Removing warts at home: a review of drugs

04/26/2018 I was prompted to write this article by an overwhelming number of questions like: “Can I remove warts at home using various solutions?”

Today I will do a short review of wart removal products and together we will try to figure out how safe and effective such methods are. We will also look at what evidence of effectiveness there is for certain substances.

Flat wart on index finger

Review of wart removal products: composition

I will not write the trade names of the drugs, I will simply list the active ingredients often found in their compositions and their properties.

1. Phenol, also known as carbolic acid

Here and further I will provide screenshots describing the properties of substances from Wikipedia.

Can phenol be used to remove warts?

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Please don’t think that I’m trying to shock you with words about toxicity, not at all. Of course, “the dose makes the poison.” However, I would like to note that there are no “natural/folk/gentle/soft” substances in the composition of the products. This substance simply burns the formation on the skin, i.e. causes a chemical burn.

2. Alkalis: sodium hydroxide (NaOH), also known as caustic soda, also known as sodium hydroxide; potassium hydroxide (KOH), potassium hydroxide

Can alkalis be used to remove warts?

3. Lapis, lapis pencil, also known as silver nitrate (AgNO3)

Can a lapis pencil (lapis) be used to remove warts?

4. Acetic acid

Can vinegar be used to remove warts?

5. Nitric acid (HNO3)

Can nitric acid be used to remove warts?

6. Any herbal ingredients

As much as we might like it, plants like jarutka, aspen, ivy, sundew, and celandine have NOT been proven effective in treating warts. I urge you not to trust stories like: “My grandmother’s aunt applied celandine to a wart, and everything went away.”

Are products with herbal ingredients effective in treating warts?

7. Salicylic acid (proven to be effective)

Perhaps the most harmless substance among these. The instructions for use note that it “suppresses the secretion of the sebaceous and sweat glands. In low concentrations it has a keratoplastic effect, and in high concentrations it has a keratolytic effect.” There are studies that confirm the effectiveness of this substance specifically in the treatment of warts [1], [2].

Please wait, run to the pharmacy for salicylic acid to finally get rid of “these terrible warts” - first read the article.

8. A mixture of propane and dimethyl ether (proven effectiveness)

The names of drugs usually include the prefix cryo.

A few studies of this method [3] have shown that its effectiveness in treating warts is comparable to liquid nitrogen. These substances cool the skin wart to a temperature that causes necrosis of the neoplasm.

9. Ointment with imiquimod (effectiveness proven)

In a literature review, which you can view here [4], the authors claim that imiquimod is effectively used in the treatment of simple and recurrent warts. At the same time, larger studies are needed to clarify how to use it most effectively.

Tablets and capsules

Drug treatment of HPV requires the use of antiviral drugs, drugs to improve the functioning of the immune system, which must be strictly prescribed by a doctor. Some of the effective tablets are available from the pharmacy only with a prescription, so a visit to a specialist is mandatory. The specific dosage and duration of treatment depends on the type of HPV and the state of the person’s immunity.

Antiviral medications inhibit the development of the virus in the body and have a detrimental effect on infected cells. The most common medications in this group in tablet form are:

If the virus is actively spreading and there are a large number of rashes, tablets with an immunostimulating effect are prescribed. The most common of them are:

• Ribomunyl.
• Immunal.
• Derinat.
• Ergoferon.

The problem of self-diagnosis of skin tumors

From the previous section it is clear that drugs for the treatment of warts are divided into 3 groups:

1. Acids, alkalis and other toxic substances.
2. Substances of plant origin that are written in the composition are most likely a distraction.
3. Drugs with proven effectiveness in the treatment of warts.

There are drugs with proven effectiveness in the treatment of warts. What is the problem?

-So what's the problem? - you ask. -We go to the pharmacy, buy the right drug and treat our warts without any doctors there.

“The problem is that you don’t know whether you have a wart or not,” I will answer.

The main difficulty lies in the wording of the question itself. The question you need to ask is not “how to effectively remove warts at home?”

A much better question would be: “How do I know that I have a wart and not skin cancer or melanoma?”

Repeatedly, patients came to see me and called pigmented nevi warts or papillomas. It is quite obvious to me that in most cases a person without specialized education will not be able to distinguish melanoma or skin cancer from a wart.

In the “indications” section for all these drugs it is written “warts, less often keratomas”. Some particularly daring authors also add moles to this pile. The manufacturer of the drug believes that the patient himself is able to make the correct diagnosis. My experience suggests that without a histological examination, even a doctor cannot always accurately determine the nature of a skin tumor by eye.

In the photo - the author with a dermatoscope

What are condylomas

Condylomas are one of the types of manifestations of the human papillomavirus. They look like papillary growths or cauliflower and tend to merge.

Their color can vary from flesh-colored to reddish. They affect the mucous membranes and skin, mainly in intimate places: the glans penis, frenulum, perianal area, perineum, vestibule of the vagina, labia minora, cervix.

Condylomas have a long chronic course, wide distribution and high susceptibility. In addition, they can degenerate into malignant neoplasms and provoke bleeding. The disease is transmitted sexually through any type of unprotected sexual contact. Intrauterine infection of the fetus from an infected mother also occurs.

The virus changes the nature of tissue growth, which causes various changes in the mucous membranes and skin, including precancerous ones. The occurrence of infection and its development occurs against the background of weakened immunity.

Factors that increase the risk of infection for men and women are:

• previous STDs;
• frequent change of sexual partners and lack of contraception;
• lack of vitamins;
• frequent stress;
• decreased immunity;
• vaginal dysbiosis;
• pregnancy.

Subsequently, HPV develops, after the end of the incubation period, condylomas with a certain oncogenic risk appear, and clinical symptoms appear, for example:

• the appearance of condylomas in the genital area, perineum;
• difficulty urinating when condylomas are localized in the urethra;
• bleeding due to injury from underwear;
• pain and discomfort;
• slight redness around condylomas;
• itching may occur.

Important! With condylomatosis, complications are possible that lead to injuries and the appearance of ulcers, inflammation of condylomas, phimosis and paraphimosis in men, progression of the disease, and, consequently, an increase in the size of tumors and their number.

Condylomas tend to merge with each other, forming something like cauliflower

What should I do? To remove or not to remove warts at home?

I understand perfectly well that with this article I cannot prevent the sale of such drugs without a prescription, that is, without a doctor’s examination. In general, I am not against removing warts using these methods, but one extremely important condition must be met.

You can burn a wart with anything, under any conditions, but only after an in-person examination by an oncologist or dermatologist, optimally with dermatoscopy. The fact that you have a wart on your skin, and not melanoma or cancer, must be confirmed by a specialized specialist. If there is the slightest doubt about the diagnosis, the wart should be removed with histological examination.

Injections

If there is a high viral load, extensive appearance of papillomas and condylomas, or detection of oncogenic HPV, antiviral and immunomodulatory injections may be prescribed:

The course of treatment with antiviral drugs with immunomodulatory properties in the form of injections is determined by the doctor individually, but usually it does not exceed 10 days. All medications in this group have contraindications and can cause side effects.

Bibliography:

1) Cockayne S, Hewitt C, Hicks K, Jayakody S, Kang'ombe AR, Stamuli E, Turner G, Thomas K, Curran M, Denby G, Hashmi F, McIntosh C, McLarnon N, Torgerson D, Watt I; EVerT Team. Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomized controlled trial. BMJ. 2011 Jun 7; 342:d3271. doi: 10.1136/bmj.d3271.

2) Dall'oglio F, D'Amico V, Nasca MR, Micali G. Treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol. 2012 Apr 1; 13(2): 73-96. doi: 10.2165/11594610-000000000-00000.

3) Nguyen NV, Burkhart CG. Cryosurgical treatment of warts: dimethyl ether and propane versus liquid nitrogen – case report and review of the literature. J Drugs Dermatol. Oct 2011; 10(10): 1174-6.

4) Ahn CS, Huang WW. Imiquimod in the treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol. 2014 Oct; 15(5): 387-99. doi:10.1007/s40257-014-0093-5.

Prevention

Eliminating the risk of HPV infection is quite difficult, since this virus is easily transmitted and most people are infected with it. You can reduce the risk of infection by following simple rules:

• Do not walk in public places without shoes.
• It is necessary to minimize the amount of physical contact with people who are infected and not to use other people’s hygiene products.
• During intimate contacts, the use of a condom is mandatory.

In order to protect yourself from HPV, it is important to follow personal hygiene rules, air your shoes and disinfect bathrooms. In addition, you need to know that the virus does not manifest itself in everyone - with strong immunity, a person may not have papillomas and condylomas, but be infectious to others.

Currently, there are no drugs that can completely eliminate HPV from the body, but several vaccines have been developed that can prevent infection. These include:

• Gardasil.
• Cervarix.

Vaccinations are recommended between the ages of 9 and 17 years, regardless of gender, before the start of sexual activity (according to indications up to 26 years). The vaccine is administered in 3 stages, which must be completed within a year. The effectiveness of vaccination is 95%, but it only protects against 4 types of HPV, so preventive methods and precautions should always be remembered.