Persistent Wart on Foot: Concerns About Healing and Treatment Options

The viral wart has developed a blister and scab that has not fallen off for over a month, and it has only been treated with cryotherapy once?

Hello Doctor, I have developed a viral wart on the sole of my left foot.
Over a month ago (about 40 days ago), I underwent cryotherapy at a dermatology clinic (the spray type).
The doctor only prescribed me with podophyllotoxin.
The next day, a large blister formed, which dried up about seven days later.
However, the thick, dark purple scab that formed over the blister has not fallen off even after a month.
When I returned for a follow-up two to three weeks later, the doctor advised me to wait until the scab falls off before coming back for another visit.
However, that scab has not come off until now.
I observe daily that after showering, it seems to start peeling, which made me hopeful, but after applying podophyllotoxin, it returned to looking intact the next day.
Recently, the scab that formed from the blister has started to peel, but it is not the entire dark purple scab that is coming off; rather, only small bits of the outer skin are shedding, while the dark purple part remains intact, and the wart itself has not fallen off.
I am quite anxious.
During my last follow-up, my doctor mentioned that since the wart has grown so large, it should be dead, and I just need to wait for it to fall off.
So far, it has been over 40 days, and I have only undergone that initial cryotherapy session.
During my follow-ups, the doctor has advised me to wait without further treatment.
I have a few questions I would like to ask the doctor:
1.
I have searched for a lot of information and found that the blister scab from a viral wart typically falls off on its own within about 7 to 10 days.
My previous experience with treatment was that it also fell off in about two weeks.
However, this time it has taken unusually long—over 40 days.
I read online that the skin on the soles of the feet regenerates more slowly, but other areas of my foot, like athlete's foot, peel quickly and grow back.

2.
In my past experiences, I would return for a follow-up two weeks later, regardless of whether the scab had fallen off, and the doctor would perform cryotherapy again (using a cotton swab dipped in liquid nitrogen).
It usually took several sessions for recovery.
However, the doctor this time has said that no further cryotherapy is needed during my follow-ups.
I have read that the intervals for treating viral warts should not be too long (about two to three weeks for another session), otherwise, the treatment may become ineffective.
But it has been over 40 days without another cryotherapy session, and I am worried that the wart is not dead as the doctor said, but may be continuing to grow underneath.
I feel like the wart that was frozen over 40 days ago seems to be getting larger—am I just imagining this?
3.
Currently, I am only applying podophyllotoxin, which seems to be an antibiotic to prevent bacterial infection.
Is there nothing else I can do for the viral wart at this point, or do I just have to wait? Thank you for your response, Doctor.

Niming, 20~29 year old female. Ask Date: 2021/06/24

Dr. Wu Yuxin reply Dermatology

The skin on the soles of the feet tends to shed more slowly; you can gently scrape it to check.

Reply Date: 2021/06/24

More Info

Persistent warts, particularly on the soles of the feet, can be a source of significant concern and discomfort. Your experience with the wart, especially after undergoing cryotherapy, raises several important points regarding treatment and healing. Let’s address your concerns systematically.

1. Healing Time and Skin Regeneration: It is true that the skin on the soles of the feet has a slower turnover rate compared to other areas of the body. This is due to the thicker skin layer and the constant pressure and friction it endures. While it’s common for warts to crust over and fall off within 7 to 10 days post-treatment, this timeframe can vary significantly based on individual healing processes, the size of the wart, and the treatment method used. In your case, the prolonged healing time of over 40 days could be attributed to the nature of the wart itself, the depth of the cryotherapy treatment, or even the presence of underlying conditions that may affect healing, such as circulation issues or skin integrity.

2. Need for Follow-Up Treatments: Your previous experiences with warts suggest that repeat treatments were necessary for effective resolution. In general, for viral warts, especially those that are persistent or larger, multiple treatments may be required. The rationale behind this is that the virus can reside deeper in the skin, and a single treatment may not eliminate all infected cells. If your current physician has advised against further cryotherapy, it may be worth seeking a second opinion, especially if you feel that the wart is not improving or is possibly enlarging. It’s essential to communicate your concerns clearly to your healthcare provider, as they may consider alternative treatments such as laser therapy, topical treatments, or even surgical excision if warranted.

3. Current Treatment with Antiseptics: The use of topical treatments like podophyllotoxin or salicylic acid is common in managing warts, but it seems you are currently using an antibiotic ointment (紫菌素) primarily to prevent secondary bacterial infections. While this is important, it does not directly address the wart itself. If the wart is still present and not showing signs of resolution, it may be beneficial to discuss with your doctor the possibility of resuming more targeted wart treatments.
4. Monitoring for Changes: It’s crucial to monitor the wart for any changes in size, color, or texture. If you notice any signs of growth or if the wart becomes painful, this should prompt a reevaluation by your healthcare provider. Sometimes, warts can be mistaken for other skin conditions, so a thorough examination is necessary to rule out other possibilities.

In summary, while it’s understandable to feel anxious about the healing of your wart, it’s important to maintain open communication with your healthcare provider. If you feel that your concerns are not being adequately addressed, seeking a second opinion from a dermatologist who specializes in skin lesions and warts may provide you with additional options and peace of mind. Remember, patience is key in the healing process, but proactive management is equally important to ensure that the wart does not persist or worsen.

Similar Q&A

Effective Treatments and Prevention Strategies for Warts on Feet

I have warts on my feet and have seen a dermatologist for cryotherapy, but they keep increasing and spreading. This might be due to my excessive foot sweating, which has hindered noticeable treatment results. What can I do to prevent them from continuing to multiply? Are there th...

Dr. Wu Yuxin reply Dermatology
Aggressive treatment until none remain, followed by close observation, typically for at least six months.

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...

Persistent Viral Warts: Seeking Effective Treatment Options

Hello, I had a viral wart on the sole of my foot with a diameter of 0.5 cm, which required weekly cryotherapy for two years at the hospital before it was cured. Towards the end of the foot treatment, I noticed a transparent small spot resembling eczema on my hand. After consultin...

Dr. Li Yufen reply Dermatology
Hello: Regarding the causes and treatment of viral warts, you can refer to the article on the Dermatology Expert Health Network at http://www.drskincare.com.tw/Qa/Detail.aspx?ID=52. Concerning the latest findings of 20 lesions, it is difficult to determine the exact disease based...

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.