Editing Wart (section)

==Treatment==
{{Further|Plantar wart#Treatment}}
There are many treatments and procedures associated with wart removal.<ref name="pmid17210977">{{cite journal|vauthors=Lipke MM| title=An armamentarium of wart treatments. | journal=Clin Med Res | year= 2006 | volume= 4 | issue= 4 | pages= 273–93 | pmid=17210977 | doi=10.3121/cmr.4.4.273  | pmc=1764803}}</ref> A review of various skin wart treatments concluded that topical treatments containing [[salicylic acid]] were more effective than [[placebo]].<ref name="Cochrane 2011">{{cite journal |vauthors=Kwok CS, Gibbs S, Bennett C, Holland R, Abbott R |date=12 September 2012 |editor1-last=Gibbs |editor1-first=Sam |title=Topical treatments for cutaneous warts |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011182/ |url-status=live |journal=[[The Cochrane Database of Systematic Reviews]] |volume=9 |issue=9 |pages=CD001781 |doi=10.1002/14651858.CD001781.pub3 |pmc=8101088 |pmid=22972052 |archive-url=https://web.archive.org/web/20130704095916/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011182/ |archive-date=4 July 2013}}</ref> [[Cryotherapy]] appears to be as effective as salicylic acid, but there have been fewer trials.<ref name="Cochrane 2011" />

===Medication===
* [[Salicylic acid]] can be prescribed by a dermatologist in a higher concentration than that found in over-the-counter products.  Several [[over-the-counter drug|over-the-counter]] products are readily available at [[pharmacies]] and supermarkets of roughly two types: adhesive pads treated with salicylic acid, and bottled concentrated salicylic acid and [[lactic acid]] solution.
* [[Fluorouracil]] — Fluorouracil cream, a [[chemotherapy]] agent sometimes used to treat [[skin cancer]], can be used on particularly resistant warts, by blocking [[Virus|viral]] [[DNA]] and [[RNA]] production and repair.<ref>{{cite journal |last1=Salk |first1=RS |last2=Grogan |first2=KA |last3=Chang |first3=TJ |date=May 2006 |title=Topical 5% 5-fluorouracil cream in the treatment of plantar warts: a prospective, randomized, and controlled clinical study. |url=https://jddonline.com/articles/dermatology/S1545961606P0418X |journal=[[Journal of Drugs in Dermatology]] |volume=5 |issue=5 |pages=418–24 |pmid=16703777}}</ref>
* [[Imiquimod]] is a [[topical cream]] that helps the body's [[immune system]] fight the wart virus by encouraging [[interferon]] production.  It has been approved by the [[U.S. Food and Drug Administration]] (FDA) for genital warts.<ref>{{cite web |date=4 June 2011 |title=Short-Acting Imiquimod Cream Approved for Genital Warts |url=http://www.medscape.org/viewarticle/740315 |url-status=live |archive-url=https://web.archive.org/web/20110818095949/http://www.medscape.org/viewarticle/740315 |archive-date=18 August 2011 |access-date=10 August 2011 |work=[[Medscape]] |vauthors=Barclay L}}</ref>
* [[Cantharidin]], found naturally in the bodies of many members of the [[beetle]] family [[Meloidae]], causes dermal blistering. It is used either by itself or compounded with [[podophyllin]].  Not FDA approved, but available through [[Canada]] or select [[United States|US]] [[compounding pharmacies]].
* [[Bleomycin]] — A more potent chemotherapy drug, can be injected into deep warts, destroying the viral DNA or RNA. Bleomycin is notably not US [[FDA]] approved for this purpose. Possible side effects include [[necrosis]] of the digits, nail loss and [[Raynaud syndrome]]. The usual treatment is one or two injections.<ref>{{cite journal |last1=Soni |first1=Prasoon |last2=Khandelwal |first2=Kanika |last3=Aara |first3=Naushin |last4=Ghiya |first4=Bhikam C |last5=Mehta |first5=Rajesh D |last6=Bumb |first6=Ram A |date=2011 |title=Efficacy of Intralesional Bleomycin in Palmo-plantar and Periungual Warts |journal=[[Journal of Cutaneous and Aesthetic Surgery]] |volume=4 |issue=3 |pages=188–191 |doi=10.4103/0974-2077.91250 |pmc=3263129 |pmid=22279384 |doi-access=free }}</ref><ref>Champion, R. H., et al. (1998). ''[[Rook's Textbook of Dermatology]]''.  [[Blackwell Science]], p. 1044, {{ISBN|0-632-06429-3}}</ref>
* [[Dinitrochlorobenzene]] (DNCB), like [[salicylic acid]], is applied directly to the wart. Studies show this method is effective with a cure rate of 80%.{{medcn|date=August 2017}} But DNCB must be used much more cautiously than salicylic acid; the chemical is known to cause [[genetic mutations]], so it must be administered by a physician. This drug induces an allergic immune response, resulting in [[inflammation]] that wards off the wart-causing virus.<ref>{{cite web |date=31 August 2002 |title=Treating Warts |url=http://www.health.harvard.edu/fhg/updates/update0303d.shtml |url-status=dead |archive-url=https://web.archive.org/web/20101103023520/http://www.health.harvard.edu/fhg/updates/update0303d.shtml |archive-date=3 November 2010 |access-date=17 May 2013 |publisher=[[British Medical Journal]]}}</ref>
* [[Cidofovir]] is an [[antiviral drug]] which is injected into HPV [[lesion]]s within the [[larynx]] ([[laryngeal papillomatosis]]) as an [[experimental treatment]].<ref name="SomaAlbert2008">{{cite journal |last1=Soma |first1=Marlene A |last2=Albert |first2=David M |year=2008 |title=Cidofovir: to use or not to use? |journal=[[Current Opinion in Otolaryngology & Head and Neck Surgery]] |volume=16 |issue=1 |pages=86–90 |doi=10.1097/MOO.0b013e3282f43408 |pmid=18197029 |s2cid=22895067}}</ref>
* Verrutop verruca treatment is a topical solution made from a combination of [[organic acid]]s, [[Inorganic Acids|inorganic acids]], and [[metal ions]]. This solution causes the production of [[nitrite]]s, which act to denature [[viral protein]]s and mummify the wart tissue. The difference between Verrutop and other acid treatments is that it does not damage the surrounding skin.
* Another product available over-the-counter that can aid in wart removal is [[silver nitrate]] in the form of a [[caustic pencil]], which is also available at drug stores. In a placebo-controlled study of 70 patients, silver nitrate given over nine days resulted in clearance of all warts in 43% and improvement in warts in 26% one month after treatment compared to 11% and 14%, respectively, in the placebo group.<ref>{{cite journal |vauthors=Sterling JC, Handfield-Jones S, Hudson PM |year=2001 |title=Guidelines for the management of cutaneous warts |url=http://www.huidziekten.nl/richtlijnen/BADguidelineCutaneousWarts2001.pdf |url-status=dead |journal=[[British Journal of Dermatology]] |volume=144 |issue=1 |pages=4–11 |doi=10.1046/j.1365-2133.2001.04066.x |pmid=11167676 |archive-url=https://web.archive.org/web/20120303031317/http://www.huidziekten.nl/richtlijnen/BADguidelineCutaneousWarts2001.pdf |archive-date=3 March 2012 |s2cid=20179474}}</ref> The instructions must be followed to minimize staining of skin and clothing. Occasionally, pigmented scars may develop.
* [[Trichloroacetic acid]] can be used to treat warts if salicylic acid or cryotherapy fail or are not available. It requires repeat treatments every week or so. Side effects are burning and stinging.<ref>{{cite web |title=Common warts - Diagnosis and treatment - Mayo Clinic |url=https://www.mayoclinic.org/diseases-conditions/common-warts/diagnosis-treatment/drc-20371131 |website=www.mayoclinic.org |access-date=6 November 2022}}</ref>
<gallery widths="200px" heights="200px">
Image:Wart ASA animated.gif|Two [[virus (biology)|viral]] warts on a middle finger, being treated with a mixture of acids (like salicylic acid) to remove them. A white precipitate forms on the area where the product was applied.
File:A Throat After CO2 Laser Treatment of HPV6 Throat Papiloma (Warts).jpg|Throat warts before and after carbon dioxide laser treatment.
</gallery>

===Procedures===
[[Image:Liquid nitrogen spray tank.jpg|thumb|[[Liquid nitrogen]] spray tank]]
* [[Treatment of warts by keratolysis|Keratolysis]], of dead surface [[skin cells]] usually using [[salicylic acid]], [[blistering agent]]s, immune system modifiers ("[[immunomodulators]]"), or [[formaldehyde]], often with mechanical paring of the wart with a [[pumice stone]], blade etc.<ref>[http://dermatology.about.com/cs/warts/a/warts.htm Warts] {{webarchive|url=https://web.archive.org/web/20080517063828/http://dermatology.about.com/cs/warts/a/warts.htm |date=17 May 2008 }} at [[About.com]]</ref>
* [[Electrodesiccation and curettage|Electrodesiccation]]<ref>{{cite journal |vauthors=Stone KM, Becker TM, Hadgu A, Kraus SJ |year=1990 |title=Treatment of external genital warts: A randomized clinical trial comparing podophyllin, cryotherapy, and electrodesiccation |journal=[[Genitourinary Medicine]] |volume=66 |issue=1 |pages=16–19 |doi=10.1136/sti.66.1.16 |pmc=1194434 |pmid=2179111}}</ref>
* Microwave Treatment<ref>{{Cite journal |last1=Solomon |first1=Katie |last2=Yip |first2=Vincent |date=December 2023 |title=The novel treatment of children with viral warts using microwave technology |journal=Skin Health and Disease |language=en |volume=3 |issue=6 |pages=e291 |doi=10.1002/ski2.291 |issn=2690-442X |pmc=10690651 |pmid=38047251}}</ref><ref>{{Cite journal |last1=Hagon |first1=Wendy |last2=Hagon |first2=Jonathan |last3=Noble |first3=Greer |last4=Brenton-Rule |first4=Angela |last5=Stewart |first5=Sarah |last6=Bristow |first6=Ivan |date=January 2023 |title=Microwave therapy for the treatment of plantar warts |journal=Journal of Foot and Ankle Research |language=en |volume=16 |issue=1 |page=37 |doi=10.1186/s13047-023-00638-8 |doi-access=free |issn=1757-1146 |pmc=10268531 |pmid=37322512}}</ref><ref>{{Cite journal |last1=Bristow |first1=Ivan Robert |last2=Webb |first2=Christopher |last3=Ardern-Jones |first3=Michael Roger |date=2017-07-27 |title=The Successful Use of a Novel Microwave Device in the Treatment of a Plantar Wart |url=https://www.karger.com/Article/FullText/477377 |journal=Case Reports in Dermatology |language=en |volume=9 |issue=2 |pages=102–107 |doi=10.1159/000477377 |issn=1662-6567 |pmc=5624246 |pmid=29033812}}</ref><ref>{{Cite journal |last1=Gupta |first1=Aditya K. |last2=Wang |first2=Tong |last3=Cooper |first3=Elizabeth A. |last4=Conenello |first4=Robert M. |last5=Bristow |first5=Ivan R. |date=October 2023 |title=The treatment of plantar warts using microwave—A review of 85 consecutive cases in the United States |journal=Journal of Cosmetic Dermatology |language=en |volume=22 |issue=10 |pages=2729–2736 |doi=10.1111/jocd.15802 |pmid=37340590 |issn=1473-2130|doi-access=free }}</ref><ref>{{Cite journal |last1=Dhinsa |first1=Arpreet |last2=Philip |first2=Gladis |last3=Daknish |first3=Fatima |last4=Amin |first4=Sahil |last5=Vlahovic |first5=Tracey |date=September 2023 |title=42057 Microwave Therapy for Plantar Warts: A Chart Review |url=https://doi.org/10.1016/j.jaad.2023.07.259 |journal=Journal of the American Academy of Dermatology |volume=89 |issue=3 |pages=AB64 |doi=10.1016/j.jaad.2023.07.259 |issn=0190-9622}}</ref><ref>{{Cite web |title=The Royal College of Podiatry |url=https://rcpod.org.uk/common-foot-problems/verrucae |access-date=2024-03-22 |website=College of Podiatry |language=en}}</ref>
* [[Cryosurgery]] or [[cryotherapy]], which involves freezing the wart (generally with [[liquid nitrogen]]),<ref>{{cite web | url = http://www.webmd.com/skin-problems-and-treatments/cryotherapy-for-warts | title = Cryotherapy for Warts | website = [[WebMD]] | url-status = live | archive-url = https://web.archive.org/web/20160709042014/http://www.webmd.com/skin-problems-and-treatments/cryotherapy-for-warts | archive-date = 9 July 2016 }}</ref> creating a blister between the wart and [[Epidermis|epidermal]] layer after which the wart and the surrounding dead skin fall off.  An average of three to four treatments are required for warts on thin skin.  Warts on calloused skin like plantar warts might take dozens or more treatments.<ref name="aafp.org">{{cite journal |vauthors=Bacelieri R, Johnson SM |year=2005 |title=Cutaneous warts: An evidence-based approach to therapy |url=http://www.aafp.org/afp/2005/0815/p647.html |url-status=live |journal=[[American Family Physician]] |volume=72 |issue=4 |pages=647–52 |pmid=16127954 |archive-url=https://web.archive.org/web/20140421082525/http://www.aafp.org/afp/2005/0815/p647.html |archive-date=21 April 2014}}</ref>
* Surgical [[curettage]] of the wart
* [[Laser]] treatment – often with a [[pulse dye laser]] or [[Carbon-dioxide laser|carbon dioxide (CO<sub>2</sub>) laser]].  Pulse dye lasers (wavelength 582&nbsp;nm) work by selective absorption by blood cells (specifically [[hemoglobin]]).  CO<sub>2</sub> lasers work by selective absorption by water molecules.  Pulse dye lasers are less destructive and more likely to heal without scarring.  CO<sub>2</sub> laser works by vaporizing and destroying tissue and skin.  Laser treatments can be painful, expensive (though covered by many insurance plans), and not extensively scarring when used appropriately.  CO<sub>2</sub> lasers will require [[Local anesthetic|local anaesthetic]]. Pulse dye laser treatment does not need [[conscious sedation]] or local anesthetic.  It takes 2 to 4 treatments but can be many more for extreme cases. Typically, 10–14 days are required between treatments. Preventive measures are important.<ref name="aafp.org" />
* [[Infrared]] coagulator – an intense source of infrared light in a small beam like a laser.  This works essentially on the same principle as laser treatment.  It is less expensive.  Like the laser, it can cause blistering, pain and scarring.<ref>{{cite journal | author = Halasz CL | title = Treatment of common warts using the infrared coagulator | journal = The Journal of Dermatologic Surgery and Oncology | volume = 20 | issue = 4 | pages = 252–56 | year = 1994 | pmid = 8163746 | doi=10.1111/j.1524-4725.1994.tb01620.x}}</ref>
* Intralesional [[immunotherapy]] with purified candida, MMR, and [[tuberculin]] (PPD) protein appears safe and effective.<ref>{{cite journal |last1=Aldahan |first1=AS |last2=Mlacker |first2=S |last3=Shah |first3=VV |last4=Kamath |first4=P |last5=Alsaidan |first5=M |last6=Samarkandy |first6=S |last7=Nouri |first7=K |title=Efficacy of intralesional immunotherapy for the treatment of warts: A review of the literature. |journal=Dermatologic Therapy |date=May 2016 |volume=29 |issue=3 |pages=197–207 |doi=10.1111/dth.12352 |pmid=26991521|s2cid=40536366 |doi-access=free }}</ref><ref>{{cite journal|last=Salman|first=Samer|title=Intralesional Immunotherapy for the Treatment of Warts: A Network Meta-analysis|journal=Journal of the American Academy of Dermatology|volume=80|issue=4|pages=922–930.e4|via=Elsevier Science Direct|pmid=30003983|doi=10.1016/j.jaad.2018.07.003|year=2019|s2cid=51617793}}</ref>
* [[Duct tape occlusion therapy]] involves placing a piece of [[duct tape]] over the wart. The [[mechanism of action]] of this technique still remains unknown.  Despite several trials, evidence for the [[efficacy]] of duct tape therapy is inconclusive.<ref>{{cite journal |last1=Loo |first1=SK |last2=Tang |first2=WY |title=Warts (non-genital). |journal=BMJ Clinical Evidence |date=12 June 2014 |volume=2014 |pmid=24921240 |pmc=4054795}}</ref><ref>{{cite journal |title= Topical treatments for cutaneous warts |author1= Kwok CS |author2= Gibbs S |author3= Bennett C |author4= Holland R |author5= Abbott R |date= 12 September 2012 |pmid=22972052 |doi=10.1002/14651858.CD001781.pub3 |volume=9 |issue= 9 |pages=CD001781 |journal=Cochrane Database Syst Rev|pmc= 8101088 }}</ref> Despite the mixed evidence for efficacy, the simplicity of the method and its limited side-effects leads some researchers to be reluctant to dismiss it.<ref>{{cite journal |vauthors=Stubbings A, Wacogne I | title = Question 3. What is the efficacy of duct tape as a treatment for verruca vulgaris? | journal = Archives of Disease in Childhood | volume = 96 | issue = 9 | pages = 897–99 | date = September 2011 | pmid = 21836182 | doi = 10.1136/archdischild-2011-300533 | s2cid = 206853952 }}</ref>
* No intervention. Spontaneous resolution within a few years can be recommended.<ref>{{cite journal |last=Goldman |first=Ran D. |date=May 2019 |title=Duct tape for warts in children: Should nature take its course? |journal=Canadian Family Physician |volume=65 |issue=5 |pages=337–338 |issn=1715-5258 |pmc=6516695 |pmid=31088871}}</ref>

[[File:Wart Treatment Timeline.jpg|thumb|600px|center|This image shows throat warts ([[papilloma]]s) before treatment and during the treatment process.  Left to right: warts prior to treatment, warts on the day of [[silver nitrate]] treatment, warts two days after treatment, warts four days after treatment, warts six days after treatment, and warts remaining nine days after treatment.]]

===Alternative medicine===
[[File:Bufo bufo 01 13Jul2009.jpg|thumb|Despite their appearance, [[True toad|toads]] do not cause warts]]
Daily application of the [[latex]] of [[Chelidonium majus]] is a traditional treatment.<ref>Gilca, Marilena, et al. [http://www.medicinabiomolecular.com.br/biblioteca/pdfs/Fitoterapia/fi-0373.pdf Chelidonium majus–an integrative review: traditional knowledge versus modern findings] {{Webarchive|url=https://web.archive.org/web/20201205045303/http://www.medicinabiomolecular.com.br/biblioteca/pdfs/Fitoterapia/fi-0373.pdf |date=5 December 2020 }} ''Forschende Komplementärmedizin/Research in Complementary Medicine''2010; 17(5): 241–248.</ref>

The acrid yellow [[sap]] of [[Greater Celandine]] is used as a traditional wart remedy.<ref>[http://www.botanical-online.com/english/celandine_for_warts.htm Greater Celandine For Warts] {{webarchive|url=https://web.archive.org/web/20140717094406/http://www.botanical-online.com/english/celandine_for_warts.htm |date=17 July 2014 }}. botanical-online.com</ref>

According to English [[folk belief]], touching [[true toad|toads]] causes warts; according to a [[Germany|German]] belief, touching a toad under a [[full moon]] cures warts.<ref name="ley196312">{{cite magazine |last=Ley |first=Willy |date=December 1963 |title=The Names of the Constellations |department=For Your Information |url=https://archive.org/stream/Galaxy_v22n02_1963-12#page/n46/mode/1up |magazine=Galaxy Science Fiction |pages=90–99 }}</ref> The most common [[Northern Hemisphere]] toads have glands that protrude from their skin that superficially resemble warts. Warts are caused by a virus, and toads do not harbor it.<ref>{{cite web | url=http://science.howstuffworks.com/environmental/life/zoology/reptiles-amphibians/toads-cause-warts.htm | title=Do toads cause warts? | publisher=science.howstuffworks.com | access-date=20 October 2012 | author=Clark, Josh | date=2 March 2009 | page=2 | url-status=live | archive-url=https://web.archive.org/web/20121016002453/http://science.howstuffworks.com/environmental/life/zoology/reptiles-amphibians/toads-cause-warts.htm | archive-date=16 October 2012 }}</ref> A variety of traditional [[folk remedy|folk remedies]] and rituals claim to be able to remove warts.

In ''[[The Adventures of Tom Sawyer]]'', [[Mark Twain]] has his characters discuss a variety of such remedies.  Tom Sawyer proposes "spunk-water" (or "stump-water", the water collecting in the hollow of a tree stump) as a remedy for warts on the hand.  You put your hand into the water at midnight and say:

{{poemquote|Barley-corn, barley-corn, injun-meal shorts,
Spunk-water, spunk-water, swaller these warts}}

You then "walk away quick, eleven steps, with your eyes shut, and then turn around three times and walk home without speaking to anybody. Because if you speak the charm's busted."  This is given as an example of [[Huckleberry Finn]]'s planned remedy, which involves throwing a dead cat into a graveyard as a devil or devils comes to collect a recently buried wicked person.  Another remedy involved splitting a bean, drawing blood from the wart and putting it on one of the halves, and burying that half at a [[Crossroads (mythology)|crossroads]] at midnight.  The [[theory of operation]] is that the blood on the buried bean will draw away the wart.<ref>[[Mark Twain]], ''[[The Adventures of Tom Sawyer]]'', [[s:The Adventures of Tom Sawyer/Chapter VI|ch. 6]]</ref> Twain is recognized as an early collector and recorder of genuine [[American Folklore|American folklore]].<ref>LeMaster, J. R. (1993) ''The Mark Twain Encyclopedia'' (Taylor and Francis, pp. [https://books.google.com/books?id=zW1k-XS6XLEC&pg=PA293 293–94] {{webarchive|url=https://web.archive.org/web/20170107065759/https://books.google.com/books?id=zW1k-XS6XLEC&pg=PA293 |date=7 January 2017 }}, {{ISBN|0-8240-7212-X}}.</ref>

Similar practices are recorded elsewhere.  In [[Louisiana]], one remedy for warts involves rubbing the wart with a [[potato]], which is then buried; when the "buried potato dries up, the wart will be cured".<ref>{{cite journal|author=Webb, Julie Yvonne |title=Louisiana Voodoo and Superstitions Relating to Health|journal=HSMHA Health Reports|year=1971|volume=86|issue=4|pmc=1937133|pages=291, 296–97|doi=10.2307/4594154|pmid=4324337|jstor=4594154}}</ref> Another remedy similar to Twain's is reported from [[Northern Ireland]], where water from a specific well on [[Rathlin Island]] is credited with the power to cure warts.<ref>{{cite journal | author = Ballard LM | title = An approach to traditional cures in Ulster | journal = The Ulster Medical Journal | volume = 78 | issue = 1 | pages = 26–33 | year = 2009 | pmid = 19252727 | pmc = 2629017 }}</ref>