Medically reviewed by William Truswell, MD
Most skin warts are harmless and often go away on their own. Wart treatments can speed up the removal of warts that are painful. While often a simple process, removing a wart involves several stages before the treated area is clear.
The wart virus can't be cured. First-line wart treatments help the wart fall off by slowly killing the skin damaged by the virus. They may also trigger an immune response to fight the virus and help contain its spread. As this skin dies, it shrinks and peels off in layers.
Knowing how your skin reacts after a wart treatment can help you look for signs of success or failure. It is normal for warts to become more unsightly as treated layers of skin are killed and removed during a period that can last up to 12 weeks.
This article describes the normal skin changes caused by wart treatments. It also explains what to do when a treated wart does not heal.
Stages of Wart Falling Off With At-Home Treatment
The most commonly used home treatment for wart removal involves over-the-counter (OTC, without a prescription) topical salicylic acid, a peeling agent that dissolves the keratin that composes the wart. It also encourages an immune reaction to the wart virus when the acid irritates it.
Salicylic acid offers an easy and typically painless application, affordability, and minimal side effects. A concentration of 17% salicylic acid topical liquid is typically advised for common warts, while 40% salicylic acid is usually for larger, thicker warts like plantar warts. Salicylic acid is widely available in formulations that include a gel, liquid, or adhesive pad.
When used as instructed, salicylic acid can be effective and rarely painful, though it is a slow process. Salicylic acid resolves 70% of warts within 12 weeks of daily applications. The stages of this process begin with preparation and involve the following steps:
Before applying the salicylic acid, the wart is loosened and softened so the medicine can penetrate the skin more easily. You can soak the wart in warm water for at least 10 minutes.
Follow up the soaking by using a single-use emery board or pumice stone to file off all the dead, white skin. Avoid filing into the normal skin around the wart. Dispose of the emery board and wash your hands to avoid spreading the wart's virus.
Apply the medicine to the wart's surface according to the product instructions before going to bed.
Protect unaffected skin from being treated with salicylic acid. This treatment should only touch the wart.
Allow the area to dry, cover it with a bandage, sock, or duct tape, and wash off the medicine in the morning.
Repeat the application of salicylic acid nightly or according to the product's instructions. The wart tissue should soften after each treatment to be easily rubbed or filed off.
Remove dead tissue daily or as needed. Use a file or pumice stone according to package directions.
If the treated area becomes painful, discontinue using the salicylic acid for two to three days, then resume its application.
Over time, the treated wart should become smaller and less uncomfortable.
Continue treating the wart until it peels off just below the level of the surrounding skin. Stop treatment when the base of the wart looks exactly like normal skin, with no signs of graininess or black dots.
When Home Treatment Should Not Be Used
While home treatment with salicylic acid is convenient and effective for many types of warts, you should consult with a healthcare provider before self-treatment if you have the following conditions:
A lesion that you suspect may not be a wart
A wart located on your genitals or face
Warts that itch, hurt, bleed, or burn
Diabetes, especially if the wart is on your foot
You should also seek medical care for warts that appear anywhere on an infant or young child.
Wart Healing After In-Office Removal
Wart healing after in-office removal is typically faster than at-home treatments. Cryosurgery for warts is the most common first-line in-office treatment. This treatment involves the application of liquid nitrogen to freeze the affected skin, preventing its survival.
The stages of a wart healing after freezing involve the following:
Remove any powder, makeup, or lotion on the area surrounding your wart before it is treated.
If your wart is very thick, your provider may remove the skin on the top of the wart using a small scalpel to help the treatment work better.
Liquid nitrogen is applied to the top of the wart and the area slightly into the surrounding tissue using a cotton swab or spray bottle.
The liquid nitrogen can cause a sensation of ice sticking to your skin or frostbite for about two minutes.
Within minutes of the treatment, you may feel a hot or burning sensation as your skin thaws. It will turn red and begin to swell.
After treatment, your skin may feel sore for the next day or two.
A clear or blood-filled blister will typically form at the site of the treated area. The timing of blister formation can vary based on the location of the wart and the thickness of the skin around the wart.
If a blister does not form, a scab may develop instead.
There is no need to cover the treated skin, although a Band-Aid can be used without harming the area.
You may be instructed to apply a product like petroleum jelly to the treated area daily for two weeks. This will help the treated area heal and prevent crusting.
The blister usually flattens in about two to three days and falls off in about two to three weeks, but it can occur faster. Attempting to remove the blister or scab before it falls off can increase the risk of scarring or infection.
Cryosurgery typically does not leave a scar after the blister or scab falls off.
The treated area may be lighter in color. It may take several months for the treated skin to return to normal color and appearance, though it can sometimes be permanent.
Treatment of a plantar wart, which grows inward, may leave a hole after wart removal. Over time, normal skin growth should help reduce the hole.
Many warts require follow-up treatment with four to six weeks between treatments. The number of cryosurgery treatments needed for full wart removal depends on the treated wart's location, size, and response.
What Delays Wart Healing?
It can be difficult to predict the timing of wart healing and what will affect the healing timeline. In addition to destroying the damaged skin, wart treatments aim to cause an immune response against the virus, but they don't kill it. The factors that can interfere with this process are hard to predict.
The following factors can contribute to a delay in wart healing:
Failure to comply with the daily 12-week treatment process often required for successful at-home salicylic acid treatments
Using a salicylic acid treatment that is too weak for the affected area
Having a cryosurgery treatment that is applied for a shorter than necessary period
Failure to return for repeat cryosurgery treatment when the first course of treatment produces poor results
Types of Warts
Knowing the type of wart you have can help you determine whether you should attempt removal at home or consult a healthcare provider for treatment. While all skin warts are caused by a virus called human papillomavirus (HPV), they can appear in different forms, as follows:
Common warts: These hard, dome-shaped warts range in size from that of a pinhead to the size of a pea. They have a rough, scaly surface and grow on your fingers, elbows, knees, and face. As their name implies, common warts occur the most often.
Filiform warts: These small warts appear on your eyelids, face, lips, or neck. They have a threadlike, spiked appearance and resemble tiny brushes with fingerlike projections.
Flat warts: These warts form in clusters on your face, legs, and the backs of your hands. They grow to the size of a pinhead with flat tops and a smooth appearance.
Periungual warts: These warts appear as thickened skin around your nails where they can cause fissures (painful splits in your skin).
Plantar and palmar warts: These warts appear on the soles of your feet (plantar) or the palms of your hands (palmar). Plantar warts can grow quite large and hurt when you walk as they are pushed inward by the weight of your body.
Genital warts: These warts are small hard nodules with rough surfaces. They are sexually transmitted and only affect your genital area. Since these warts are linked to cervical, anal, and other cancers, they require prompt treatment by a healthcare provider.
Wart Not Going Away: Next Steps
When a wart is not going away despite treatment, it is best to contact your healthcare provider or a dermatologist. If infection or improper healing delays wart removal, postponing proper treatment can worsen the problem and risk the potential spread of the wart virus to other areas.
There are many treatments available to eradicate stubborn warts. The most commonly used in-office treatments include the following:
Cantharidin: Cantharidin is a topical treatment that triggers the formation of a blister under the treated wart. The blister pushes the wart up until it separates from your skin. After a week, you return to your dermatologist's office, where the dead wart is clipped away.
Electrosurgery and curettage: Electrosurgery (burning) involves using an electric device to burn off the wart cells. It is followed by scraping off (curetting) the dead wart cells with a sharp knife or small, spoon-shaped tool. These procedures are often used together.
Pulse-dye laser treatment: Pulse-dye laser treatment, or cauterization, is typically reserved for warts that do not respond to other therapies. This treatment can be painful so that the wart may be numbed with an anesthetic injection before treatment.
Chemical peels: Chemical peels may be appropriate for flat warts that often appear large. The treatment involves applying a peeling medicine at home daily. These treatments may include prescription-strength salicylic acid, tretinoin, and glycolic acid.
Bleomycin: Bleomycin is a chemotherapy drug that is injected into the wart. It works by disintegrating the wart. This treatment can be painful. It can also cause other side effects like nail loss when applied to your fingers.
Immunotherapy: This treatment uses your immune system to fight severe warts when other treatments fail. It involves applying a chemical called diphencyprone (DCP) to the warts. It causes a mild allergic reaction around the treated warts, which may cause them to die away.
Learn More: The 6 Best Wart Removers of 2023
If you have a wart that is painful or ugly, you may prefer not to wait until it clears on its own. Using a wart treatment can kill the wart and help you restore normal skin. It may also trigger your immune system to attack the virus that causes warts.
While effective, these treatments can take time for the wart to die. During that period, your skin may look much worse before it gets better. Peeling and blisters are common effects of first-line wart treatments.
Keeping up with treatments and care as advised can help you support the best results. Knowing the normal process involved in killing a wart can help you notice when the process succeeds or stalls and needs more care.
Read the original article on Verywell Health.