Wart removal

Warts need to be removed because they are contagious viral diseases. Warts spread easily to the uninfected skin of the host, as well as to people who are in direct or indirect contact with him. Sometimes, warts can spontaneously disappear, but it is rare and unpredictable.

Warts of viral origin are formed by overproduction of cells under the influence of HPV virus and can be recognized by a harder, rough and raised surface comparing to healthy skin.

Of the approximately 150 HPV virus types, a dozen cause warts on the skin. Although we are often in contact with HPV viruses (handshaking, contaminated surfaces), only a small number of people will develop viral warts. Children and people with weakened immune systems are the most sensitive groups. However, there is no clear explanation as to why some people are more prone to warts than others. Also, damaged skin is more suitable for wart spreading and increases the chance of an infection, so it is necessary pay more attention to hygiene and be cautious.

Warts can appear anywhere on the skin and are most often found on hands and feet. In the genital region, they are called condyloma, or genital warts.

New studies suggest that about half of the warts will disappear spontaneously after a year, and two thirds after two years. Whether they will spontaneously resolve or spontaneously spread depends on the immune system of the infected person and no one can tell for sure. They are easily transmitted from person to person and to the other parts of the body of an infected person. Therefore, it is not recommended to wait for them to resolve spontaneously, but it is strongly advisable to undergo an urgent treatment to remove them. The most efficient and the easiest way of removal is using radiofrequency. The wound that remains after the treatment usually takes three to four days to heal, but it is not unusual for the recovery period to last even longer, up to four weeks. An experienced dermatologist will always inform the patient of the recovery period and the prognosis.

When warts are very large, which usually happens with plantar warts, and grouped together as to form entire plates, other procedures will be used, most often bleomycin treatment. It is a cytotoxic drug that “soaks” the wart and during the period of one month the organism itself rejects the virus. The procedure is suitable for children and athletes, because there are no wounds and recovery.

The goal of wart treatment is to physically remove it and/or trigger the body’s immune system to fight the infection.

Even with an adequate treatment, it is possible for the warts to recur, which is why dermatologists will recommend an adequate therapy or a combination of therapies in consultation with the patient, with mandatory follow up.

Removal of warts with liquid nitrogen is less precise. It is necessary to freeze the skin so a bruise is formed under the wart. The disadvantage of this treatment is that it requires more visits.

Treating warts with CO2 laser is very similar to radiofrequency removal except that a laser rather than a high frequency current is used to evaporate the tissue.

Wart removal – Treatments

Radiofrequency wart removal

Removal of warts using radiofrequency is performed under local anaesthesia applied in a form of cream or injection, depending on the wart type and location. The success rate of this method is 80 to 90%, which means that 10 to 20% of patients may have a recurrence of warts.
After warts are removed with radio waves, a scab will form on the treated area.
When the scab falls off, very rarely it might leave a small scar or a whitish change on the skin.

Wart removal with CO2 laser

Wart removal with CO2 laser or other ablative laser is similar to the removal using radiofrequency. The laser is less precise when it comes to the depth of lesion removal because it is sometimes unpredictable to what extent the tissue will evaporate under the laser beam.

Surgical wart removal

Surgical removal of warts is possible when the wart is up to 15 mm in size. This is not the method of choice because the virus can appear on the scar tissue.

wart removal using bleomycin injection
Wart removal using bleomycin injection

Wart removal using bleomycin injection

Bleomycin injection is the treatment of choice for persistent warts covering large areas, especially for plantar warts or warts around the nails. This method does not cause a wound like radiofrequency wart removal or laser wart removal do. After the end of the therapy, a black scab forms on the treated area and falls off spontaneously within a month. After the scab falls off, the wart also disappears or is significantly reduced.

This procedure increases local immunity response and leads to the rejection of the virus. It is often used in patients who are active athletes and cannot put their activities on hold. The number of treatments is individual.

warts before and after removal
Warts before and after removal

Wart removal with pulsed dye laser

Pulsed dye laser is a vascular laser that closes blood vessels. When blood vessels on the wart are closed, the wart dries out and falls off. The success rate of this method is 70%.

Wart removal with liquid nitrogen

Liquid nitrogen freezes the skin. In 3 to 4 treatments, a properly treated wart should fall off. Liquid nitrogen cryotherapy should be performed in such way as to make a bruise under the wart during skin freezing. If the treatment is carried out in a more delicate way, a large number of treatments will be needed.

Wart removal with acid

Applying acid can successfully remove a wart. It is performed at home, usually for 2 to 3 months. Professional acids can also be applied in the medical practice, and the results are similar to those with liquid nitrogen.

Any viral wart can recur regardless of the method used to remove it.

In our practice, we use the radiofrequency method, bleomycin injection, where the success rate is 90% for one treatment.
Slightly less often we use pulsed dye laser or acid.

Natural method of wart removal

Vinegar, onion and garlic, various herbs such as dandelion are often mentioned as natural remedies for warts. However, they cannot effectively remove viral warts.

One should have in mind that warts spread easily and if we delay professional treatment by a dermatologist and try to remove them at home, we can cause the worsening of the infection or its spreading to other people.


Svetlana Đurišić specijalista dermatovenerologije

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