Viral Warts: Treatment Challenges and Misconceptions

Viral warts issue

Hello, doctor.
On June 28, I had liquid nitrogen treatment on my left index finger, and I started applying salicylic acid on July 1.
After another liquid nitrogen treatment on July 5, I developed a blister.
The doctor said that once the blister healed and the peeling started, it should be fine.
However, when I saw the doctor again on June 16, there was no peeling, and the doctor mentioned that peeling doesn't happen that quickly and can take two to three weeks.
My lesion is very tiny, and the doctor performed liquid nitrogen treatment without being sure of the diagnosis.
It’s so small that it’s hard to see, so why is it taking so long to peel? It looks more like a brown scar now.

1.
Is it possible that this is not a viral wart? Additionally, I had another lesion treated at a different clinic on June 27, which developed a large blister right away.
I saw the doctor again on July 5, and he said to wait and see after the blister healed.
The blister resolved on July 6, but there was still no sign of peeling.
I started applying salicylic acid on July 9, and when I saw the doctor on July 16, he said I was using too much salicylic acid, causing the skin to thicken, and that the epidermis was not coming off easily.
I explained that since the blister had resolved on July 6 without peeling, I started applying salicylic acid.
The doctor said that just because the blister resolved doesn’t mean peeling will happen quickly, and he performed another liquid nitrogen treatment.
2.
Why was there no pain during the treatment?
3.
Isn’t salicylic acid supposed to corrode the virus itself? Why is the skin thickening and not peeling off? My son has viral warts on his feet, and despite both of us receiving liquid nitrogen treatment and using salicylic acid, his warts, even without blisters, are peeling on their own.
For instance, after the blister on July 5 resolved, his started peeling by July 14.
Why is mine not peeling?
4.
Is it possible that my finger lesion is not a viral wart?
5.
Could it just be an allergic rash? This might explain why my healing process differs from my son’s viral warts.

6.
Furthermore, my son has warts on his feet.
You mentioned that I was infected by him, but why did my warts appear on my hand? I understand that they are both caused by the human papillomavirus (HPV), but are the strains on the feet and hands different? Is there a possibility of cross-infection?

Wenwen, 40~49 year old female. Ask Date: 2019/07/18

Dr. Wu Yuxin reply Dermatology

Your questions are hypothetical and involve medical uncertainties; your child's treatment experience may not necessarily apply to you.
Without actually seeing the lesion, it is impossible to make a definitive assessment.
If you are very concerned, please seek medical attention promptly, as only a professional evaluation can address your situation.

Reply Date: 2019/07/18

More Info

Understanding viral warts, also known as verrucae, can be quite challenging due to the various misconceptions surrounding their treatment and the variability in individual responses to therapy. Let's break down your concerns and provide clarity on the nature of viral warts, their treatment, and the reasons behind your specific experiences.

What Are Viral Warts?
Viral warts are benign growths caused by the human papillomavirus (HPV). They can appear on various parts of the body, including the hands and feet. The virus infects the top layer of skin, leading to the characteristic growths. Warts can vary in appearance, size, and duration, and they often resolve on their own, but treatment is sought for cosmetic reasons or discomfort.

Treatment Options
Common treatments for viral warts include:
1. Cryotherapy: This involves freezing the wart with liquid nitrogen. It can cause blisters and peeling as the skin heals.

2. Salicylic Acid: This topical treatment works by gradually peeling away the wart. It is essential to apply it correctly and consistently for optimal results.

3. Laser Therapy: This method uses focused light to destroy wart tissue.

4. Immunotherapy: This approach stimulates the immune system to fight the virus.

Your Specific Concerns
1. Duration of Healing: It is not uncommon for warts to take several weeks to months to resolve, especially if they are deep-rooted. The healing process can vary significantly between individuals due to factors like skin type, immune response, and the wart's location. The fact that your wart appears as a brown scar may indicate that it is healing, but it can take time for the skin to regenerate fully.

2. Pain Sensation: The absence of pain during treatment can be puzzling. Some warts may not be sensitive, especially if they are not deeply embedded in the skin. Pain perception can vary widely among individuals and even between different warts on the same person.

3. Thickened Skin: The thickening of the skin around the wart after applying salicylic acid can occur due to irritation or overuse of the product. It is crucial to follow the application instructions carefully and allow the skin to breathe. If the skin becomes too thick, it can hinder the effectiveness of the treatment.

4. Differentiating Warts from Other Skin Conditions: If your wart does not respond to treatment as expected, it may be worth considering other diagnoses. Conditions like eczema, contact dermatitis, or other benign skin lesions can mimic the appearance of warts. A dermatologist may perform a biopsy if there is uncertainty.

5. Transmission and Location: HPV can be transmitted through direct contact, and while it is common for warts to appear on the hands and feet, the virus can infect different areas of the body. The fact that your son has warts on his feet and you have them on your hands does not negate the possibility of cross-infection. The virus can be present in various forms and can manifest differently depending on the site of infection.

Conclusion
In summary, viral warts can be stubborn and may require patience and consistent treatment. If you continue to experience issues or if the wart does not improve, it is advisable to consult with a dermatologist for further evaluation. They may recommend alternative treatments or investigate other potential skin conditions. Remember that while warts can be bothersome, they are generally harmless and can be managed effectively with the right approach.

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