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Sometimes, the Old Ways are the Best Ways to Treat Warts

(HealthDay News) – How to get rid of the unsightly wart?

It’s still one of the most-asked questions in the world of practical medicine, meaning that one doesn’t need to be a Harvard Medical School graduate to give it a shot.

Nevertheless, wart removal is still a medical procedure, and to paraphrase George Orwell, not all warts are created equal. Some may pose more danger than others.

People have used banana peels, potatoes, garlic, charms, and even the milky juice in the stem of a dandelion. Huckleberry Finn once tried to remove them by carrying a dead cat into a graveyard at midnight.

A more common therapy used nowadays is to freeze them off with substances like liquid nitrogen, but research by a British team maintains that this method works no better than topical treatments sold over the counter.

After examining 50 clinical studies on wart treatments, the researchers found that an inexpensive tube of salicylic acid -- Compound W and the like -- is just as effective as any other treatment.

"The research seems to show that the cheapest and humblest treatment probably works best. That's probably hard to bear for patients because they want high-tech treatments," says study author Dr. Sam Gibbs, a dermatology consultant at the Ipswich Hospital in England. His team’s review of wart-removing methods appeared in the British Medical Journal.

Gibbs examined the issue because he was concerned that the more expensive treatments don't appear to be much better than cheap ones.

"It's a common problem. Just about everybody gets a wart at some point in their life. So, on a national level, probably a lot of money is spent on it," he says.

In the studies, salicylic acid, the active ingredient in over-the-counter treatments such as Compound W and Wart-Off, appears to work as well as other methods. However, Gibbs also found that almost all of the wart studies were less rigorous than most medical trials. For example, the results for cryotherapy -- where the wart is frozen off -- and laser treatment were lacking, he says.

"It is difficult to do a good trial on warts. We're not saying it's easy, but more work has to be done," Gibbs says, adding that he intends to lead more extensive research.

Part of the problem is that most of the trials counted warts instead of people when evaluating a treatment, which slants results. The reason: Many responsive patients were treated for multiple warts. Also, studies often didn't compare results against other methods or placebos. Also, because warts can go away by themselves, the pool of patients often wasn't stable throughout the trials.

Perhaps the biggest difficulty is that in treating warts doctors focus more on a person's immune system than the wart itself, says Dr. Philip Shenefelt, an associate professor of medicine at the University of South Florida. Instead of eliminating the wart virus, most treatments merely stimulate the body's immune system to fight the wart on its own.

"It's a viral infection, and basically the body has to build up enough of an immune response so the wart won't come back," Shenefelt says. "It's not that strong a virus, but because it's on the upper layer of the skin it's not adjacent to the blood flow, so it's hard for the immune cells to notice the virus without treatment."

For that reason, different patients need different treatments, which is why most dermatologists have multiple therapies at their disposal. Doctors call upon the quicker but more expensive cryotherapy if patients are unwilling to apply salicylic acid daily for weeks or months, or if they have done so and failed to remove the wart, Shenefelt says.

The British research begged to differ.

"Although it is widely believed that cryotherapy may succeed when topical salicylic acid has failed, there was no clear evidence to support this. Indeed some evidence shows that at best cryotherapy is only equal in efficacy to topical salicylic acid," the study says.

However, Shenefelt counters that having multiple treatments gives patients options. In fact, of all the therapies, he favors hypnotherapy. He says if you concentrate, you can stimulate your immune system.

"It's not clear that one method is better than others," he says. "There are some dermatologists who have preferences, but there are others who say, 'I have five or six therapies for treating warts, let me tell you the pluses and minuses of each one.'"

On the Web

Not all warts are harmless, especially those on the feet, which can make walking painful. For information about treating plantar warts, visit the American Academy of Orthopaedic Surgeons.

SOURCES: Sam Gibbs, M.R.C.P., general dermatologist, Ipswich Hospital, Ipswich, England; Philip Shenefelt, M.D., associate professor of medicine,, University of South Florida, Tampa; Aug. 31, 2002, British Medical Journal
Publication date: March 2007
Author: Ross Grant, HealthDay Reporter
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