HPV-infected cells grow abnormally, but like normal skin cells, they die on reaching the surface. When they multiply, the virus also multiplies, thus perpetuating the infection.

HPV-infected skin can look normal for a long time. The lesions develop slowly and may take 2-9 months from viral entry before becoming noticeable. The typical wart is raised with a very thick, dry and rough surface. It may be the same color as the surrounding skin or darker. A robust immune system can easily contain the virus, so healthy people may not grow any lesions, or if they do, they’ll see them clearing up even without therapy.

Wart treatments do not always get all HPV-infected cells, especially the ones that may still look normal on the outside. Recurrence results if the immune system cannot eliminate the remaining viruses.

Are Warts Contagious?

Yes, warts are contagious. HPV spreads through skin-to-skin contact, with skin breaks making people vulnerable. Autoinoculation occurs if a person spreads the virus elsewhere in their body.

What Are the Different Types of Warts, and Why Is It Important to Know?

Warts are classified according to their appearance and location. Each type is associated with one or several HPV subtypes. We describe them below.

Common Wart

Common warts, also known as “verruca vulgaris,” are scaly, rough, round or irregularly shaped protuberant lumps appearing singly or in clusters on any part of the skin. They are usually caused by HPV 2, 4, 27 and 29.

Flat Wart

“Verruca plana” or flat warts are slightly raised, minimally scaling, flat-topped lesions 1-4 millimeters in size. They appear most frequently on the face, hands and lower limbs. HPV 3, 10, 28 and 49 are the subtypes most often found in flat warts.

Deep Plantar and Palmar Warts

These lesions occur on the soles (plantar) and palms (palmar). Common warts also appear in these areas, but deep plantar and palmar warts grow inwardly instead of forming bulging lesions. Mosaic warts emerge from coalescing hand and foot warts. Removal of the surface cells reveals black pinpoint lesions created by blood vessel clots.

Deep hand and foot warts are frequently caused by HPV 1. These lesions produce pain—even disability in severe cases—because they are typically subjected to heavy pressure.

Butcher’s Warts

Butcher’s warts are so-called because of their association with meat and fish handling. They appear in multiples on the palms and backsides of the hands and around the fingernails. HPV 7 is the main cause of these lesions.

Cystic Wart

Cystic warts have smoother surfaces and are filled with cheese-like material. They usually appear on the soles. HPV 60 is the subtype most commonly associated with cystic wart formation.

Filiform Wart

Filiform warts have projections shaped like horns or spicules. They mostly appear on the face, neck and skin folds. HPV subtypes 1, 2, 4, 27 and 29 are the usual causes.

Heck’s Disease

The warts of Heck’s disease are not skin warts but appear on the mucosal surfaces of the mouth. The lesions are soft and bulging, often occurring in multiples. HPV 13 and 32 are the usual causes. However, susceptibility to these subtypes is thought to be hereditary because the condition occurs in families

Genital Warts

Genital warts have several forms, but we won’t discuss them here. They are usually sexually transmitted in adults. Infants younger than 6 months may also develop these lesions after acquiring HPV at birth from their mothers. But if found in older children, sexual abuse must be suspected.

Genital warts can affect both the skin and mucosa of the private areas. The lesions have cauliflower-like surfaces and variable shapes and sizes. Many HPV subtypes can cause genital warts, but the ones to watch out for are HPV 16, 18 and other so-called “high-risk” subtypes.

Identifying wart types correctly is important primarily for two reasons. First, it impacts short-term disease management. For example, what works on mucosal warts may not work on skin warts because of the different responses of the surface cells to treatment. Second, high-risk HPV subtypes causing genital warts increase a patient’s susceptibility to genital tract cancers. Knowing one’s cancer risk affects long-term management.

Do Wart Home Remedies Work?

The simplest answer is some do, but most don’t.

Let’s start with the ones that studies show are effective or somewhat effective in clearing warts. We include over-the-counter and prescription medications in this category.

• Exfoliants

The exfoliant most commonly used for treating warts is salicylic acid, which is available in various topical formulations. It loosens up the surface cells, including virus-infected ones, until they are easy to scrape off or shed on their own. The drug can also trigger an immune response.

Most topical solutions contain 17% salicylic acid. Generally, the regimen consists of the following steps:

• Cleaning the problem area
• Scraping off the dead skin cells with a wart file, pumice stone or similar abrasive material
• Soaking in warm water
• Patting the site dry
• Applying the medication on the wart, avoiding normal skin
• Covering with an airtight dressing overnight

This routine is repeated nightly for about 6 weeks.

Studies show that warts clear up in 60-85% of patients after one salicylic acid treatment course. Its main advantages are its convenience, low cost, mild side effects and the drug’s availability even without a prescription. However, its biggest downsides are the following:

• The possibility of poor patient compliance. Not everyone can finish a 6-week routine or perform the treatment properly when unsupervised by a healthcare provider.
• Autoinoculation if the patient touches the wart with bare hands or recycles the materials they used during treatment. As a rule, applicators, wart files and dressing materials must be thrown out and replaced with every use.

Mild local irritation is the most common side effect of salicylic acid. But if applied on very large skin surfaces, it may cause salicylic acid toxicity, signified by ringing of the ears, confusion, vomiting, fast breathing, dizziness and other systemic symptoms.

Infection-prone patients, such as those with diabetes mellitus, immunosuppression, and poor blood circulation in the limbs, must be under medical supervision when using this treatment.

• Retinoids

Retinoids are vitamin A-like drugs that may be used orally or topically at home. Etretinate and tretinoin are examples. Retinoids normalize skin cell growth and modulate the skin’s immune system. Their clearance rate reaches up to 85% with good patient compliance.

Topical formulations may produce transient mild local irritation. Oral preparations may cause skin dryness and light sensitivity. Retinoids may result in birth defects and premature birth if taken by pregnant women.

• Virucides

Virucides penetrate the skin, deactivating the virus. They also harden the wart’s surface, making it easy to scrape off. Warts clear up after three months in 70-80% of cases.

Examples of virucides are formaldehyde and glutaraldehyde. Both agents are used once or twice daily. They may cause mild local irritation, but only glutaraldehyde can stain the skin brown.

• Imiquimod

Imiquimod is marketed as “Aldara.” It is applied topically, acting as an immune response modifier. It is used primarily in treating warts in private areas, though your dermatologist may also prescribe it for resistant common warts.

Aldara 5% cream is applied three times a week in the evening and must be washed off after 6-10 hours. Its clearance rate, when used alone, is low, ranging from 30-50% after 2-3 months. But combining it with other wart treatments has a synergistic effect.

• Podophyllin

This drug is mainly prescribed for genital warts because it penetrates non-genital warts poorly. Podophyllin stops cell growth and breaks down wart tissue. The clearance rate is 70% after 4 weeks, while the recurrence rate may reach 25%.

Meanwhile, home remedies with insufficient evidence of efficacy include the following:

• Cimetidine

This drug is more commonly used for hyperacidity. However, it can also enhance the skin’s immune response as a side effect. It was once thought that cimetidine could be used to treat warts, but studies failed to demonstrate its effectiveness.

• Heat therapy

Exposing warts to temperatures as high as 60℃ for 30-60 minutes can destroy HPV-infected cells. It is possible to reach such temperatures at a dermatologist’s office with the aid of radiofrequency-emitting devices but not at home.

• Home cryotherapy

Home wart-freezing kits are available over the counter. But as in heat therapy, they are nowhere near as effective as in-office cryotherapy because they cannot reach the optimum temperatures.

• Homeopathy and other alternative treatments

Various alternative remedies have been tried on warts, including:

• Calcium
• Sodium
• Sulfur
• Aloe vera
• Topical vitamin C
• Duct tape
• Tea tree oil
• Banana peel
• Castor oil
• Garlic

However, there is insufficient scientific evidence supporting their effectiveness against this viral infection.

Patients may prefer at-home wart treatments due to their convenience and low cost. Some also choose to skip doctor visits because they are too embarrassed to let others see the lesions

We understand these concerns. However, even at-home treatments that supposedly did well in clinical studies have very high failure or relapse rates, reaching as high as 80%. Patients in the real world are unsupervised by their providers, unlike in clinical trials where the therapeutic conditions are controlled. Moreover, severe side effects are more likely to occur when using at-home wart remedies.

Potential Complications of Home Remedies

Why Should You See a Dermatologist for Wart Treatment?

Board-certified dermatologists are the best medical professionals to consult about wart removal. The following are the advantages you get when you see them for this condition:

• Correct diagnosis

Warts can look like other lesions. Some of them are also infectious, such as syphilitic chancres. Non-infectious wart-like blemishes include skin tags, psoriasis, skin cancer and many others.

Board-certified dermatologists are trained to recognize a much wider variety of skin diseases than any other medical professional. A doctor can only give the proper treatment if they have the right diagnosis. Failure to identify a skin condition correctly, especially time-sensitive ones like warts and skin cancer, can be dangerous.

• Treatments are guaranteed to be safe and effective

When treating warts, the goal is not only to get rid of the infection but also to leave the skin scar-free. This is especially important if the lesion is in prominent areas like the face. Board-certified dermatologists are experts in performing skin treatments that effectively get rid of warts without damaging the surrounding normal tissues. 

• Improves quality of life 

A plantar wart can make it painful for you to run early-morning laps around the neighborhood. Meanwhile, filiform facial warts are unsightly and can make you self-conscious. The sooner you eliminate these lesions, the sooner your lifestyle and mental health will improve.

• Cost-effectiveness

Wart treatment by a board-certified dermatologist typically has a high clearance rate and low chance of relapse. These metrics translate to fewer doctor visits for the same condition, greater mobility, low risk of complications, fewer medically-related work absences and lower healthcare spending overall. Meanwhile, ineffective or botched wart treatments will just cause you to spend more.

So clearly, your best move against this infectious skin growth is to leave it to no less than a board-certified dermatologist.

How Do BHSkin Dermatology Specialists Get Rid of Warts?

At BHSkin Dermatology, we offer a wide range of services that can safely and effectively eliminate warts. They include the following:

Cantharidin

Cantharidin loosens the top surface of the wart, causing it to blister and dry up. The procedure itself is quick and painless, but the blisters can hurt. The downtime may be as short as a few days for lesions in non-weight-bearing areas and as long as 1-2 weeks for plantar warts.

Cryotherapy

In this procedure, the doctor uses liquid nitrogen to freeze the wart. You will feel minimal discomfort during your session. However, a blister usually forms on the treated site, which can cause pain for a few days. As in cantharidin treatment, recovery after cryotherapy may last a few days to a couple of weeks, depending on the wart’s location.

Electrosurgery and Curettage

This procedure entails scooping out the wart tissue and using a pen-like electric heating device to control the bleeding and burn the remaining infected cells. It is done under local anesthesia, so you won’t feel any pain during your session. Recovery can take 1-2 weeks for lesions in non-weight-bearing areas and up to a month in plantar wart removal cases.

Simple Excision

Here, the doctor will snip out the wart after injecting local anesthesia. The recovery period is similar to electrosurgery and curettage.

Laser Treatment

The dermatologist may use an ablative or non-ablative laser to remove warts. Lasers are precise instruments, so they can be used in tight areas like those around the nails. The dermatologist may also perform laser procedures for widespread lesions, which can be too risky or complicated to treat with manual excision. 

Ablative lasers include CO2 and erbium lasers, which use long infrared light waves. The dermatologist will use the device to cut out the wart. Ablative laser surgery may be done under local anesthesia, nerve block, or sedation, depending on the wart’s location and extent. The downtime is similar to surgical excision.

Non-ablative lasers include the VBeam laser, a pulsed dye laser. It uses yellow-green light energy to burn the wart’s blood vessels without cutting the surface. The wart dries up once deprived of its blood supply. Injectable pain medications are unnecessary because the device sprays a cold mist to numb the skin.

The downtime after non-ablative laser treatment may be as short as a few days for small warts in non-weight-bearing regions. Plantar areas may need protection from heavy pressure for 2-4 weeks, depending on the lesion’s size.

Radiofrequency Ablation

In this procedure, radiofrequency waves are used to cauterize warts. A numbing cream or local anesthetic may be given before the procedure. The downtime is similar to surgical excision.

Photodynamic Therapy

Photodynamic therapy (PDT) entails applying aminolevulinic acid on the skin to sensitize it to blue light. The light beams are highly selective for abnormal cells, so the procedure may be used to treat multiple warts covering wide areas. Numbing medication reduces the discomfort of PDT. The recovery period can take up to 2 weeks to give time for the skin to clear the burned wart tissues.

Bleomycin Injection

Bleomycin is an anti-cancer drug that stimulates the skin’s immune system. The treatment may be used alone or in combination with others against extremely stubborn warts. Injecting the drug into the lesion can hurt, although numbing medication is usually not required. Little to no downtime is needed after the procedure, but slight tenderness can persist in the treated area for up to 2 weeks.

Choosing the right procedure depends on many factors, such as the patient’s medical status, past wart remedies used and costs. Trust your BHSkin Dermatology specialist to help you find the most suitable treatment option for you.

For more information on wart removal aftercare, you may read our article on the subject.

How Effective Are In-Office Wart Treatments?

The clearance rate of office-based procedures usually reaches 70% to greater than 90%, making them far better than home remedies. The recurrence rate depends on various factors (see below) but ranges between 2% and 25%. Treatment-resistant and recurrent warts may be remedied using combination regimens.

In-office wart removal does not depend on the unpredictability of patient compliance and technique but the healthcare provider’s skill. So if you choose a highly-trained, board-certified dermatologist to perform your wart treatments, you can be sure that you’re in good hands.

Here is a table summarizing the vital differences between the wart treatment options just discussed:

Comparison of Various Wart Treatments

From this table, you can see that office-based procedures have a lot more advantages over home remedies, making them more cost-effective overall.

Will Warts Come Back After an In-Office Treatment?

No single wart remedy is 100% effective, which is why combination treatments are sometimes necessary. The factors that can increase the likelihood of wart resistance or recurrence include:

• Delayed treatment
• Advanced age
• Poor immune status
• Long intervals between treatments in cases where more than one is required
• Poor technique used during the procedure
• Cigarette smoking, which weakens the immune system
• Repeat exposures at home and outside

However, the following measures can help you keep warts gone for good:

• Practice good personal hygiene.
• Avoid sharing personal items.
• Get immunized with a polyvalent HPV vaccine.
• Avoid direct skin contact with warts.
• Treat skin breaks promptly. Use moisturizers to enhance skin resilience.
• Use alcohol or bleach to sanitize communal sports equipment.
• Avoid walking barefoot in communal pools, showers and locker rooms.
• Avoid cigarette smoking.
• Boost your immune system with a balanced diet, physical activity and plenty of sleep.

Additionally, your choice of healthcare provider determines the long-term success of your wart treatment. So trust only a bona fide skin infection expert to get rid of this condition.

Making Sure That Warts Stay Gone

Warts are common blemishes resulting from HPV infection of the skin. They are classified according to their physical appearance and location, and their correct identification is vital to disease management.

Home and office-based wart treatments are available. While some home remedies have shown promise in clinical trials, their dependence on patient compliance and technique compromises their effectiveness in the general population. Meanwhile, there are plenty of in-office wart removal procedures to choose from, all proven safer and much more effective.

Finally, the short-term and long-term success of your wart treatment heavily depends on your healthcare provider’s skill. Entrusting the procedure to a skin infection specialist is the best way to eliminate this condition and keep it gone for good.

Say Goodbye to Stubborn Warts with the Help of LA’s Best Dermatologists!

Warts can be very frustrating to treat, but no one else understands this skin problem better than LA’s top wart removal specialists.

At BHSkin Dermatology, our award-winning skin infection experts have helped many patients eliminate this condition effectively and scar-free. Visit us at our Glendale or Encino clinic or use our teledermatology portal for your initial consultation.

Book your appointment today!

Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online