Aftercare and Recovery from Wart Removal Procedures: All You’ll Need to Know

Recovery from a wart removal procedure depends on several factors. The ones of particular importance are the type of treatment done, the lesion’s location and severity and the patient’s immune status.

We at BHSkin Dermatology have a number of quick, safe and effective solutions even for the most stubborn warts. You might have even discussed some office procedures with me or our other doctors on your last visit. Understandably, questions may remain about how we perform each treatment, how uncomfortable it would be and how long it would keep you from your daily activities.

I shall explain in this article the recovery process from each wart removal procedure and what you can do to ensure proper healing.

What Are the Factors that Can Impact Recovery from a Wart Removal Procedure?

In-office wart treatments produce some kind of controlled skin injury. As such, recovery focuses on the post-treatment wound healing process. Many factors affect skin repair, and your care provider at BHSkin Dermatology will evaluate your fitness for a procedure based on these.

The Lesion’s Location

The specific concerns here include occurrence in a weight-bearing area, growth on a site involved in movement, circulation and sun exposure.

The pressure from one’s weight delays healing because of oxygen depletion. Post-treatment wounds in weight-bearing areas, like the soles of the feet, need to be protected until they heal. If you have just undergone plantar wart removal, we may advise you to use loose footwear and crutches for a while.

You’ll know that healing is well on its way when walking on the affected foot becomes comfortable again. For some individuals, this may happen in as little as 2-3 weeks, but others may need to be on crutches longer. Other forms of pressure, such as that coming from a pen when writing, may also slow down recovery.

Sites involved in movement, like those on hand joints, may also heal slowly without immobilization. Skin contraction is a natural body process that closes up wounds, but movement can disrupt the contraction of healing skin.

Poor circulation is a complication of diseases like diabetes mellitus and peripheral arterial disease. Post-surgical wounds may heal slowly or not heal at all when blood, oxygen and nutrient supply are inadequate. We don’t advise invasive procedures in sites with poor circulation due to the risk of non-healing and secondary bacterial infection.

Tissue changes inside a closed wound will continue for months, even years. Sun exposure can darken newly repaired skin and break down its new connective tissues. To get the best cosmetic results, you may need to continue sun protection long after resuming normal activities.

The Post-Treatment Wound’s Size and Shape

Smaller post-surgical wounds generally heal faster than big or scattered ones. Inflammation of small skin breaks typically subsides within a few days to a week in healthy individuals.

Meanwhile, the repair time for bigger lesions largely depends on the post-treatment wound’s shape. Thin incisions allow the skin’s top surface to contract easily, so they typically heal faster than round wounds.

Stitches, skin glue, skin tape and surgical staples help speed up wound closure. They are appropriate for slit-like cuts but not for round or wide lesions.

The Wart Removal Procedure

The type of procedure influences pain severity and duration, as well as recovery time.

Generally, less invasive office procedures hurt less and only briefly. They include bleomycin injections, which produce only puncture wounds, and the non-invasive cantharidin treatment. These therapies require little to no downtime, depending on the wart’s location and other factors.

Cryotherapy is minimally invasive, but patients do not usually need numbing medication during the session. However, it will create a blister that can stay sore for days. Little to no downtime is required if it is done in non-weight-bearing areas.

Other office procedures burn the warts or create larger incisions, requiring pain medication during the session and sometimes afterward. They include electrosurgery and curettage, VBeam laser treatment and excision. Recovery time is variable.

The Patient’s Immune Status

When the skin breaks, immune cells go to the site to clean it up and prevent damage from spreading. They initiate inflammation, killing off any microbes that may be present in the area. Healing starts after the immune cells have done their job. Individuals with poor immune status, such as persons with HIV and diabetes mellitus, are at risk for delayed recovery or non-healing.

Other Factors that Can Delay Wound Healing and Recovery

A number of other health factors can also slow down healing and recovery time. They include the following:

• Clotting abnormalities, as clotting is the first process that closes up a wound. Liver disease, inborn clotting disorders, low platelet counts, blood thinner intake, etc., can put patients at risk of significant bleeding and wound non-closure.
• Treatments that suppress the immune system, such as steroid intake and radiotherapy in a nearby site.
• Factors that prolong the inflammatory process, like post-treatment wound infection and bruising (hematoma) and radiotherapy in a nearby location. Foreign bodies like dirt and retained gauze can irritate the skin further and delay recovery.
• Connective tissue disease, since wound healing generates a lot of new connective tissues. Therefore, healing would be difficult for individuals with conditions like Ehlers-Danlos syndrome, systemic lupus erythematosus and others.
• Malnutrition, because the formation of new connective tissues requires healthy levels of proteins, carbohydrates, fats and vitamins.
• Recent surgery in another body part, because the other post-surgical wound will divert nutrients from the wart removal site.
• Age, because elderly individuals typically experience slower wound healing than younger ones.
• Smoking, because it introduces free radicals and other toxins that can delay recovery. It also causes blood thickening and blood vessel narrowing, both of which deplete the wart removal site of oxygen and nutrients.

An uncomplicated skin repair process ensures fast recovery. In our practice, we’ve seen patients shorten their downtime with healthy practices like good post-treatment wound care, proper diet and rest, medication adherence, avoidance of smoking and others.

What Can You Expect During the Procedure, and How Do You Treat the Area After Wart Removal?

As previously mentioned, office wart treatments differ according to their level of invasiveness. Consequently, they require different pain management approaches and aftercare regimens. The type of procedure also determines the need for post-treatment activity limitation and repeat sessions. Below, we describe these aspects of the office wart treatments BHSkin Dermatology specializes in.

Cryotherapy

What to expect: In this procedure, we freeze the wart with liquid nitrogen. It is quick and may be done in a few minutes. Some patients try thinning the wart down beforehand with buffing and salicylic acid, but cryotherapy often requires no pretreatment preparation.

Is cryotherapy painful? During the procedure, patients feel a cold sensation and some discomfort on the site, which will last only a few seconds. Numbing medication is usually not required. The area will get inflamed and blister within 24 hours. Blistering may cause mild to moderate pain for a few days.

Downtime: The recovery period after cryotherapy depends on the body part involved. Patients may resume normal activities as soon as it is done. However, if the treated area is in a weight-bearing or repeatedly compressed location, we advise them to protect it for a week to let it dry up before returning to their usual routines. The site can be washed when bathing.

Aftercare: The blister will need a plaster for protection. It is expected to form a scab a week after treatment. However, if it breaks before scabbing, we recommend applying an antiseptic on the site and avoiding contact with the fluid. The scab will fall off on its own. Until then, patients must not pick at the site, as that will spread the wart virus.

Cryotherapy rarely leads to bacterial infection, but patients should seek medical attention if the treated site develops signs of infection. One or two treatments may be enough for small warts, but bigger ones often require more.

Cantharidin

What to expect: In this procedure, we apply a chemical—derived from blister beetle secretions—on the wart and cover it with non-porous tape. This should take only a few minutes. Cantharidin application does not require any pretreatment preparations.

Is cantharidin treatment painful? Cantharidin application itself is painless, but blistering usually occurs in 1-2 days, making the site feel tender. The discomfort normally goes away in 4-7 days as the blister dries up.

Downtime: As in cryotherapy, the downtime for cantharidin treatment also depends on the body part involved.

Aftercare: We usually instruct patients to wash the area with soap and water 4 hours after cantharidin application. They can remove it sooner if they feel a burning sensation or severe pain on the site. They may wash the treated area while showering and cover it with a plaster afterward.

Occasionally, patients develop bigger, more painful blisters that need fluid drainage. If this happens, we advise them to apply an antiseptic solution to the area and then prick one side of the blister with a sterilized needle. Patients must avoid touching the fluid or removing the blister roof to prevent spreading the wart virus or developing a bacterial infection. The area may be dried with gauze and sterilized again once drainage is done.

The wart will dry up a week after the treatment. We inform our patients that we can clip the dead wart on their follow-up visit if it has not fallen off by then.

Complications are rare after cantharidin treatment, but patients should seek medical attention if they experience severe bleeding, itchiness or pain. Resistant warts will require multiple sessions.

Electrosurgery and Curettage

What to expect: In this procedure, we start by cleaning the area and numbing the treatment site. We use a small blade or spoon-like device to scoop out the wart. A pen-like, electric heating device will stop the bleeding and burn the rest of the growth. The session’s duration depends on the wart’s severity, but it usually takes about 15-30 minutes from the time we inject the numbing drug.

The procedure creates a round or wide wound that will not need suturing. We advise patients to get medical clearance or stop some medications a few days before the session, depending on their health status.

Are electrosurgery and curettage procedures painful? The combined treatment is painless because of the anesthetic, but the site may feel tender for 1-2 weeks, requiring over-the-counter painkillers.

Downtime: The recovery period after electrosurgery and curettage depends on the post-operative wound’s depth, size, and location. Patients may be advised to avoid exertion in the first 1-2 weeks. Wounds from this procedure take 2-4 weeks to heal.

Aftercare: We usually give our patients specific post-operative wound care instructions. Generally, the wound is kept dry and bandaged for the first 24-48 hours to let it clot properly. They can then wash it afterward with gentle soap and water. The bandage must be changed regularly.

If done properly, electrosurgery and curettage rarely cause complications. However, patients must see a healthcare professional if they experience severe pain, bleeding, and fever, or if the site develops a yellowish discharge.

Warts usually need only one session of electrosurgery and curettage.

Excision

What to expect: In this procedure, we clean the area, inject local anesthesia, cut out the wart tissue then close the wound. The whole session takes about 30 minutes for small warts but longer for bigger lesions.

Surgical excision creates a wound that we can cauterize or stitch up. Depending on the patient’s health condition, they may need to get medical clearance or avoid some medications a few days before their appointment.

Is wart excision painful? The procedure itself is painless because of the numbing medication, but the site will feel tender for a couple of weeks. Over-the-counter medications help stave off pain and other inflammatory symptoms.

Downtime: Recovery from wart excision depends on the lesion’s size, shape and location. We advise our patients to avoid strenuous activities for 2-4 weeks to avoid trauma to the site. We recommend crutches to avoid heavy pressure on plantar excisions.

Aftercare: We teach our patients proper wound care techniques before sending them home. We advise them to call us if they experience severe pain, bleeding, fever or other signs of infection.

Warts need only one session of excision surgery.

VBeam Laser Treatment

What to expect: In this procedure, we use a powerful light beam to break down the wart’s blood vessels. Each session takes about 15 minutes to 2 hours, depending on the problem’s severity.

Before their laser wart treatment appointment, we ask our patients to avoid sun exposure, chemical peels, vitamin A-containing medications and other treatments that may cause their skin to become photosensitive.

Is VBeam laser treatment of warts painful? The device sprays a cold, numbing mist on the skin as we apply the laser. Most patients experience minimal discomfort during the procedure, although warts in sensitive areas may need topical or injectable pain medication. The site may feel mildly tender for up to 2 weeks.

Downtime: The duration of the recovery period after laser wart removal surgery depends on the wart’s size, distribution and location. Downtime is minimal if it is small and away from the plantar areas or other frequently compressed sites. Otherwise, recovery can take a few weeks.

Aftercare: The wart will dry up in 1-2 weeks, and the site may turn black as it heals. We advise patients to keep the treated area clean, dry and sun-protected. Some may experience itching or bruising, which will go away in a few days.

We ask patients to avoid picking at the treated site before it fully heals. Drinking plenty of fluids helps the body clear the treated site of dead cells and potentially infectious materials.

Some warts respond immediately to VBeam laser treatment, but most cases require multiple sessions.

Bleomycin Injection

What to expect: In this procedure, we clean the site and inject an anti-cancer drug into the wart. It should take only a few minutes. Brief, pinpoint bleeding may occur. Bleomycin injection does not require pretreatment preparations.

Is bleomycin treatment of warts painful? A bleomycin shot can cause discomfort on the injection site, but numbing medication is usually not necessary. Warts in the palms and plantar areas may be more sensitive to the injections. Slight tenderness may persist for up to 2 weeks.

Downtime: Bleomycin injections require no downtime. Patients may proceed with their normal activities after the session.

Aftercare: Patients may experience wart bleeding at home. If this happens, we recommend dressing up the site with clean gauze and elevating the affected body part. The area must be kept clean and dry.

Patients must seek medical attention for persistent bleeding, signs of infection, severe pain or intolerable allergic reactions.

Bleomycin is not injected in a hairy area or close to the nails, as it can affect hair and nail growth. It can also cause uneven skin tone on the wart removal site.

Bleomycin responses vary, but most patients require at least 4 sessions spaced 3-4 weeks apart. Drying up of the wart indicates that the treatment is effective.

The table below compares the recovery processes of the different office wart treatments just described.

The success rates of these procedures vary and are explained in the BHSkin Dermatology article How to Get Rid of Warts: Which Treatments Are Truly Worth Your Dime and Time?

As in any other health condition, treatment success depends on the care provider’s expertise. However, a large part of a patient’s recovery also hinges on their adherence to the aftercare regimen. At our clinic, we ensure our patients understand their personalized treatment plan and what to do to recover quickly from a wart removal procedure.

Wart Removal Recovery: The Takeaways

In-office wart treatments result in limited skin injury, so recovery depends on factors that can affect wound healing. Foremost of these factors is the type of procedure performed because it also impacts pain management, aftercare, the need for post-treatment activity limitation and treatment efficiency. Choosing the right dermatologist ensures the procedure’s success, but aftercare regimen adherence increases the chances of a speedy recovery.

Stubborn Warts? Not a Problem! The Best LA Dermatologists Got You

Warts are persistent, infectious lesions that can ruin your perfect complexion and become a source of personal distress. Still, they are no match for the expertise of our specialists at BHSkin Dermatology. Our board-certified dermatologists can get rid of any stubborn wart without leaving unsightly marks on your skin. Come pay us a visit at our Encino and Glendale clinics or connect with us through our virtual portal for telederm consults.

Book your appointment today so you can be one step closer to having that flawless complexion you’ve always wanted!

Sources:

1. Alavi, A. and Kirsner, R. (2019). Chapter 149: Wound Healing. Fitzpatrick’s Dermatology (9th ed). McGraw Hill Education. https://accessmedicine.mhmedical.com/content.aspx?bookid=2570&sectionid=210430166
2. Alhajj, M. and Goyal, A. (2020). Physiology, Granulation Tissue.
   StatPearls. https://europepmc.org/article/nbk/nbk554402
3. Azmat, C. E. and Council, M. (2017). Wound Closure Techniques. StatPearls. https://europepmc.org/article/nbk/nbk470598 
4. Caňedo-Dorantes, L. and Caňedo-Ayala, M. (2019, June 2). Skin Acute Wound Healing: A Comprehensive Review. International Journal of Inflammation. 2019. https://doi.org/10.1155/2019/3706315 https://europepmc.org/article/NBK/nbk518964
5. Haimovich, A. et al. (2019). Chapter 203: Excisional Surgery and Repair, Flaps, and Grafts. Fitzpatrick’s Dermatology (9th ed). McGraw Hill Education. https://accessmedicine.mhmedical.com/content.aspx?bookid=2570&sectionid=210445887
6. Kwatra, S. G. and Loss, M. (2019). Chapter 196: Other Topical Medications. Fitzpatrick’s Dermatology (9th ed). McGraw Hill Education. https://accessmedicine.mhmedical.com/content.aspx?bookid=2570&sectionid=210444935
7. Lipke, MM. (December 2006). An Armamentarium of Wart Treatments. Clinical Medicine and Research. 4(4), 273-293. https://doi.org/10.3121%2Fcmr.4.4.273
8. Mekhail, P. et al. (2016, October 12). Surgical Management of Wounds. Wound Healing: New Insights into Ancient Challenges. https://www.intechopen.com/chapters/51749
9. Nguyen, J, et al. (2016, September 1). Laser Treatment of Nongenital Verrucae: A Systematic Review. JAMA Dermatology. 152(9). https://escholarship.org/content/qt4t21196v/qt4t21196v.pdf 
10. Vujevich, J. J. and Goldberg, L. H. (2019). Chapter 206: Cryosurgery and Electrosurgery. Fitzpatrick’s Dermatology (9th ed). McGraw Hill Education. https://accessmedicine.mhmedical.com/content.aspx?bookid=2570&sectionid=210446346 

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