John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Warts

Patient Information Sheet

Warts are caused by a virus. Warts are contagious. You got your warts from someone else. You can give them to other people. More importantly, they can spread on you. In treating warts, we must get all the warts. You cannot leave one behind because it will spread to other areas.

The virus that causes warts is called Human Papilloma Virus (wart virus, HPV for short). There are at least 130 or more different strains of wart virus. Several types have been implicated in some skin cancers. These are mostly genital warts and anal warts. Nevertheless, I think the risk of getting skin cancer from warts is very low. The main problem is that they spread.

Once you have a wart growing on you, it can spread to other parts of your body and to other people. Consider these examples:

  1. If you have a wart on your finger and chew the wart, it can cause warts to grow inside your mouth. Usually, these are easily treated with liquid nitrogen. But, if warts grow on the vocal cords, they are a big problem. Before having an ENT doctor do vocal cord surgery, we could try safe, simple cimetidine pills (Tagamet).
  2. If you have warts on your fingers and scratch other parts of your body, you can spread the warts to those areas. I feel that warts on the hands have a high priority for treatment.
  3. If you have warts on the bottom of your feet (plantar warts), you can give warts to others in public showers, locker rooms, and indoor swimming pools. To protect yourself against getting warts in such places, it helps to wear shower thongs, little rubber sandals with a strap that fits between the toes or Aqua Socks (rubber booties).

REMEMBER: Warts are caused by a virus, a germ. Warts are contagious.

So, you can see why it is necessary to get rid of ALL your warts, not just all but one. As long as you have one wart left, you can get more. We must cure all your warts. If other members of your family have warts, there is a risk that you may get reinfected with warts.

Treatment

Left on its own, any individual wart is 60% or more likely to go away in two years. The problem is that during that time, it may spread to other areas. Most warts are relatively easy to treat. The longer the wart is there, the harder it is to treat. Some areas that are more stubborn are:

  1. Warts around or under the fingernails (periungual warts).
  2. Warts in the web spaces of the fingers or toes.
  3. Warts on the bottoms of the feet (plantar warts).
  4. Warts of the vagina, penis, or inside the urethra (the hole you pee from).

Since 1971, I have treated many thousands of warts. Based on my experience, I will suggest the treatment I expect to be most likely to work for your warts. The final choice of type of treatment is yours. When we discuss this, be sure to ask me any questions you may have about the treatment, its side effects or complications, or the diagnosis. I tend to be a little conservative in my treatments. I do not want to use treatments that are extremely painful or likely to leave scars.

Treatment failures are not unusual with warts. It might require several visits to get rid of your warts. In rare cases, warts just won't go away with standard treatments. In those cases, a fairly nice treatment called immunotherapy can be considered. The trick to getting rid of warts is being persistent. Keep after them until they are gone. Don't get discouraged. Don't give up.

Types of Treatment

The standard treatment for simple warts is freezing with liquid nitrogen. This usually works very well. Rarely, if a water blister forms, liquid nitrogen can make a wart larger. To get around this, I often perform a smaller freezing and let it thaw out. Then I repeat this freeze-thaw cycle several more times. Liquid nitrogen hurts for about 2 seconds like a strong pinch or bite.

Many stubborn warts and warts around the fingernails, plantar warts, and others respond better to using a series of small treatments. I start by trimming the warts down a little using a razor blade. Then I apply a series of concentrated strong acids including phenol, nitric acid, and bichloroacetic acid. Each acid treats the wart in a different way. Each step hurts a little, but usually not too much. It is tolerable. I prefer using a series of steps each of which hurts only a little over one big very painful step.

Flat warts on the face may do well with a topically applied liquid called 5-fluorouracil, an anti-cancer drug. But liquid nitrogen usually works well for face warts.

Less painful treatments that I often use for children's warts are cantharidin (what I call tweetle beetle juice) and Ver-Var. I don't like to hurt little kids. They cannot understand why they are being hurt.

If you want to try to treat your warts on your own at home before coming in to spend money on me, I have no objections. I feel that there is about a 60% chance you can get an over-the-counter wart medicine to work. The trick is to use it longer than the label says. Usually, the label says to stop if the area gets inflamed. In my experience, you must use such products until inflammation occurs and then continue another week or two.

A product that claims to be liquid nitrogen like is actually a mixture of liquid ether and butane. This is a highly flammable, explosive set of chemicals that worries me. It gets down to temperature of about -32 F. Liquid Nitrogen is -320 F. So, it is not the same. But it may work sometimes. It is cold enough that it can cause blisters.

Complications of Wart Treatment

Complications from wart treatments are uncommon. Rarely, infection occurs. If your wart gets infected, call me so that I can prescribe an antibiotic for you. Infection is characterized by pus or progressive redness, swelling and pain. Be sure to let me know if you are allergic to any antibiotics. By the way, although I don't like warts to get infected, I must admit it usually makes them go away.

What antibiotics are you allergic to?

What to Expect from Liquid Nitrogen

Liquid nitrogen treatment hurts a lot for a few seconds, like a very hard pinch. It's bearable since it is so brief. If it hurts too much, let me know. This is not a torture contest. About two days after the treatment, the wart starts to dry up and make a scab that comes off in 2 weeks. A blister may form after two days. I prefer not to make blisters because it can make the wart larger especially on the hands and feet. The blister may contain water or even blood. Don't let this alarm you. Don't break the blister. Protect it and let it dry up.

Immunotherapy

My treatment of last resort used to be DNCB immunotherapy (1975-1985). I was trained in DNCB immunotherapy by its inventor Henry Lewis, M.D. in Denver. I used it for about 13 years. It worked great, and I did not run into any problems with it. But, I do not use it anymore, and I know of no doctor in Montana who does. Dibutyl Squaric Acid Ester has replaced DNCB. and as far as I know only Dr. David Baldridge in Great Falls uses it. The first step is for me to rub a tiny amount on your leg. We wait 2 weeks for a rash to develop. Then you rub in on the wart once a day. If all goes well, the wart goes away in about 2 month.

Let me know if you are already prone to getting rashes from topical contactants such as:

It may be possible to make up a lotion with the allergic ingredient and to rub it on the wart daily. I have had good results with topical nickel sulfate.

Is there anything that gives you a rash when it comes into contact with your skin such as jewelry or creams?

Cimetidine (Tagamet) Pills

You have seen it advertised on TV many times. It cuts down of over production of stomach acid. Many people do not know it, but it also stimulates cell-mediated immunity, the branch of the immune system that fights off warts. I have found it helpful for grown ups with warts to take the 400 mg Tagamet pill twice a day during the wart treatment period and for about a month after the wart is gone. Tagamet, in my experience, works best for little kids. The dose is 1/2 of a 200 mg table twice a day for about 1-2 months. Several little kids with large numbers of warts have gotten rid of all the warts with just Tagamet alone and no other treatment.

Aldara

Aldara is cream that is rubbed on the wart. Aldara stimulates the immune system to attack the wart. I had a patient with a wart on his finger 30 years that just would not go away with aggressive wart treatments. He used Aldara daily for a month, and the wart went away. In sensitive areas such as the anus, it is used Mondays, Wednesdays, and Fridays. If the area is not delicate and can take it, I find daily treatments work better. That is not an FDA approved dose. Aldara is $1,600 an ounce, 4 times more expensive than gold. But a $178 supply may be enough to work.

To Prepare for Your Visit

On the first visit for warts, it is a good idea to look around for other warts. If there is time, the night before your visit, soak in the tub or shower about 5 or 10 minutes. Get out of the tub and dry. While your skin is a still a little wet, look for warts and circle them with a pen. Warts absorb about 3 to 5 times their weight in water and swell up. So they are easier to see after a bath. They stand out more.

You will have to read and sign a copy of this before being seen by Dr. Tkach for your warts.

The information provided in these patient information sheets is offered for general informational and educational purposes only; it is not offered as and does not constitute medical advice. In no way are any of the materials presented meant to be a substitute for professional medical care or attention by a qualified practitioner, nor should they be construed as such.

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