Treatment Options for Viral Warts on Toes: Expert Insights

May I ask the doctor?

Dear Dr.
Wu,
I would like to ask about my father's condition.
Recently, he has developed thick calluses on the outer sides of both big toes, and the skin on the big toes appears somewhat rough.
A dermatologist diagnosed it as a viral wart and recommended applying a wart treatment solution twice a day for two weeks, after which it should fall off on its own.
As for the rough areas, they are suspected to be early signs of viral warts, which are currently not very noticeable, and the doctor suggested observing them until they become more pronounced before treating them.
I have been applying the wart treatment solution for nearly a week, and I have a few questions:
1.
Is the effectiveness of the wart treatment solution for viral warts not inferior to that of cryotherapy?
2.
Shouldn't newly formed viral warts be treated with medication right away? I have my doubts about this.
3.
After nearly a week of applying the wart treatment solution, I noticed that the white areas are increasing.
I'm unsure if I accidentally applied it to the surrounding normal skin, which might also turn white, or if it's the wart itself.
Will the white areas on normal skin eventually shed on their own? Is it necessary to remove the thick white keratin with a file or scissors? Will it fall off on its own? I'm concerned about injuring the normal skin (sometimes my father experiences pain when using a file or scissors).
4.
If the thick keratin does not fall off on its own, what methods can enhance the natural shedding of the skin? This is quite troubling for me.
5.
The instructions for the wart treatment solution state not to use it on warts larger than 5 cm.
However, my father's wart is quite large.
Does this mean it won't fall off normally and may not be effective?
I apologize for asking so many questions, but this situation is very concerning for me.
I understand this is a long-term issue, but I can't help but wonder why we aren't opting for cryotherapy a few times instead.
I'm worried that the situation might worsen.
Thank you.

Xiao Xin, 40~49 year old female. Ask Date: 2018/09/19

Dr. Wu Yuxin reply Dermatology

1.
The combination of cryotherapy and wart treatment solution yields the best results.

2.
The principles of new and old treatments remain the same.

3.
It is likely that too much wart treatment solution was applied, causing it to spread to normal tissue.

4.
You can try gently scratching it after 1-2 weeks.

5.
Finally, I advise you to consult your father's attending physician, as they are the most familiar with his condition.

Reply Date: 2018/09/19

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding the treatment of viral warts on your father's toes. I understand that dealing with warts can be frustrating, and I will do my best to address your questions and provide some insights based on current medical knowledge.

1. Effectiveness of Wart Treatments: You are correct that there are various treatment options for viral warts, including topical treatments (like the wart solution your father is using) and cryotherapy (freezing). Cryotherapy is often considered more effective for larger or more stubborn warts because it directly destroys the wart tissue and can stimulate an immune response. However, topical treatments can also be effective, especially for smaller warts. The choice between these methods often depends on the size, location, and number of warts, as well as patient preference.

2. Early Treatment of Warts: It is generally advisable to treat warts as soon as they are identified, especially if they are causing discomfort or concern. The topical solution your father is using is designed to help eliminate the wart, but if the wart is still small and not causing pain, some healthcare providers may recommend a watchful waiting approach. However, if there is any uncertainty about the diagnosis or if the wart appears to be growing, it is wise to follow up with a healthcare professional.

3. Skin Changes and Side Effects: The whitening of the surrounding skin that you are observing could be due to the wart treatment solution affecting the normal skin. This is not uncommon, as many topical treatments can cause irritation or a chemical burn to the surrounding skin. If the normal skin is turning white, it may not necessarily be a cause for alarm, but it is essential to monitor it. The white areas should eventually return to normal, but if there is significant irritation or pain, it may be best to consult with a dermatologist. As for the thickened skin, it is often best to avoid aggressive removal methods like cutting or filing unless advised by a healthcare professional, as this can lead to further irritation or infection.

4. Encouraging Natural Shedding: If the wart does not fall off on its own, there are several methods to encourage the skin to shed naturally. Keeping the area clean and moisturized can help. Additionally, some people find that using over-the-counter salicylic acid treatments can help to gradually remove the wart and surrounding thickened skin. However, it is crucial to apply these treatments carefully to avoid damaging normal skin.

5. Size of the Wart and Treatment Limitations: The warning on the treatment solution regarding the size of the wart is important. If the wart is larger than the recommended size, it may not respond well to the topical treatment, and alternative methods like cryotherapy or laser treatment may be more effective. It is advisable to consult with a dermatologist who can assess the wart and recommend the most appropriate treatment based on its size and characteristics.

In conclusion, while topical treatments can be effective, larger warts may benefit from more aggressive treatments like cryotherapy. It is essential to monitor the situation closely and consult with a healthcare professional if there are any concerns about the treatment or if the wart does not improve. Remember, patience is key in wart treatment, as they can take time to resolve.

I hope this information helps alleviate some of your concerns. Please feel free to reach out if you have any further questions.

Best regards,
Doctor Q&A Teams

Similar Q&A

Effective Treatments for Persistent Viral Warts: Options and Insights

Dr. Jiang: Hello! My son is in the second year of junior high school and has had viral warts on his hands and toes for about two years. He has undergone treatments such as electrosurgery, excision, and cryotherapy, all of which have been ineffective. I know there is an immune-mod...

Dr. Jiang Zheen reply Dermatology
Generally speaking, thicker warts, especially those on the feet, do not respond well to Aldara (imiquimod) when used alone. Recent medical reports indicate that combining cryotherapy with topical medications can yield good results. If this is still ineffective, carbon dioxide las...

Understanding Viral Warts: Causes, Treatments, and Management Tips

Hello, doctor. I have developed a viral wart on my left pinky finger and my right middle finger. I consulted a dermatologist who confirmed that they are indeed viral warts. They prescribed a topical wart treatment for me to apply daily. However, I lack the discipline to stick wit...

Dr. Wu Yuxin reply Dermatology
Viral warts are transmitted through contact. Viral warts, athlete's foot, and nail fungus all require patient and prolonged treatment; they cannot be resolved in just one or two sessions.

Understanding Plantar Warts: Treatment Options and Concerns

My mother has had warts on the soles of her feet since the year before last. Due to her busy schedule and a lack of motivation to see a doctor during the winter, she has not received proper treatment. Finally, I managed to persuade her to see a dermatologist at the end of last ye...

Dr. Li Yufen reply Dermatology
Hello: For a detailed introduction to viral warts, you can refer to the article on Care Online at https://www.careonline.com.tw/2017/08/warts.html. If cryotherapy and topical medications do not yield satisfactory results, you may also consider electrosurgery or outpatient surgery...

Effective Treatments for Plantar Warts: Tips to Prevent Spread

I have had a viral wart on my toe for over a month, and recently several more have appeared on the same toe. It itches, and I have touched it with my hands, but I’m not sure why I now have a small wart on each hand. I would like to know if viral warts should not be touched to avo...

Dr. Lin Xinpeng reply Dermatology
Hello: Viral warts can be transmitted through contact, so when you scratch or touch a viral wart, or if you have a wound caused by scratching, it can easily lead to secondary infections, which should be particularly noted. Duofilm, a topical solution, contains salicylic acid and ...