Warts

Signs and Symptoms

• Common warts. Usually begin as tiny, smooth, flesh-colored eruptions and grow into rough growths, about 1/4 inch across, or in clusters.
• Flat warts. Small flesh-colored or pink growths with flat tops.
• Genital warts. Tiny eruptions that grow to resemble common warts.
• Plantar warts. Rough, flattened, callus like growths, often with tiny black dots in the center; frequently tender; can disrupt your posture, resulting in leg or back pain.

What Causes It?

Warts commonly occur in children and young adults, but they may appear at any age. Genital warts are contagious, while common, flat, and plantar warts are less likely to spread from person to person. However, plantar warts may be spread from moist surfaces in communal swimming areas. All warts can spread from one part of the body to another. Some warts will disappear without treatment, although it can take up to 2 years. Whether treated or not, warts that disappear often reappear.

Warts are caused by various strains of a common virus in humans, the human papillomavirus (HPV). They are more likely to occur if the skin has been broken or damaged in some way. The following factors increase your risk of developing warts:

• Direct contact with warts or the fluid in warts (notably genital warts)
• Using communal facilities (such as locker rooms)
• Skin trauma
• Diseases or drugs that weaken your immune system

What to Expect at Your Provider's Office

Most warts can be diagnosed by location and appearance. Your health care provider may want to cut into a wart to verify that it is not a corn, callus, or other growth. Your provider is unlikely to order laboratory tests, however, you may receive a sonogram to confirm plantar wart diagnosis. If you have genital warts, your provider will check inside your anus and (in women) vagina.

Treatment Options

In most cases, the best treatment is no treatment at all because most warts will disappear over time without any intervention. Studies show that one half of cutaneous warts resolve spontaneously within one year, and about two-thirds within two years. Some research shows 70% of warts clear within 3 months without any treatment. For warts that are painful or unsightly, medical treatments include drug therapy (application of salicylic acid), cryosurgery with liquid nitrogen ("freezing" the wart to destroy tissue), electrosurgery (burning), lasers, and cutting out the wart.

Other potential treatments include bleomycin (an anticancer drug that is injected into the wart), interferon (a treatment to boost the body's immune reaction to the wart), and other forms of immunotherapy. Preliminary research suggests that immune stimulants like Propiorium bacterium parvum may help the body produce antibodies and destroy warts. Preliminary studies suggest injections of vitamin D3 into the base of plantar warts resolves the issue in 80% of patients. There is even some anecdotal evidence that applying duct tape and leaving it in place for 6 days, can help treat common warts. Simply repeat the process every 6 days, leaving the wart uncovered for 12 hours before covering it for another 6 days until the wart resolves. Unless your wart is causing significant problems, you should avoid treatments that have risks or could result in scarring.

Drug Therapies

Common, flat, and plantar warts

Nonprescription preparations using salicylic acid are available over the counter. Special cushions are available to relieve pressure and pain from plantar warts. Your doctor may prescribe medications in some instances.

Genital warts

In most cases, if you are healthy and not pregnant, your health care provider will either apply podophyllin weekly or prescribe a podofilox for you to apply. A vaccine is now available to protect women against contracting the HPV virus responsible for genital warts. The vaccine is 90% to 100% effective in protecting against HPV.

Complementary and Alternative Therapies (CAM)

Nutritional and herbal support may enhance immune function and minimize recurrence of HPV, the virus that causes warts. Work with a knowledgeable physician to find the therapies or supplements that are right for you. Natural supplements may interact with a variety of medications. Always inform all of your providers about any supplements or therapies you are using.

These nutritional tips may help reduce symptoms:

• Try to eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your provider may want to test you for food allergies.
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy is present), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy is present) or beans for protein.
• Use healthy cooking oils, such as olive oil or coconut oil.
• Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Eliminate caffeine, alcohol, refined foods, and sugar.
• Avoid caffeine and other stimulants, alcohol, and tobacco.
• Exercise, if possible, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, to boost immunity. Cold-water fish, such as salmon or halibut, are good sources. Omega-3 fatty acids can have a blood-thinning effect, so speak with your doctor if you are taking blood-thinning medications, such as aspirin and Coumadin.
• Probiotic supplement (containing Lactobacillus acidophilus). For maintenance of gastrointestinal and immune health. Refrigerate probiotic supplements for best results. People with severely weakened immune systems should speak to their doctors before taking probiotics.
• Grapefruit seed extract (Citrus paradisi). For antibacterial, antifungal, and antiviral activity, and for immunity. Grapefruit products may interact with a variety of drugs. Speak with your physician.

Herbs may help strengthen and tone the body's systems. As with any therapy, you should work with your provider to diagnose your problem before starting treatment. Some herbs may have side effects or interact with certain medications you are taking, so you should speak with your provider before starting any herbal therapy. You may use herbs as dried extracts (capsules, powders, and teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. (5 grams) herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis). For antioxidant effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb. Ointment made from green tea extract has been shown to be effective for genital and anal warts.
• Cat's claw (Uncaria tomentosa). For antibacterial, antifungal, and antiviral activity, and for immune support. Cat's claw can interfere with many different medications; speak to your doctor. DO NOT use cat's claw if you have Leukemia.
• Reishi mushroom (Ganoderma lucidum). For antiviral and immunity activity. You may also take a tincture of this mushroom extract. Reishi mushrooms can lower blood pressure and slow blood clotting. As such, it may increase the effects of medications for blood pressure and blood thinning. Speak with your doctor.
• Olive leaf (Olea europaea). For antiviral and immune activity. You may also prepare teas from the leaf of this herb. Olive leaf may lower blood pressure and/or blood sugar levels.

Topical applications may also be effective for treating warts. Stop any topical application if irritation develops in the surrounding skin. For plantar, flat, and common warts use the following applications:

• Banana peel patch. Cut a piece of banana peel and place it over the wart before going to bed. Tape in place.
• Raw garlic patch. Cover the wart and surrounding skin with a thin layer of castor oil or olive oil. Apply a thin slice of fresh garlic and tape in place. Never use castor oil on a small child.

To maximize benefit, place 2 to 4 drops of tincture of thuja or tea tree oil (Melaleuca alternifolia) on the wart before covering with peel or garlic. DO NOT use tea tree oil internally. This application may need to be repeated nightly for up to 3 weeks. The wart will turn black as it begins to die. Use only commercially-prepared products that are formulated for this type of use. Avoid contact with eyes, mouth, or nose. Never use internally. If you are pregnant or nursing, speak to your doctor before using these topical remedies.

For external genital warts, paint the warts with vitamin A or beta-carotene once or twice daily. Add 3 to 4 drops each of thuja, echinacea, and lomatium for best results. Use only commercially-prepared products that are formulated for this type of use. Avoid contact with eyes, nose, or mouth. Never use internally. DO NOT use vaginal treatments if you are pregnant, unless specifically directed to do so by your doctor.

Two well designed trials evaluating the use of homeopathy in the treatment of common and plantar warts found that the remedies were no more effective than placebo in reducing the number of warts. Despite the lack of evidence from these two trials, professional homeopaths might recommend one of the following treatments for warts based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account your constitutional type, including your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Antimonium crudum. For either rough and hardened or smooth warts, as well as plantar warts in otherwise healthy people.
• Causticum. For fleshy warts anywhere on the body, but particularly those near the fingernails, lips, or on the face.
• Dulcamara. For large, smooth, and flat warts on the face, fingers, or back of the hand.
• Nitricum acidum. For soft warts on the genitals, anus, or lips. These warts are often irregularly shaped and may bleed and produce an excessive pain.
• Ruta. For plantar warts, particularly if they are sore and have a smooth surface.
• Thuja. For warts of any location, except plantar. This remedy may be particularly useful for warts that are on the chin, anus, or genitals, and are generally soft and bloody or painful.

In one study of 40 people, hypnosis resolved more warts than either topical salicylic acid, or a placebo (dummy treatment). In a study of localized topical treatment, 86% of the treated warts cleared compared to 41% of placebo-treated warts.

Even with treatment, some warts may return. Genital warts are more likely to return because there is no cure for the virus that causes them, and because warts are more difficult to control in a moist environment.

Acupuncture may help stimulate your immune system.

Special Considerations

DO NOT use podophyllin if you are pregnant.

Supporting Research

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Aktas H, Ergin C, Demir B, Ekiz O. Intralesional vitamin D injection may be an effective treatment option for warts. J Cutan Med Surg. 2016;20(2):118-122.

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