Warts – To Treat Or Not to Treat?

No one likes warts, except perhaps the Wicked Witch of the West.

Finger warts. Plantar warts. Genital warts.

They’re all caused by HPV – some strain of human papilloma virus. It would be nice if you could take a pill, like penicillin, but so far there is no equivalent antiviral to do the job.

So, what’s it worth to get rid of a wart? Ten bucks? $100? A grand?

The trouble with warts is they tend to come back. The trouble with treatment is neither you nor your doctor can tell if every wart particle has been abolished. The virus can lurk in adjacent, normal-looking skin, or even elsewhere on your body.

If you have no co-pay on office visits or medications, it’s probably cheapest to seek professional treatment. For anyone who pays, however, self-treatment is worth considering.

For hand warts or plantar warts, OTC treatments are often effective, from salicylic acid to cryotherapy. Acid treatments “dissolve” the thick skin of a wart, layer by layer. Acid treatments come in the form of gels, liquids, plasters, and pads, all for about $10 to $20. The most important aspect of acid treatments is consistency. Soak the affected area, rub off the dead skin, then apply the acid, generally once a day.

Cryotherapy is freezing treatment, now available over the counter from Dr. Sholl’s, Wartner, and Compound W, all for about $20 to $25. Each canister contains several treatments. Especially for plantar warts, repeat treatments are usually required. The freezing liquid is not exactly the same as what a dermatologist might use (liquid nitrogen), but safer for non-professionals.

Genital warts are a little trickier and usually require medical evaluation. But even then, you should know your options. If only a few lesions are present, freezing is an option. However, since “invisible” warts are often present, doctors often advise covering the entire external genitalia with medication.

Imiquimod (Aldara) cream is a popular option, but one day’s treatment runs about $45, and 12 treatments may be needed. If you’re choking on the thought of a $400 medication, consider podofilox (Condylox) at $100 a bottle. If that doesn’t work, you can always move up to the expensive medication.

For a more thorough evaluation on the cost of treating genial warts visit: www.aafp.org/afp/2004/1215/p2335.html.

Why treat genital warts anyway? Since certain strains of HPV are linked to cervical cancer, does treating genital warts decrease the chance of developing cancer? Does it lessen the risk of transmission?

Probably not, on both accounts. Treating genital warts is currently only aimed at decreasing symptoms (such as friction irritation) and improving appearance. Sometimes warts just go away. If you’re lucky, your immune system will recognize the foreign invader and fight it off. Watchful waiting is certainly an option.

But small warts are easier to treat with chemical or freezing methods, so don’t wait until they’re the size of a cauliflower. Then you will get stuck spending hundreds of dollars to rid yourself of the offending growth.

Copyright 2010 Cynthia J. Koelker, M.D.