“Dear Dr. Basuk: I suffered with a wart growing under my finger nail. I’ve had it now for over 20 years and every Dr. I visited treated it in the same manner until I was introduced to you. You did a biopsy to see exactly what we were dealing with – hmm, that seems pretty smart. Then you began trating it by injecting the same virus as you had diagnosed with the theory being that my body would naturally fight the virus and kill the wart. Well, after 20 years of pain, discomfort and ugliness, I don’t have any pain or discomfort and I don’t wrap the finger with a Band-Aid any longer. Thank you very much for your professionalism, caring and for always keeping me informed along the way. You are a credit to your profession. Thank you again!!!” – D.H.

Warts are small growths on the skin and are one of the most common, persistent, and frustrating skin conditions encountered in a dermatology office. They are usually painless and harmless, but can itch and can hurt. Warts are typically round with a rough, scaly surface but can be flat or raised. There are several different forms of warts, which vary based on location. Warts are caused by a virus called the human papillomavirus (HPV) and there are more than 150 types of wart virus that have been identified. Warts can be chronic and patients often require several office visits for treatment.

The most common type of wart is found on the hands and feet but warts can also be in the genital area and be sexually transmitted. There are many different types of warts such as the common wart, plantar (foot) wart, flat warts, and genital warts. Common warts are usually found on the fingers, nails, and hands. Plantar warts are commonly located on the soles of the feet and when found in clusters, are known as mosaic warts. Black dots are often seen in warts which are formed by blood vessels embedded in the warts. Flat warts are smaller and smoother and are commonly found on the face in both sexes and on legs in women (irritation or small cuts in the skin from shaving probably contribute to them). Genital warts are also known as condyloma acuminata and are usually sexually transmitted. They are spread by close physical contact and can be found anywhere in the genital area. Some genital HPV types have been linked to cancer and, therefore, special tests may be done in the office to determine if the genital wart is associated with a risk of malignancy.

Viral warts may occur at any age but are more common in children and adolescents. Infection occurs as a result of person-to-person contact. The course of the disease is unpredictable: sometimes the spread is self limiting and sometimes treatment is necessary. Warts can be embarrassing and can be unsightly, especially when present on the face and hands. They can be painful when they are located on the feet and around the nails.

There are many treatment modalities that can be used against warts but none are uniformly effective in eliminating all of the lesions: there is no perfect wart treatment. Topical treatment and physical destruction are widely used in dermatology for treatment of warts. Liquid nitrogen treatment (cryotherapy) is one method but has a common side effect of pain and blistering. Electrosurgery involving thermal coagulation (burning) to destroy the HPV affected lesion is an alternative treatment but local anesthesia is usually required. Laser therapy with a pulsed dye laser is another treatment option. No single optimal treatment has been found for treatment of warts. The most common method involves topical therapies. They are also the least painful and the patient can apply the medication at home. Salicylic acid is one of the most commonly used home treatments for warts; various preparations of salicylic acid are available commercially. Newer topical therapies are continually being brought to market. Immune modulators have been shown to be effective and may stimulate the patient’s own immune system to fight the wart virus. This method has been shown useful in people that have resistant warts or who have numerous lesions covering large surface areas. A common immune modulator used in our office is Candida which causes the immune system to recognize and clear HPV. A side effect of this treatment can be itching or, rarely, a flu-like illness. Oral therapies may be prescribed in patients who have more resistant warts.

Physicians work with patients to decide the best approach for each individual type of wart. Treatment aims to cure the patient’s physical and psychological discomfort and to prevent the spread of the infection.

“My daughter had plantar warts and warts on her elbow for months and was afraid to see a doctor. She saw previous doctors for warts, which were treated, and they scarred. Then, she came to Dr. Basuk’s office for treatment. Dr. Basuk recommended injections and the warts cleared after the first treatment, and there was only slight discomfort for a few days. She has never had a new wart since that treatment. And now I have a plantar wart and I asked Dr. Basuk for the injection.” – S.C., Long Island