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Warts

26 Ways to Win the War

Okay, we're only going to say this once, so listen up. Toads have nothing to do with warts. They don't cause them; they don't spread them; they don't even know what warts are. Got that?

Warts are benign skin tumors that can occur singly or in large packs on just about any part of the body. And while each type carries its own special name, all are caused by various trains of the fiendish papilloma virus. It masterfully tricks the body into providing it with free room and board in a sheltered "house" that is know medically as the wart proper.

At any one time, says Robert Garry, Ph.D., an associate professor of microbiology and immunology at Tulane University School of Medicine, about 10 percent of the population has a wart. Probably 75 percent of all people will get one sometime in their lives. No wonder we spend an estimated $125 million annually on wart treatments! After acne, warts are the most common dermatologic complaint.

Unfortunately, standard medical treatment often comes in the form of nasty-sounding destructive methods such as burning, scraping, cutting, freezing, injecting, or zapping with a laser. These techniques may or may not be effective. Many of them are painful and may leave scars. To add insult to injury, warts often reappear, no matter what treatment is used.

Knowing all this, you may want to try some home remedies before heading to the doctor's office. But, by all means, heed the advice of Memphis dermatologist Thomas Goodman, Jr., M.D., an assistant professor of dermatology at the University of Tennessee Center for Health Sciences. "Don't injure yourself with wart treatments. Start with simple measures and persist for several weeks before proceeding to stronger ones."

Unless otherwise noted, the following are effective for both common warts and plantar warts (those found on the foot).

MEDICAL ALERT

Are you Sure That's a Wart?

Remember what Davy Crockett said: "Be sure you're right and then go ahead." That advice applies to treating warts as surely as to anything else in life. The absolute first rule of thumb (and finger, foot, and elbow) is: Make sure it is a wart and not a corn, callus, mole, or cancerous lesion. According to Alvin Zelickson, M.D., "Normally, you'd think it would be pretty easy to identify a wart, but it's amazing how many people end up treating skin cancers or other growths as warts." So if you have the slightest doubt about what you're dealing with, see a doctor.

In general, warts are pale, skin-colored growths with a rough surface, even borders, and blackened surface capillaries. Normal skin lines do not cross a wart's surface. And contrary to popular opinion, warts are very shallow growths—they don't have "roots" or "runners" that go down to the bone.

Leave 'em alone. Like Little Bo Peep's sheep, many warts respond to a loose hand. According to one estimate, 40 to 50 percent of all warts eventually disappear on their own, typically within two years. Children in particular often lose warts spontaneously.

Marc A. Brenner. D.P.M., past president of the American Society of Podiatric Dermatology and a private practitioner in Glendale, New York, does caution that warts constantly shed infectious virus, and if left untreated they may get larger or spread to other areas. So if your warts start multiplying, take action.

Call in the A-team. Dr. Garry has had great success applying vitamin A directly to warts. "Get capsules that contain 25,000 international units of natural vitamin A from fish oil or fish-liver oil. Simply break open a capsule, squeeze some of the liquid onto the wart, and rub it in. Apply this once a day." He emphasizes that the vitamin should be applied to the skin only. Taken orally in large doses, vitamin A can be toxic.

"Different warts respond differently to this treatment. Juvenile warts can be gone in a month, although two to four months is more like it. Plantar warts might take two to five months longer," he says.

Dr. Garry recalls one woman who had more than 200 warts on her hand. By persisting with the vitamin A therapy for seven or eight months, she was able to lose all but one stubborn wart under her fingernail.

How to Avoid a Wart

Warts are caused by a virus. It's in the air, and you pick it up the same way you do any viral infection. If you're susceptible to the virus and if you have an appropriate cut or crack in the skin for it to take hold, you'll get a wart. It's that simple. Even so, there are a few things you can do to lessen your chances of sprouting a wart.

Keep your shoes on. The wart virus thrives in a very moist environment, says Suzanne M. Levine, D.P.M., so always wear plastic thong sandals around swimming pools, health clubs, and locker rooms to avoid foot contact with it. By not going barefoot, you also sidestep minute cracks or cuts in your feet through which the virus could easily enter.

Change shoes frequently. Since the wart virus breeds in moist places, you should change your shoes frequently and allow shoes to dry out between wearings, says Dr. Levine.

Clean up. "At a health club or gym, you might even want to clean the shower our first with a product like Lysol," says Dr. Levine. "Even just household bleach works to kill viruses and bacteria."

Look but don't touch. "Warts spread easily," says Marc A. Brenner. D.P.M. "So if you have one on the bottom of your foot, for instance, try not to touch it with your hand. If you have even a small cut on your finger, you risk getting a wart there."

Pamper your cuticles. If the wart virus enters a cut or opening around your cuticle, it can cause a particularly nasty type of wart. Called periungual warts, they're very difficult to treat, says Dr. Levine. "If you do get a cut in the cuticle, put on a topical antibiotic cream (such as Bacitracin) and then cover it with a bandage until it heals."

Play it cool. "My own feeling is that people seem to be more susceptible to warts when they're under stress and eating poorly," says Dr. Levine. "And the warts seem to spread more than." So try to take it easy.

See what another vitamin can do. Making a paste from crushed vitamin C tablets and water has helped some people. Apply to the wart and then cover with a bandage so the paste doesn't rub off. Jeffrey Bland, Ph.D., who spent many years studying vitamin C at the Linus Pauling Institute in Menlo Park, California, says that "although no formal research has been done in this area, there is some evidence that the high acidity of ascorbic acid [vitamin C] can kill the wart-producing virus." Keep in mind, though, that vitamin C (at least in its ascorbic acid form) may irritate the skin, so you should try to cover only the wart with the paste.

Keep that wart under wraps. "I've had success applying a tape bandage to warts," says Dr. Goodman. "Use any kind of medical or first-aid tape. Apply it snugly over the wart and leave it there 24 hours a day, 7 days a week. Change the tape only when you need to look clean. Be patient and persist for a least three weeks. It really does work for some people if they do it properly."

Try a dose of castor oil. For a variation on the tape technique, says Dr. Goodman, apply a drop of plain castor oil to the wart twice daily and then tape it as above.

Herbal consultant and educator Jane Bothwell of Arcata, California, also believes in the usefulness of castor oil, this time mixed into a thick paste with baking soda. Apply the paste a couple of times a day. To keep it from rubbing off, either apply a bandage or put on a glove or sock.

Stay dry. Warts thrive on moisture, so keeping the feet very dry might help eliminate plantar warts. Says Dr. Brenner, "If you wanted to work on a plantar wart without using chemicals, you could try changing your socks at least three times a day. And apply a medicated foot powder such as Zeasorb frequently—ten times a day if necessary. There are other drying agents that might help. Believe it or not, I have used a Clorox solution on people who have not responded to anything else, and occasionally it has worked."

Opt for an OTC. Probably the most popular commercial wart remedies are the over-the-counter salicylic acid preparations. Salicylic acid is believed to work against warts by softening and helping dissolve them. These products come in liquid, gel, pad, and ointment form. Diabetics and those with impaired circulation should not use them.

There are three rules for dealing with an acidic OTC, says podiatrist Glenn Gastwirth, D.P.M., of Bethesda, Maryland, director of scientific affairs at the American Podiatric Medical Association. "First, be certain that it is a wart you're treating (see "Are You Sure That's a Wart?" on page 624). Second, follow package instructions to the letter. And third, if the wart does not respond within a reasonable amount of time—say a week or two—see a doctor."

"A liquid product like Compound W can work if you use it on a small wart," says Christopher McEwen, M.D., chairman of the Department of Dermatology at the Ochsner Clinic in Baton Rouge, Louisiana. Adds New York City podiatrist Suzanne M. Levine, D.P.M., clinical assistant podiatrist at Mount Sinai Hospital, "One good thing about Compound W in particular, is that it contains a little oil, which makes it less irritating to the skin than some other salicylic acid products."

Dr. Brenner advises, however, that the liquid and gel products, which typically contain only about 17 percent salicylic acid, may not be strong enough to work on plantar warts that have a thick callus covering them.

The Alternate Route

Some Simple Folk Cures

When all is said and done, you never know just what will cure any particular wart. The remedy that so neatly dispatched one little growth might leave another completely unscathed. So perhaps your most powerful weapon in the war of the warts is an open mind. That's why you shouldn't be quick to overlook the healing potential of so called folk cures: treatments that have never undergone formal scientific scrutiny but that have worked just fine for many people. Here are a few that some folks swear by:

Apply vitamin E oil, clove oil, aloe vera juice, milkweed juice, the milky juice of the sow's thistle plant, or the milky juice of unripe figs directly to the wart.
Take garlic capsules or tablets.
Soak lemon slices in apple cider with a little salt. Let stand two weeks. Then rub the lemon slices on the wart.
Rub with a piece of chalk or a raw potato.
Tape the inner side of a banana skin to a plantar wart.

Pad the wart. "If I had to pick one over-the-counter product," says Dr. McEwen, "I'd go with a 40 percent salicylic acid plaster such as Mediplast. It works fairly well for plantar warts and can also be effective on hand warts, although it's harder to keep the patch in place on the hand."

"The main drawback to pads," says Dr. Levine, "is that people often use too large a piece, which exposes the surrounding skin to serious irritation. And they put on a new pad every day. Pretty soon they have an ulcer around the wart that's far worse than the wart they started with. The best course of action is to use one little pad every four or five days."

To ensure a good fit, cut out a little cardboard template exactly the shape and dimensions of your wart. Then use that template to precut a supply of patches from the adhesive plaster. Lightly coat the perimeter of the wart with petroleum jelly to prevent any of the medication from touching the skin.

Go with an ointment. Rounding out the salicylic acid arsenal is 60 percent ointment. For best results, advises Dr. Levine, soak the area in lukewarm water for about 10 minutes to allow for greater penetration. Dry well, then apply a drop of the ointment to the wart. Cover with a bandage. If you're dealing with a plantar wart, do this at bedtime so you won't have to walk around on the wart and rub off the ointment. In the morning, soak the area again and lightly pumice off any softened skin.

Try an old-fashioned cream. "A product that has historically been used for warts is Vergo cream, which has calcium pantothenate [a B vitamin], ascorbic acid [vitamin C], and starch in it," says Nicholas G. Popovich, Ph.D., an associate professor of pharmacy practice at Purdue University. "Those particular ingredients have never been demonstrated by the Food and Drug Administration panel on wart products to be effective for wart removal. That doesn't necessarily mean the product doesn't work; it's just that its effectiveness is probably based on testimonial evidence rather than clinical studies."

Unlike the salicylic acid products, Vergo cream is not caustic and will not burn, blister, or injure surrounding tissue. Average treatment time is two to eight weeks.

Get timed-release relief. If you're ready to see a doctor but not ready for him to freeze or laser your wart off, there's a brand-new product designed for self-care use that you can ask him about. The Trans-Ver-Sal transdermal patch is "very effective in treating warts," says Dr. McEwen, who's gotten good results with it. Like other transdermal patches, it's applied directly to the skin (in this case to the wart) and delivers a continuous dose of medication for several hours. And like other transdermal patches, it's available only by prescription.

The active ingredient in the patch is salicylic acid, the same drug used in over-the-counter wart removers. The big difference, according to Alvin Zelickson, M.D., a clinical professor of dermatology at the University of Minnesota Medical School, "is that the salicylic acid istransferred to the wart. With standard plaster pads, for instance, very little actually gets released into the wart. These patches are easy to use and don't require presoaking the skin. You put one on at bedtime and remove it in the morning. It's available in two sizes (and strengths), so it's appropriate for both common and plantar warts."

Mind Games: Who's in Control Here?

Go into a trance. "You are getting very sleepy—soon you will be in a deep trance—soon your warts will disappear." Hogwash? No, hypnosis. And it may be a formidable weapon against warts.

According to psychiatrist Owen Surman, M.D., of Massachusetts General Hospital in Boston, "Hypnosis does seem to be a scientifically validated tool for treating warts. Why it would be is subject to guesswork. Currently, people are very interested in this area called psychoneuroimmunology. It's attractive to think that mental phenomena could affect immune function."

In one study, Dr. Surman hypnotized 17 people who had warts on both sides of their bodies for a series of five sessions and told them that their warts would disappear from one side only. Another 7 people were not hypnotized and were instructed to abstain from using any wart remedies on their own. Three months later, more than half of the hypnotized group had lost at least 75 percent of their warts. The people who hadn't been hypnotized still had their warts.

And although the warts that did go away disappeared from both sides of the hypnosis group's bodies, "we felt the experiment was a success," says Dr. Surman.

Imagine your warts away. The power of suggestion alone—without hypnosis—may be equally effective at wasting warts. Perhaps the most research in this area has been done by Nicholas Spanos, Ph.D., a professor of psychology, and his colleagues at Carleton University in Ottawa. "We tell patients to imagine that their warts are shrinking, that they can feel the tingling as their warts dissolve and their skins become clear. Initially, we give them about 2 minutes of this type of imagery, then we have them practice on their own at home for 5 minutes a day.

"Believe it or not, we can actually predict who will achieve results based on the very first session. people who report really vivid imagery that first day are more likely to lose warts than those who say their imagery was relatively weak."

Be a believer. Other doctors have had plenty of informal success with the power of suggestion. Says Christopher McEwen, M.D., "I've treated a couple of kids who could not tolerate freezing, which is how we usually remove warts. So I gave them a harmless substance to use and impressed upon them that it was a very strong medicine that would knock out the warts. And it worked." Strong belief in a cure may also explain the continued popularity of such offbeat, old-fashioned folk remedies as rubbing the wart with a penny and then burying the penny under the porch.

Dr. Zelickson, who conducted full-scale tests of the patch on about 40 patients, found that the patch removed warts about 80 percent of the time, typically in four to twelve weeks.

PANEL OF ADVISERS

Jeffrey Bland, Ph.D., was formerly a senior researcher at the Linus Pauling Institute in Menlo Park, California. He is president of HealthComm, a wellness-education consulting service in Gig Harbor, Washington.

Jane Bothwell is a practicing herbal consultant and educator in Arcata, California. She was formerly an instructor at the California School of Herbal Studies.

Marc A. Brenner, D.P.M., has a private practice in Glendale, New York, is past president of the American Society of Podiatric Dermatology, and author of The Management of the Diabetic Foot.

Robert Garry, Ph.D., is an associate professor of microbiology and immunology at Tulane University School of Medicine in New Orleans, Louisiana.

Glenn Gastwirth, D.P.M., a podiatrist in Bethesda, Maryland, is director of scientific affairs at the American Podiatric Medical Association.

Thomas Goodman, Jr., M.D., is a dermatologist in private practice and assistant professor of dermatology at the University of Tennessee Center for Health Sciences in Memphis. He is the author of Smart Face and The Skin Doctor's Skin Doctoring Book.

Suzanne M. Levine, D.P.M., is a podiatrist in private practice and clinical assistant podiatrist at Mount Sinai Hospital in New York City. She is author of My Feet Are Killing Me and Walk It Off.

Christopher McEwen, M.D., is chairman of the Department of Dermatology at the Ochsner Clinic in Baton Rouge, Louisiana.

Nicholas G. Popovich, Ph.D., is an associate professor of pharmacy practice at Purdue University in West Lafayette, Indiana.

Nicholas Spanos, Ph.D., is a professor of psychology at Carleton University in Ottawa.

Owen Surman, M.D., is a psychiatrist at Massachusetts General Hospital in Boston and an assistant professor of psychiatry at Harvard Medical School there.

Alvin Zelickson, M.D., is a clinical professor of dermatology at the University of Minnesota Medical School in Minneapolis.

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