Warts
If you’ve been trying to manage a wart on your own without much success, you’re not alone. Professional treatment can offer a more targeted approach and better, longer-lasting results.
Warts are caused by the human papillomavirus (HPV) and can appear anywhere on the skin, though the hands, feet, and face are the most common sites. They're benign but persistent, and while some resolve on their own over months or years, many don't, and they can spread to other areas or to other people in the meantime. Professional treatment offers options more effective than home remedies for stubborn, large, or recurring warts, including liquid nitrogen cryotherapy at temperatures far below those reached by home freezing kits, and laser treatment for warts that have resisted other approaches. At Element Dermatology in Sartell, MN, we treat warts of all types.
About This Condition
Types of Warts and What to Expect from Treatment
All warts are caused by HPV, but different HPV strains produce different types of warts in different locations. Knowing which type you're dealing with helps set realistic expectations about treatment. Some types respond quickly to a single session, others require multiple treatments, and some locations are more challenging than others.
Common types of warts we treat:
Common Warts (Verruca Vulgaris)
Rough, raised growths with a cauliflower-like surface, most often on the fingers, hands, and around the nails. May have small black dots (thrombosed capillaries) visible on the surface. Common warts are the type we most frequently treat, and they generally respond well to cryotherapy, though multiple sessions are often needed for larger or deeper warts.
Plantar Warts
Warts on the sole of the foot, which grow inward rather than outward because of the pressure of walking. Often flat with a thickened, callus-like surface, and can be painful underfoot. Among the more challenging types to treat because of their depth and location. May require multiple cryotherapy sessions or combination treatment approaches.
Flat Warts (Verruca Plana)
Small, smooth, flat-topped warts that tend to appear in clusters on the face, forehead, and legs. More common in children and young adults. Because of their location and number, flat warts require gentler treatment approaches. Topical treatments and light cryotherapy are preferred over aggressive freezing on facial skin.
Periungual and Filiform Warts
Periungual warts grow around or under the fingernails and toenails, often causing nail distortion and tenderness. Filiform warts are long, narrow, thread-like growths that appear most often on the face around the mouth, eyes, and nose. Both types require treatment approaches matched to their location and structure.
Warts can spread, so treatment sooner rather than later is your best course of action. HPV spreads through direct contact and through surfaces, and can autoinoculate, spreading from one area of your own skin to another. A single wart on the finger that's left untreated for a year may become several. Treating warts while they're small and isolated is easier and faster than treating a larger cluster that's had time to establish.
Targeted Treatments
How We Treat Warts
Cryotherapy (Liquid Nitrogen)
Cryotherapy is the most common treatment for warts. Liquid nitrogen is applied at -321°F, which then freezes and destroys the wart tissue, triggering an immune response that helps clear the HPV. Expect a brief sting during application, followed by blistering over one to two days as the treated tissue separates.
Laser Treatment
The pulsed dye laser and Aerolase can target the blood vessels that feed a wart, cutting off its blood supply and triggering immune clearance. Useful for warts that have failed multiple rounds of cryotherapy or that are in locations where cryotherapy carries a higher risk of scarring.
Immunotherapy
For warts that haven't responded to standard treatments, intralesional immunotherapy with agents such as Candida antigen or squaric acid dibutylester can provoke a local immune response that may clear resistant warts. These approaches work by alerting the immune system to HPV-infected tissue.
Prescription Topical Treatments
Higher-concentration salicylic acid formulations, tretinoin, and imiquimod are all useful adjuncts to cryotherapy or as standalone treatments for flat warts and warts in sensitive locations where aggressive freezing isn't appropriate. Canthardin, a blistering agent, is effective for common and plantar warts and works especially well in children.
Curettage and Excision
For isolated, large, or persistently bothersome warts that warrant a more direct approach, curettage (scraping) or surgical excision under local anesthetic physically removes the wart. Not a first-line option because scarring is a consideration, but appropriate in select situations.
Combination Approaches
For stubborn or widespread warts, the best results often come from combining treatments: cryotherapy to destroy the wart tissue alongside topical salicylic acid or imiquimod to maintain pressure between sessions, or laser in combination with immunotherapy.
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Frequently Asked Questions About Warts
Will my wart go away on its own?
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Some do, eventually. Studies suggest that around 65% of warts in healthy adults clear on their own within two years, as the immune system gradually recognizes and clears the HPV infection. The problem is that two years is a long time to wait, and in the meantime, the wart can spread to other sites or to other people. For warts that are growing, multiplying, in a bothersome location, or that have been present for more than six months without change, professional treatment is a more efficient path than watchful waiting.
Can warts come back after treatment?
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Yes, though this is less common when the wart is fully cleared than when it is partially treated. Recurrence happens because the treatment addresses the visible wart but not the HPV in the surrounding skin. If residual virus remains, a new wart can develop in the same location. Completing the full course of treatment, including follow-up sessions once the wart appears gone, reduces the recurrence rate. New warts in different locations reflect ongoing HPV exposure rather than recurrence of the treated wart.
Are warts contagious?
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Yes. Warts spread through direct skin-to-skin contact with an HPV-infected person, or through contact with surfaces they've touched. Common routes include shared towels, gym floors, pool surrounds, and handshakes with someone who has a wart on their hand. They can also spread from one part of your own body to another, often through shaving or nail biting. Keeping warts covered when in shared spaces, not picking at them, and washing hands after touching a wart reduces the risk of spread.
Does cryotherapy hurt?
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There's a sharp sting during the freeze and a throbbing sensation for a few minutes afterward that most patients find manageable without numbing. Plantar warts tend to be more uncomfortable to treat because of the pressure required to reach a wart that's grown inward. A blister usually forms over the treated area within 24 hours and resolves within 1 to 2 weeks. Most patients find the discomfort easier to handle than anticipated, and it's brief. The freeze itself takes seconds per wart.