Common Treatments for Warts

By: Oli Byrne

Plantar warts, caused by the human papillomavirus (HPV), can be a painful and persistent problem for many individuals. It is estimated that plantar warts have a 12% annual incidence within the general population and that up to 40% of the population is infected with HPV. Plantar warts are especially common in children and adolescents [1].

As podiatrists, we see firsthand the discomfort and frustration these warts can cause. Fortunately, advancements in treatment options have made managing and eliminating plantar warts more effective than ever before. In this blog, we’ll explore the latest treatments available, including common topical treatments, the innovative SWIFT therapy, and surgical options.

Topical Treatments

Topical treatments are often the first line of defence against plantar warts. These treatments work by applying medications directly to the wart, which gradually break down the wart tissue. While some products are available over the counter at the chemist, your podiatrist may use variations with higher concentrations or different active ingredients. Some of these products include:

• Salicylic acid: Available in various forms, salicylic acid works by softening the skin layers of the wart, which then needs regular debridement by your podiatrist. Treatment may continue for several weeks for optimal results. While generally safe, salicylic acid can cause skin irritation and should be used with caution on sensitive skin.
• Silver nitrate: This chemical cauterises the wart tissue, causing it to die and fall off over time. Like salicylic acid, it needs to be applied and debrided at regular intervals and treatment may continue for several weeks.

Some key concerns with topical treatments are the long treatment times, the potential damage to surrounding skin tissue and the need to keep the area clean and dry – sometimes for weeks at a time.

Cryotherapy

Cryotherapy is a common wart treatment used by both podiatrists and general practitioners. It involves freezing the wart tissue with liquid nitrogen, causing it to blister and eventually fall off. This treatment is effective but may be painful during treatment and the temporary blister may cause additional pain and discomfort. It is likely that multiple sessions may be required for complete removal. 

SWIFT Therapy

One of the most exciting advancements in wart treatment is SWIFT therapy. SWIFT therapy is an emerging form of microwave therapy. It uses controlled microwave energy to heat wart tissue and alert an immune response and destroy wart tissue. This treatment is quick, with each session generally only lasting a few minutes, and typically requires three sessions spaced four weeks apart. SWIFT therapy is particularly effective for stubborn warts that have not responded to other treatments. Research has shown effective clearance rates of up to 83.3%, higher than many of the other treatments discussed in this blog [2-3].

In recent times, SWIFT has become more popular. The appeal seems to lie in the reduced frequency of treatments and the shorter treatment duration required per session. While this treatment can be painful, the pain is much shorter lasting than cryotherapy. I’ve certainly noticed that SWIFT consistently delivers better results compared to other non-surgical treatments.

Surgical Options

For warts that are resistant to all other treatments, surgical intervention may be necessary. Surgical options for plantar warts include:

• Curettage: This procedure involves scraping away the wart tissue with a sharp instrument called a curette. While effective, curettage may leave a scar and requires local anaesthesia.
• Laser therapy: Laser therapy uses a focused beam of light to destroy the wart tissue. This treatment is precise and effective, but it can be costly and may require multiple sessions.

What to Expect

Regardless of the treatment option chosen, it’s important for patients to understand that wart removal can be a gradual process. Multiple treatments may be necessary, and patience is key. It’s also important to follow your podiatrist’s instructions carefully to ensure the best possible outcome.

In conclusion, the latest treatments for plantar warts offer effective solutions for this common foot condition. Whether using common topical treatments, surgical options, or innovative therapies like SWIFT, patients can find relief from the discomfort of plantar warts. As a podiatrist, I am excited to see these advancements improving the lives of my patients and look forward to continuing to provide the best possible care.

References

1. Witchey DJ, Witchey NB, Roth-Kauffman MM, Kauffman MK. Plantar warts: Epidemiology, pathophysiology, and clinical management. The Journal of the American Osteopathic Association. 2018 Feb 1;118(2):92. doi:10.7556/jaoa.2018.024
2. Hagon W, Hagon J, Noble G, Brenton‐Rule A, Stewart S, Bristow I. Microwave therapy for the treatment of plantar warts. Journal of Foot and Ankle Research. 2023 Jan;16(1). doi:10.1186/s13047-023-00638-8 
3. Kwok CS, Holland R, Gibbs S. Efficacy of topical treatments for cutaneous warts: A meta-analysis and pooled analysis of randomized controlled trials. British Journal of Dermatology. 2011 May 26;165(2):233–46. doi:10.1111/j.1365-2133.2011.10218.x