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Warts

As this is published I am finishing the last day of a 12 day stretch covering my partner while he is off trying to get MDRTB and typhoid fever.  He is in India. I may have to autoclave him when he returns before I let him in the hospital.  Double the work means double the fun, but free time goes down by the power.  Same thing happens with the kids.  If you have two kids, the work squares, three kids, the work cubes.  A linear change in one domain leads to exponential change in other domains.  I am sure that phenomena has a name that one of our readers will know.

I lack the mad typing skills of other contributors and it usually takes me at least a week to carefully construct the spelling errors and grammatical faux paux for which I am justly famous.  And then I have to come up with content to surround the faulty English.  This week I have little time and so a ‘fun’ post.

When I make rounds it is not unusual for people to ask questions about their health and their family.  I learned long ago to ask why they want an answer to a particular question so I do not inadvertently offend a colleague.  When I offend I like to be advertent.  Years ago I was asked what I thought of hyperbaric oxygen, and I replied that it is great for the bends but otherwise mostly serves to enrich the hyperbaric doctors.  Why do you ask?  I am the new director of the hyperbaric program, was the reply.  Open mouth and insert foot.

So recently a nurse asked me if duct tape would remove warts.  Wary, I asked why, and she showed me a huge wart on her hand.  I have used duct tape for many purposes; few home repairs cannot be (temporarily) accomplished with duct tape. But treating warts?  Do you use the tape as a way to yank the wart out by its roots?  Got me.  I gave my best Gallic shrug and went looking for information.

Warts, and from here on I am referring to common warts on the hand, are due to a virus, the papilloma virus.  Or so I was taught.  For the first two years I took the bus to medical school and occasionally someone would see I was reading a medical text and strike up a conversation.  This usually occurred on the trip to school.  After gross anatomy lab, the last class of the day, I usually sat alone, I assume the  result of my smell.  Preserved cadavers have a penetrating fragrance that saturates the skin and hair and will drive away even urine stained crazies.

Once it was a student at the naturopathic school who noted that, contrary to what I was taught, warts are actually the result of the body walling off toxins and expelling them.  I remember thinking at time, this is a loon, and the last thing you do is egg-on a loon when you can’t run away.  So I smiled grimly, made non-committal grunts and was relieved when he got off the bus.  Turns out he wasn’t a loon, but was repeating the teaching of his school.  It is the school that has the loons.

Naturopaths believe that such symptoms as warts are the result of toxins in the body, and an immune system that is not running efficiently. They may prescribe treatments such as colonic irrigation, alongside a program of healthy eating to raise the general level of health. A naturopath may suggest a paste made with vitamin C, applied to the wart daily for a period of a few weeks.

Remember, these folks want to be primary care docs: have a wart, get a colonic.

Determining effective treatments for warts is problematic since the natural history for warts is to go away.  In a study that is slightly creepy, but how it was done back in the day, they found:

The natural history of warts was recorded by examining 1,000 institutionalized mentally defective children for 2 years. Treatment of warts was withheld. We found: (1) The overall incidence increased from 18% to 25% in 2 years. (2) The dynamic aspect of warts was reflected by the fact that two-thirds of the original lesions in 168 cases involuted within 2 years. (3) Involution occurred almost twice as often in boys as girls.

That is the only study of the natural history of warts I can find.  2/3 will go away in two years.  So if you get two years of colonics you can credit the colonic with the resolution of the warts.

And the Cochrane reviews notes

In 21 trials with placebo groups that used participants as the unit of analysis, the average cure rate of placebo preparations was 27% (range 0 to 73%) after an average period of 15 weeks (range 4 to 24 weeks).

Warts are a self-limited disease.

There are many popular remedies for warts.  Pick a SCAM, it has been used on warts.  Some allege benefit, some do not.  My wife, who grew up in rural Minnesota, swears by milkweed.  She is anecdote central for the efficacy of milkweed.  Warts melt away with application of the milkweed milk.  There was one clinical trial out of India that evaluated milkweed and  it did not work.

There are over 140 types of milkweed, and in Minnesota it is Asclepias syriaca, not the Asclepius curussavica tested in India, so the best you can say is one down, 139 to go.  Besides, I am not going to cross my wife on the efficacy of milkweed, although I would on vaccines if needed.

Of the popular cures for warts my favorites are from Mark Twain:

Aha! Talk about trying to cure warts with spunk-water such a blame fool way as that! Why, that ain’t a-going to do any good. You got to go all by yourself, to the middle of the woods, where you know there’s a spunk-water stump, and just as it’s midnight you back up against the stump and jam your hand in and say:

‘Barley-corn, barley-corn, injun-meal shorts,
Spunk-water, spunk-water, swaller these warts,’
and then walk away quick, eleven steps, with your eyes shut, and then turn around three times and walk home without speaking to anybody. Because if you speak the charm’s busted.”
“Well, that sounds like a good way; but that ain’t the way Bob Tanner done.”

“No, sir, you can bet he didn’t, becuz he’s the wartiest boy in this town; and he wouldn’t have a wart on him if he’d knowed how to work spunk-water. I’ve took off thousands of warts off of my hands that way, Huck. I play with frogs so much that I’ve always got considerable many warts. Sometimes I take ‘em off with a bean.”

“Yes, bean’s good. I’ve done that.”

“Have you? What’s your way?”

“You take and split the bean, and cut the wart so as to get some blood, and then you put the blood on one piece of the bean and take and dig a hole and bury it ’bout midnight at the crossroads in the dark of the moon, and then you burn up the rest of the bean. You see that piece that’s got the blood on it will keep drawing and drawing, trying to fetch the other piece to it, and so that helps the blood to draw the wart, and pretty soon off she comes.”

“Yes, that’s it, Huck — that’s it; though when you’re burying it if you say ‘Down bean; off wart; come no more to bother me!’ it’s better. That’s the way Joe Harper does, and he’s been nearly to Coonville and most everywheres. But say — how do you cure ‘em with dead cats?”

“Why, you take your cat and go and get in the graveyard ‘long about midnight when somebody that was wicked has been buried; and when it’s midnight a devil will come, or maybe two or three, but you can’t see ‘em, you can only hear something like the wind, or maybe hear ‘em talk; and when they’re taking that feller away, you heave your cat after ‘em and say, ‘Devil follow corpse, cat follow devil, warts follow cat, I’m done with ye!’ That’ll fetch any wart.”

Although the final cure does run risk of witnessing a murder and all the adventures that follow.

There is an interesting and variable literature on hypnosis curing warts that someday I would like to review but I know so little about hypnosis and this is not the time or place.  Warts have a more supernatural/mind-body reputation to their treatment than most common ailments.  Although I had always been told that people could hypnotize away warts on one side of the body only, what literature I could find suggests it is not true.  Bummer.  One of my favorite myths.  I will feel the need to start a sentence with actually next time the topic comes up.

I received an interesting email from a colleague, Dr. Robinson, with this approach to warts:

Burkhart freezes them first. Then he adds a yeast extract and several liquids, including the juice from a Asian blistering beetle – not sold in the United States.

But here, Burkhart plumbs the darker methodology. At 33, dressed in a bow tie, the Chapel Hill physician hardly looks the part of wart shaman. Spend 20 minutes in his Southern Village office, and you get the feeling he could smile the warts off your finger.

He’s eradicated more than 100 of the little devils, mostly from children. He’s tackled the common sort that pop up around the eyes, the stubborn variety that sprout around fingernails and, once, an irritating growth from a football player’s foot.

But he’s willing to dive into weird practices, or at least the pages of long-forgotten Advanced Dermatology Therapy, published in 1987 by fellow Toledo native Dr. Walter B. Shelley.

Borrowing the late Shelley’s technique, Burkhart wraps the offending growth in silk tape and asks the patient to describe its mood. Angry wart? He draws an angry face on the bandage. Sad wart? He draws a sad face. Next, he offers the patient an exotic coin. He carries them in a Ziploc bag: Norwegian kroner and Argentine pesos. One coin equals the price of one wart. If the growth returns, he expects his coin back. But so far, after probably 100 wart exorcisms, he’s never needed a refund.

Finally, he tells patients to remove the bandage at the stroke of midnight. If that’s too late for a patient, he offers bedtime as a substitute.

I get the feeling that Burkhart is having fun with the wart therapy, since he is treating children, and it is part of the art of medicine that I can appreciate and admire.  But it still has the odd vibe that hypnosis adds to wart therapy.

I have to stay on topic.  The topic is duct tape.  Squirrel.

There are a surprising number of hits when searching the topic on PubMed.

The mechanism by which duct tape is alleged to work is the Goldfinger effect: by occluding the area it is denied oxygen and dies.  Warts are supplied from the inside, as are people, and neither warts nor Jill Masterson will die as a result of being covered with duct tape or paint.

There are clinical trials for duct tape.  Duct tape does not work in adults:

There were no statistically significant differences in the proportions of patients with resolution of the target wart (8 [21%] of 39 patients in the treatment group vs 9 [22%] of 41 in the control group). Of patients with complete resolution, 6 (75%) in the treatment group and 3 (33%) in the control group had recurrence of the target wart by the sixth month.

But warts are usually more difficult to treat in adults, so how about kids? Nope.

Duct tape applied to the wart or placebo, a corn pad (protection ring for clavi), applied around the wart for 1 night a week. Both treatments were applied for a period of 6 weeks. Patients were blinded to the hypothesis of the study.
MAIN OUTCOME MEASUREMENT:
Complete resolution of the treated wart.
RESULTS:
After 6 weeks, the wart had disappeared in 16% of the children in the duct tape group compared with 6% in the placebo group (P = .12). The estimated effect of duct tape compared with placebo on diameter reduction of the treated wart was 1.0 mm (P = .02, 95% confidence interval, -1.7 to -0.1). After 6 weeks, in 7 children (21%) in the duct tape group, a surrounding wart had disappeared compared with 9 children (27%) in the placebo group (P = .79). Fifteen percent of the children in the duct tape group reported adverse effects such as erythema, eczema, and wounds compared with 0 in the placebo group (P = .14).
CONCLUSION:
In a 6-week trial, duct tape had a modest but nonsignificant effect on wart resolution and diameter reduction when compared with placebo in a cohort of primary school children.

At least no better than placebo, but better than cryotherapy:

INTERVENTION:
Patients were randomized using computer-generated codes to receive either cryotherapy (liquid nitrogen applied to each wart for 10 seconds every 2-3 weeks) for a maximum of 6 treatments or duct tape occlusion (applied directly to the wart) for a maximum of 2 months. Patients had their warts measured at baseline and with return visits.
MAIN OUTCOME MEASURE:
Complete resolution of the wart being studied.
RESULTS:
Of the 51 patients completing the study, 26 (51%) were treated with duct tape, and 25 (49%) were treated with cryotherapy. Twenty-two patients (85%) in the duct tape arm vs 15 patients (60%) enrolled in the cryotherapy arm had complete resolution of their warts (P =.05 by chi(2) analysis). The majority of warts that responded to either therapy did so within the first month of treatment.
CONCLUSION:
Duct tape occlusion therapy was significantly more effective than cryotherapy for treatment of the common wart.

Although when you read the wart treatment literature there is great variability in all the responses to all the therapies depending in part how long you follow them.

The Cochrane reviews only found two duct tape studies, as did I, and suggest that most therapies for warts are of minimal efficacy over doing nothing.  Systematic reviews suggest that best therapy is not still known for warts.

Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness, but the same was also true for trials comparing cryotherapy with [salicylic acid]. Only one trial showed cryotherapy to be better than both SA and placebo, and this was only for hand warts. Adverse effects, such as pain, blistering, and scarring, were not consistently reported but are probably more common with cryotherapy. None of the other reviewed treatments appeared safer or more effective than SA and cryotherapy. Two trials of clear duct tape demonstrated no advantage over placebo.

It appears duct tape does nothing and other therapies little more.  Me?  I’m sticking with the dead cat in the cemetery.  Anything that involves a dead cat is good by definition.

Posted in: Clinical Trials, Naturopathy

Leave a Comment (61) ↓

61 thoughts on “Warts

  1. Janet says:

    Every wart in our family (numerous spouses and six kids, eight grandkids–including all the blending) has been resolved with cryotherapy–with never more than two treatments, and usually just the one. Some were done by the family physician, some by the dermatologist, but most by Dad (my former spouse), who used refrigerant–he’s an HVAC engineer. The warts would turn black and shrivel away in a few days. None ever came back except one I had (as you mentioned) close to a fingernail. I’m not suggesting we were plagued by warts, but there were more than a few over the years with all the kids and step-kids, plus a few friends who didn’t have insurance.

    I cannot believe this study you link to, and have entirely lost my “faith” in allopathic medicine! (That’s a joke, of course, but I am dismayed and have no idea what to think). :-/

  2. pharmavixen says:

    That Cochrane review helps explain why I have sold so many salicylic acid wart removal kits to the same people multiple times.

    Anecdotally, I stopped getting warts on my feet when I let my membership at the YMCA lapse.

  3. windriven says:

    “Remember, these folks want to be primary care docs: have a wart, get a colonic.”

    Damn, I never get those little ditties right. I thought it was: have a wart, drink a gin and tonic. Which might explain why I really don’t care about warts anymore and why you can hammer railroad spikes with my liver.

    Seriously though, what is it with the woo set and poo? There has to be an urgent telegram for Sigmund Freud in there somewhere. Warts? Colonic. Pancreatic cancer? Colonic. Inverted subluxation secondary to stripped muffler bearings? Colonic.

    Now here’s the real poop on wart cures. My sainted grandmother had me do this when I was about 6 and it worked!!! Take a bite out of an apple, rub the apple on the offending protuberance and bury it (the apple, not the protuberance). I don’t think crossroads were involved as I wasn’t allowed to play in the street. And midnight was way past my bedtime. Anyway, I did it and the next time I thought about my wart it was gone. But then I wasn’t obsessive about the wart so that might have been thirteen years later. Or an hour.

    Whatevs.

  4. Alex says:

    The only warts I’ve ever had are plantar warts, and after the torture of having a doctor burn one off, I swore I’d never go that route again. I ended up stumbling across food grade, 35% Hydrogen Peroxide, and I came up with a very effective protocol. Soak the foot in hot water to soften the wart. Cut or abrade away as much dead tissue as possible from the top of the wart. Then apply a tiny drop of peroxide to the wart with an eyedropper. If enough dead tissue has been removed, it will sting. Wait a few minutes, pat dry with a tissue, and repeat once more. A few days later, do the treatment again. On the two plantar warts I’ve treated with this method, two treatments were all it took.

    Warning: 35% Hydrogen Peroxide is very different from the 3% stuff at the drug store. At 35% concentration, it will burn skin and needs to be handled with extreme caution. I keep a quart bottle of it in the deep freezer, and when I need to use it, I carefully transfer about a teaspoon of it into a small jar so that I don’t constantly handle large quantities of it; this also prevents the large bottle from being contaminated.

  5. pharmavixen says:

    @ Alex: what I suggested to folks using the 40% salicylic acid paste probably applies here – put petroleum jelly on the skin around to wart to protect yourself from burns.

  6. EHobbes says:

    In high school, I had an outbreak of warts at the base of my fingernails, which spread across my hands (and one onto my face). The dermatologist tried freezing them off, but that didn’t work. She ended up recommending an “experimental” treatment – high doses of Tagamet (cimetidine)+ rubbing a cream recently approved for genital warts on them. They went away in about 3 months. (And a plastic surgeon removed the one on my face.) The warts were so bad, and I was so traumatized, that I was convinced of the effectiveness of the treatment. After reading this post, I did a brief internet search, and it seems that studies have found cimetidine ineffective for the treatment of warts…although it is heavily promoted on SCAM & co sites. So maybe it was the cream and not the cimetidine – or just treatment coinciding with the self-limiting nature of the warts…but now I’m terrified of them returning since there really isn’t much in the way of effective treatments!

  7. Helga435 says:

    I got a massive plantar wart in my heel when I was 13 (I blame swim team) that I had frozen and cut out 4 times. Every time the gaping wound healed, about a week or so later the wart would start growing again until it was just as bad as before the removal. I tried numerous over the counter treatments (all of which failed) until finally when I was 20 I read about duct tape. I put a square of duct tape over the wart every morning and every evening when I took it off the innards of the wart were puffy and enlarged and I cut and filed it off level. It took several weeks but the darn thing finally went away and hasn’t been back since.

    Anecdotal, I know, but that wart was so embarrassing to me I would have tried just about anything to get rid of it.

  8. superdave says:

    When you consider the cost benefit analysis of duct tape, I think this is a myth that will never go away.

  9. windriven says:

    @superdave

    “When you consider the cost benefit analysis of duct tape, I think this is a myth that will never go away.”

    And good quality duct tape is slightly less unsightly than the wart. So it’s a twofer! ;-)

  10. Narad says:

    Two trials of clear duct tape demonstrated no advantage over placebo.

    What on earth is “clear duct tape”? It’s fabric-backed tape. (No effect for me on verruca plana, BTW. Burn, baby, burn.)

  11. annappaa says:

    Shifting the topic below the belt, I have often heard apple cider vinegar touted as a cure for genital warts. Given that I write about sexual health, and have in the past covered the supposed connections between cranberry juice and UTIs and yogurt and yeast infections, I was pretty excited to dive into the evidence about apple cider vinegar’s effect on genital warts.

    Except that I can’t find any studies — none at all! So if I were to write a piece about apple cider vinegar and genital warts, it would consist solely of the sentence, “You may have read on the Internet that apple cider vinegar can cure genital warts, but there is no scientific evidence to back this claim — or to discredit it.”

    My unproven hypothesis is that people have gotten HSV mixed up with HPV, and conflated apple cider vinegar with the antiherpes med acyclovir, both of which are abbreviated ACV.

  12. Jacob V says:

    Duct tape, schmuck tape. Everyone knows rubbing a wart with half a raw onion which is then buried in the back yard at midnight is the real cure.

  13. Nowadays, the study with ‘institutionalized defectives’ would not get IRB approval. We have the tick boxes to ask whether institutionalized persons are involved. There is no compelling scientific reason to carry out a wart study with institutionalized children compared to community-recruited children.

    Cryotherapy x 10 sec for a few sessions won’t work. I had a provider try that.

    At first I tried ignoring, but a 2nd one popped up. I believe that this was the time frame when I was regularly exercising and shoowering at a YMCA. Someone ought to do the epi on the public shower-wart connection.

    Since a 2nd had appeared, I feared more.

    Fortunately on the third visit to my provider, he was on vacation. His substitute listened to my story, and had a look of surprise when I related the 15 sec time span each of the recent two weeks. He said a good minute of cryotherapy was needed.

    Sure enough. As the blister followed its natural history, the wart became history.

    All the 15 sec cryotherapy did was give me pain and a blistered wart.

  14. WilliamLawrenceUtridge says:

    Duct tape, schmuck tape. Everyone knows rubbing a wart with half a raw onion which is then buried in the back yard at midnight is the real cure.

    Two points:

    1) It must be worn at the belt first.
    2) Midnight is only used when above latitude 66N.

    Ignorant comments like these make me wonder where you got your witchdoctor training. Tsk.*

    There is no compelling scientific reason to carry out a wart study with institutionalized children compared to community-recruited children.

    I would argue there are several compelling scientific reasons (you can control a lot more factors – common exposure to disease, several genetic confounds, behaviours, diet, exercise, geography and probably more). You can convince staff members to treat all children the same and there is less risk of confounding through a parent’s desire to do something to feel like they have some measure of control over the disease.

    It’s the ethical ones that do, and should, prevent us from undertaking them.

    *My I hope that comes across as amusing rather than douche-y…

  15. Quill says:

    I am frankly astonished. I never thought there would be anything duct tape couldn’t help. My faith in my stretchy, silvery friend is much shaken.

    Though I do love it when Tom Sawyer is quoted as medical authority especially because it beats any homeopathic notions by a country mile.

    For those interested in other Mark Twain medical opinions and writings, there is a really good compilation of just that called “Any Mummery Will Cure” by K. Patrick Ober. Twain had much to say on the subject of medicine!

    http://www.amazon.com/Mark-Twain-Medicine-Mummery-CIRCLE/dp/0826219659

  16. Narad says:

    He said a good minute of cryotherapy was needed.

    My dermatologists would certainly be surprised to hear this. I can scarcely imagine the burn, unless you’re referring to application with cotton swabs. (One thing I have noticed is that skill is key in spraying LN2; you need to be at just the right distance to really get the thing. Seems to be a focus to these devices. But heaven spare me from a new derm resident. Then again, flat warts aren’t quite the same as regular ones.)

  17. Alia says:

    Over here the traditional folk treatment for warts is chelidonium sap. Haven’t tried it, though, my mother is rather science-based, so when I got one on my foot as a child, she took me to a doctor and then regularly smeared the wart with SA-based mixture. It seemed to help, although it might have been the self-limiting nature of warts, of course.

  18. lilady says:

    Years ago (1930s), when my mother was in a hospital-based nursing school, she developed a painful plantar wart. The medical students took her into the X-Ray suite (after hours), and successfully “treated” the wart with a series of X-Ray treatments. No, her foot didn’t fall off or become cancerous.

    When my daughter was ~ 10 years old, she developed a painful plantar wart. Her pediatrician injected some xylocaine (?), and dug that sucker out, packed and bandaged the wound. Cured!

  19. Angora Rabbit says:

    I am saddened to learn that there is something that duct tape cannot fix.

    What I heard long ago is that anything along those adhesive lines will work – duct tape, bandaid, surgical tape. The hypothesis (I no longer recall where) was that the adhesive tape allows the salts and urea from underlying skin / sweat to accrue, creating an unfavorable environment for viral propagation. The urine therapy for warts had a similar rationale.

    Now, 8M urea was great for denaturing DNA in sequencing gels (and now you know how old I am – sequencing gels???), but this does sound a bit like a Just So Story. Glad to see someone has done the clinical trial.

  20. Narad says:

    I am saddened to learn that there is something that duct tape cannot fix.

    You know what’s even worse? Not all duct tapes are durable in the laundry. The cheap stuff peels, and then that repair of the dungarees becomes a bigger job when you have to tear off the rest. For home repairs, I’m thinking about going with gaffer’s tape from here on out.

  21. Harriet Hall says:

    There’s a delightful book about the experiences of a country doctor entitled “Bag Balm and Duct Tape.” The title comes from one of his patients, an old farmer who used that recipe to treat a bad laceration on his arm. http://www.amazon.com/Bag-Balm-Duct-Tape-Vermont/dp/0449217930

  22. BillyJoe says:

    You know how people pick their noses? Well, I never do that. Instead I pick my wart. That is, I picked that wart for about twenty years. Then one day I went to pick my wart and it was gone. You know what I do now?
    I miss my wart. ;)

  23. BillyJoe says:

    The local dermatologist triple freeze/thaws warts every three weeks, supplemented by daily salicylic acid applications by the patient, until they disappear.
    Money spinner?

  24. dbe says:

    I feel like this article is only half finished. There are surely more common procedures that could be discussed.

  25. hat_eater says:

    There is also a therapy that seeks to cure the underlying cause of warts and not just the symptoms. Contrary to homoeopathy which claims to do the same it uses an active ingredient. But it also doesn’t seem to work. Which is a bummer, because I’d be happy to get rid of papilloma.

  26. norrisL says:

    My wart story number 1
    My dad was a tennis coach (he actually played with Ken Rosewall and Rod laver, but that’s another story)
    So I played a lot of tennis. I had a wart on my left elbow and one Saturday morning, while playing on a bitumen court, I dived for a ball and succeeded in entirely surgically removing said wart. This would have been in the late 1970′s. Recently (some time in the last few years) a wart has sprung up very close to the original. Related? Who knows.

    My wart story number 2
    I was, until recently, a veterinarian until the onset of left frontal lobe epilepsy and early onset of dementia. When I was a fairly young vet (late 1980′s), I had a palmar wart (mostly below skin level, just a minor raising of the skin at the surface) at the base of my left index finger. I let it go. But my curiousity got the better of me. How can I get rid of this thing? I tried some lignocaine, but it appeared that there were perhaps enough pain receptors present in my wart to cause enough pain to cause my therapeutic efforts to cease. But, it had to go, so, one night, I persisted with lignocaine, dug out as much tissue as I could and then, and this is the fun bit, I placed 1 drop of 10% formalin on the “surgical site”. Instantly it was like an electric shock running up my arm, through my armpit. Cure rate (in my experience) = 100% on a study of one case.

    My wart story number 3
    Did I mention dementia? Well, I’ve forgotten wart story 3. Damn. Where’s my breakfast? Maybe I’ve already eaten it.

    If I can recall WS3 I will post.

  27. Narad says:

    Contrary to homoeopathy which claims to do the same it uses an active ingredient. But it also doesn’t seem to work.

    I wouldn’t throw imiquimod under the bus entirely, but it was of no assistance for me with the flat warts, which seem to have a well-defended base camp in the crook of my elbow. I remain an adherent of simple mechanical damage and agnostic on the mechanism.

  28. BillyJoe says:

    I have a question.

    It seems that warts can spontaneously disappear, but what about scars? I mentioned the wart on the back of my right hand that I subjected to twenty years of mechanical damage. Well, that did leave a scar, but when I look now I can’t find that scar anymore. Also I just checked where I had a scar from a cigarette burn when I was about three years of age (apparently a teenager stubbed out his cigarette on my abdomen just below my navel though, curiously, I cannot remember the incident) and that has also disappeared.

    It might explain how Norris’ wart reappeared after twenty years. The virus may have been trapped in the scar and, when the scar spontaneously disappeared, the virus was released and produced another wart.

  29. laproxdoc says:

    Burn ‘em down with either the CO2 laser (small thin warts) or the KTP-532 laser for thicker larger warts, apply small amounts of Tea Tree Oil 15% to the residual base, occlusive dressing with either white cloth surgical tape or duct tape; scrape with a curette and reapply the TT Oil every week until resolved, usually requires about 4 treatments, some scarring. Works in about 50% of cases. Have used this protocol for about the last 10 years in a General Surgery practice.

  30. BillyJoe says:

    And you arrived at this protocol exactly how?

  31. Neil J says:

    Cryotherapy worked really well for myself, my siblings and my schoolmates when plantar warts made the rounds at my elementary school. Then again, everyone was treated this way so we had no control groups to compare to.

    I do have a treatment protocol that I’m sure would prove 100% successful for the eradication of plantar warts, though. However, I think most people are rather opposed to double amputation.

  32. Calli Arcale says:

    Cryotherapy was used on my wart, which came back, was frozen again, and stayed gone the second time. Both times, it blistered up nicely and the wart seemed to come off with the blister.

    My daughter had plantar warts; they were frozen, and then gone, and have not recurred.

    N=2, and so far I’d try cryotherapy again, but couldn’t speak to its efficacy in light of the rather dismal results discussed above. It might be one of the less useless methods. ;-)

    I am tempted to try duct tape next time, though, just because duct tape. :-P

  33. Scott says:

    @ Neil:

    Sounds oddly similar to my own sure-fire cure for headache. I can 100% guarantee you’ll never get one again. Some side effects may occur.

  34. BillyJoe says:

    Seems everyone reverts to unscientific thinking when it comes to warts. Why is that? That surgeon above who has developed a complicated protocol for eliminating warts that seems to be based on thin air. Either that or he has conducted clinical trials on each element of the protocol to confirm it as a legitimate part of the protocol. No, of course he has not. He has pulled the protocol out of nowhere. I mean warts don’t really matter that much, but is it really that difficult to think scientifically?
    Unless, of course, you are all just having a bit if fun.

  35. mousethatroared says:

    BillyJoe – warts don’t matter that much unless they are on the bottom of your foot, then, I’m told, it’s like walking on a pebble.

  36. Narad says:

    warts don’t matter that much unless they are on the bottom of your foot, then, I’m told, it’s like walking on a pebble.

    Well, I’ve been told that they have an unfortunate habit of migrating from the hands to the genitals, if you know what I mean.

  37. mousethatroared says:

    @Narad – I suppose that there might be some sort of research to indicate the risks of virus transmission.

    In terms of discomfort. I’m willing to take the anecdotal evidence from my daughter’s testimony that having a wart on the ball of your foot is like walking (or running in her case) with a pebble in your shoe. Not fun for an active kid.

    We had success with dermatologist removal, although it took 3 or 4 sessions, with some sort of liquid that caused a blister to form. The nice thing was that the process was pain free.

  38. Sialis says:

    Years ago I was asked what I thought of hyperbaric oxygen, and I replied that it is great for the bends but otherwise mostly serves to enrich the hyperbaric doctors.

    Now that a few years have passed, have you had an opportunity to reassess your opinion on the use of HBOT in light of any new studies? I have seen studies, outside of the infectious disease realm, that evidence HBOT as being an effective anti-inflammatory treatment for treatment resistant Crohns, IBD and ulcerative colitis, and possibly for certain types of neuropathic pain.

    Otherwise, and in line with the topic, I’m pleased to report that I have no warts, no where. I do think that the vitamin C treatment might be effective for some warts. The vitamin C might have enough of a drying effect to make it break off. If you combined the vitamin C with high doses of salt, then we’d be talking a cure for sure. Salt/C for warts, just like promoted for Lyme. Humor aside, I would think that warts, depending on their location, might be a safe way to experiment with the vitamin C treatments.

  39. xwolp says:

    I am pretty sure it should not be too hard to develop a school of alternative medicine around the WD40-Duct Tape dichotomy (‘does it move?’,'should it?’)
    It would coincidentally make more sense than regular Kinesiology.

  40. kathy says:

    When I was a student I had several plantar warts under both my feet that were burned out by a doc in town.

    The positive was they didn’t recur; the negative was that couldn’t get a lift so I had to take a bus back to the varsity. The burns were deep and bled through the bandages so that I tracked bloody footprints all down the aisle of the bus, like some creature out of a horror movie.

    I didn’t realise it because the anaesthetic was still operating … till the grossed out expressions of my fellow-passengers told me something was wrong.

  41. kathy says:

    Oops, mistake! They weren’t burned out they were cut out. ‘Pologies!

  42. tjohnson_nb says:

    “I do think that the vitamin C treatment might be effective for some warts. The vitamin C might have enough of a drying effect to make it break off. If you combined the vitamin C with high doses of salt, then we’d be talking a cure for sure. Salt/C for warts, just like promoted for Lyme. Humor aside, I would think that warts, depending on their location, might be a safe way to experiment with the vitamin C treatments.”

    Given that humans do not synthesize AA the way the majority of other mammals do, apparently because of a missing enzyme, would you consider this worthy of investigation? Would it seem appropriate to try giving people similar amounts of AA to see what effect it had on then general health? It seems to me that this is the way science works – if you have a hypothesis and you have a prediction and you experiment to see if it is fulfilled. It seems that AA is involved in so many aspects of our health that there is no point singling out just one condition and trying to establish a ‘one cause => one effect’ relation which seems to be the point of RCT’s. In this sense, RCT’s seem to be designed as way to establish the effectiveness of single compounds on a single condition and so is of limited use for investigating overall health. In other words, the Science of Health is not the same as the Science of Medicine.

  43. laproxdoc says:

    @BillyJoe:

    Ah, I wish that I had pulled that particular laser/wart protocol out of thin air or my nether parts, but no – it was a modification of our department’s protocol for extensive genital warts, mainly switching Tea Tree Oil for the podophyllin, mostly because the odor is more pleasant…

  44. Sialis says:

    The vitamin C might have enough of a drying effect to make it break off. If you combined the vitamin C with high doses of salt ,…

    IANAD. Better phrased, that statement would have specified that the C or C and salt mixture would be applied to the outer surface of the wart in an attempt to dry it out. By no means would I suggest that anyone ingest high doses of C and salt. The ‘high dose C/Salt’ remark was made specifically to poke fun at one of the dangerous methods being marketed to treat Lyme disease.

  45. norrisL says:

    Laproxdoc

    “doc”?

    Let me tell you of the dogs that I have had to treat here in Australia, the home of tea tree oil (malaeleuca lineafolia or m. alternafolia) after owners have bathed the dogs in a tea tree oil shampoo. One lady took on a franchise for doing dog hydrobaths. She was told that “This is the shampoo that you will use.” A tea tree oil shampoo. She bathed her first dog at 4pm in the afternoon. Now, the head on the hydrobath hose is several iches wide; basically a shower head nozzle. The tendency is to spend most of the time with the shower head moving up and down the dog’s dorsal midline.

    At 8am the following morning I was presented with a dog who had NO hair down its dorsal midline. In addition, the ingestion of tea tree oil is highly toxic to the liver and can, and has, caused neurological disorders in dogs bathed in a shampoo containing a relatively small amount of tea tree oil. Tea tree is potentially dangerous at ANY dilution. Its only practical use is for removing adhesive tape residue on walls etc. It does smell nice, it gives the impression of opening blocked airways, without actually doing so.

    http://www.petpoisonhelpline.com/poison/tea-tree-oil/

    DO NOT USE TEA TREE OIL UNLESS YOU ARE WEARING GLOVES AND REMOVING ADHESIVE TAPE FROM A WALL.

  46. BillyJoe says:

    Laprodoc,

    Did you blindly follow that protocol or did you ask for the clinical studies that demonstrate the efficacy of every element of that protocol and then refuse to follow that protocol unless and until that efficacy was demonstrated?

  47. pharmavixen says:

    @ norrisL: When I was a retail pharmacist and parents would come to the store seeking head lice treatments, I’d recommend the usual product that is derived from chrysanthemums. But some parents would balk, asking for something “natural,” like tea tree oil. So then I’m explaining that tea tree oil doesn’t work on lice, and some of the deadliest poisons in existence are “natural.”

    Here in Canada, tea tree is marketed as a “natural” alternative for the treatment of a myriad of conditions, primarily, dandruff, head lice, and acne. From your post, I’m thinking you would not put it on a child.

    I use nail polish remover (primarily acetone) to remove adhesive tape from a wall. Ketones are natural, no?

  48. norrisL says:

    pharmavixen

    I try to explain to my clients (I am a veterinarian in Australia) that Taipan venom is natural. The Inland Taipan being the most toxic terrestrial snake on earth, but fortunately for us here in Aus, Inland Taipans live in Central Australia, so unless you go to the Simpson Desert, you are unlikely to cross one.

    No, I would not apply tea tree oil to any living thing.

    Yes, ketones are natural, just ask a diabetic, and would be effective for glue removal. :)

  49. Alia says:

    So, I must admit something. I had a small wart on my finger. It wasn’t really painful or anything, so I let it be for two years or something. But having read the article, I decided to do something about it. I went to a pharmacy, asked the pharmacist about something for warts and she recommended a liquid containing salicylic acid and lactic acid. The leaflet said that you should put it on a wart twice a day for 6-8 weeks. It’s been two weeks and the wart is gone, with only slight scarring left. I do hope it’s gone for good.

  50. BillyJoe says:

    Alia,

    Those acids dissolved away the skin affected by the wart virus. Chances are that, though the wart has gone, the virus itself lies in wait to strike again. So I will back the odds and say that that wart will be back. You may be lucky of course. So, when it does come back, you can continue to treat it with acid and eventually your immune system will have enough of that wart virus attacking the skin of the body that it evolved to protect, and then that wart virus, along with the wart it is responsible for producing, will be gone forever. There is some suggestion that the acids’ assault on the wart helps to persuade the immune system to act, but there is little evidence that that is the case.

    And, since everyone has abandoned science and promoted their own anecdotes, let me just add mine and say that I never at any time treated my wart with any chemical of any description.
    Therefore nothing works. ;)

  51. mousethatroared says:

    @BillyJoe – Cochrane Database of Systematic Reviews – “Salicylic acid (SA), a cheap and easily‐available solution painted on to warts, had a definite but modest beneficial effect compared to placebo. It is effective for warts at all sites and has few adverse effects, but it may take several weeks of daily use to work.”

    also “Trials of salicylic acid (SA) versus placebo showed that the former significantly increased the chance of clearance of warts at all sites (RR (risk ratio) 1.56, 95% CI (confidence interval) 1.20 to 2.03). Subgroup analysis for different sites, hands (RR 2.67, 95% CI 1.43 to 5.01) and feet (RR 1.29, 95% CI 1.07 to 1.55), suggested it might be more effective for hands than feet.”

    http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011182/

    How is using Salicylic Acid could be considered abandoning science?

  52. mousethatroared says:

    On acetone – (natural or not – I don’t care) I use it occasionally in my work, although I try not to cause it’s nasty stuff and on my mental list of things that will probably mess with my immune system, given a chance. I treat all solvents with caution. At my old job, I was dismayed to be informed by the fire marshall during an inspection that an acetone soaked rag can spontaneously burst into flames, particularly when friction is applied, but even when the rags are stored in a cupboard. So be careful my friends – maybe just don’t put tape on your walls. ;)

  53. Alia says:

    In a way, I just wanted to thank Mark Crislip for his article, because it spurred me to look for some kind of treatment for my wart. And since salicylic acid does seem to show some moderate effects in clinical trials, I decided to give it a try. Hopefully, the effect will be lasting. If not, I have almost a full bottle of this stuff and it was cheap.

  54. BillyJoe says:

    Michelle,

    Mark Crislip concludes his post with the following quote from Cochrane Systematic Reviews on the treatment of warts….

    “Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness, but the same was also true for trials comparing cryotherapy with [salicylic acid]….None of the other reviewed treatments appeared safer or more effective than SA and cryotherapy”

    In other words, cryotherapy = salicylic acid = other reviewed therapies = placebo.
    More or less.
    Also, clearance =/= cure.
    After all, one of the treatments for warts is serial curettage, which CLEARS the wart within minutes.
    The only way to CURE warts is for your immune system to develop an immunity to the wart virus. This is how warts clear “naturally”. The question then is: Can anything you do hurry this process along? The evidence based answer seems to be: No.

  55. BillyJoe says:

    Alia,

    “Hopefully, the effect will be lasting”

    Apparently hoping doesn’t help either. :)

    Apparently 2/3 return within 6 months.
    The remaining 1/3 either come back after 6 months or never come back because, in the mean time, the immune system has cleared the virus.
    Has your treatment assisted the immune system in clearing the virus?
    Apparently the evidence-based answer is….No.

  56. mousethatroared says:

    BillyJoe – I linked to a 2012 Cochrane review that stated the evidence showed modest benefit for SA for warts.

    You ignore this in preference of a blog summary of a summary of a review. I think you are over stating the evidence and conclusion quoted and your suggestion that using SA on a wart is “abandoning science” is a huge exaggeration. You are not a doctor, much less a dermatologist. You are not qualified to make the claims you are making.

  57. BillyJoe says:

    Well, Michelle, it seems the bit quoted by Mark Crislip from Cochrane is directly out the systematic review that you linked to. So let me quote it again:

    “Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness, but the same was also true for trials comparing cryotherapy with [salicylic acid]….None of the other reviewed treatments appeared safer or more effective than SA and cryotherapy”

    The above is from the authors’ comment.
    Your quote is from the abstract.
    Interestingly, they add the following:

    “Many of the studies were judged to be at high risk of bias in one or more areas of trial design”

    That may explain the difference between the two. The authors are making a conclusion taking into account the actual results obtained together with their assessment that there was a high risk of bias which would reduce the significance of the results which were only moderate in any case.

  58. BillyJoe says:

    Oh, I forgot:

    “You are not a doctor, much less a dermatologist. You are not qualified to make the claims you are making.”

    Non-sequitur. Doctors and dermatologists are not necessarily competent to assess clinical trials and systematic reviews. Conversely, you do not need to be a doctor or dermatologist to assess clinical trials and systematic reviews. The doctors in this blog are a biased sample. But if you read comments by doctors on other websites, you’ll see a lot of ignorance about evidence based medicine, let alone science based medicine.

  59. Narad says:

    The question then is: Can anything you do hurry this process along? The evidence based answer seems to be: No.

    Given that they plainly spread, I’ll take mechanical removal even if they tend to recur at the original site. I’ve certainly had some that were successfully destroyed, even though the underlying virus is still active.

  60. mousethatroared says:

    Once again, the review* summarizes “Aside from the use of SA and aggressive cryotherapy there is insufficient evidence from RCTs to support the use of other therapies. Higher quality evidence is needed to evaluate other therapies.”

    Yes of course, BillyJoe, you are just as competent as any other person on the internet to judge whether someone is “abandoning science” by not using your precise reading of the review. Thanks for the free medical advice. It was worth every penny.

    *Yes it is the same review, I was confused by the different publishing dates.

  61. BillyJoe says:

    Michelle,

    You a being a little unfair here.

    I do have some experience reading clinical trials. In this case I am unable to do so because only the extract and author comment are available. But I have learnt enough to realise you have to read between the lines. And you can do it too with a little practice.

    As i pointed out, the authors clearly wrote the following in their commentary:

    “Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness, but the same was also true for trials comparing cryotherapy with [salicylic acid]….None of the other reviewed treatments appeared safer or more effective than SA and cryotherapy”

    As you pointed out, they also wrote the following in the results section:

    “Trials of salicylic acid (SA) versus placebo showed that the former significantly increased the chance of clearance of warts at all sites (RR (risk ratio) 1.56, 95% CI (confidence interval) 1.20 to 2.03). Subgroup analysis for different sites, hands (RR 2.67, 95% CI 1.43 to 5.01) and feet (RR 1.29, 95% CI 1.07 to 1.55), suggested it might be more effective for hands than feet.”

    Elsewhere they said that the effect was moderate.
    Finally, as I pointed out, they also said the following by way of introduction to the results:

    “Many of the studies were judged to be at high risk of bias in one or more areas of trial design”

    I’m not trying to score points here, but how would you put this all together, Michelle?
    I got the distinct impression that Mark Crislip was not impressed and neither was I. You cannot take clinical trials at face value, otherwise what would you say about a meta-analysis of clinical trials of acupuncture that concluded the following:

    “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.”

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