Warts on the hands and feet can be particular concerning to patients (and parents!).  They are often very challenging to treat and can take quite a while to resolve completely.  

There are many over-the-counter treatment options.  Our personal choice of medications is something called Wart STICK (which looks exactly like a tube of ChapStick) and is available over the counter. It can sometimes be very difficult to find but is usually available at Walgreens (although you may need to ask the pharmacist for it since they often keep it behind the counter).  This is our choice because the active ingredient is 40% salicylic acid, the strongest and best available over-the-counter agent, and it is a solid gel that can be applied directly to the wart and is less likely to spill onto normal intact skin.

Duoplant is another good option because it comes in a gel and, again, can be more easily applied to the lesion and not the skin.

There are multiple other choices but sometimes the liquid or dropper preparations can be more difficult to apply and can have more skin irritation.

There are also now over-the-counter “freezing” applicators. In general the use of these should be discouraged. They can sometimes be successful for the very tiniest of warts that will very easily be killed, but for the most part these “freezers” don’t obtain a temperature cold enough to fully freeze the wart, sometimes can be painful, and not uncommonly can cause spreading of the lesions.   Contrary to what the packaging states, they are not as effective as the liquid nitrogen a dermatologist or podiatrist would use to treat warts.

Instructions for application of topical wart medicine:

To get the greatest benefit from the wart medications, follow these directions. It is best to do these steps in the evening/before bed:

  1. Soak the wart in warm water for 5 minutes (bath or shower will do for plantar, or foot warts).
  2. Dry with a paper towel, and keep the paper towel around in case you need it later.
  3. Pick away any old dead wart tissue and old medicine with a toothpick. This is best done by the child, since he or she will know what feels okay and what hurts. It isn’t necessary to get everything off each day, even if it looks like some of the wart is ready to come off. If it hurts to pick a piece all the way off, just leave it and it will come off in a few days.
  4. Put new medication on the remaining wart, but be careful to not get the medication on the normal skin around the wart. If you realize the medicine has gotten on the skin when it was applied, wipe it off with the paper towel before it dries and usually no soreness will occur. As time goes by, the skin around the wart will pull away from the sides of the wart, exposing more of the lower portion of the wart tissue and making it possible to treat that portion as well.
  5. After the medication has been applied, cover the entire area with a large piece of silver duct tape (a small piece of tape that only barely covers the wart itself is insufficient). If at all possible, leave the duct tape on for the entire night and then remove it in the morning. Repeat these steps nightly.

It may take 2-3 months for all the wart to disappear, but eventually you will get to the base. When there is nothing left to treat that looks like wart, stop applying the medication but recheck the area in a few days to see if the wart is growing back. If it does seem to grow back to some extent, just restart the medication and you can get rid of the rest of it before it has a chance to get much larger. 

Because warts are caused by a virus in the skin, it is possible that new warts will appear while you are treating the present wart. This does not mean that you are not succeeding in getting rid of the warts since the virus sits in the skin for some time before a new wart appears. You can go ahead and start treating the new wart while you continue to treat the old one.

In order to make this whole process easier to accomplish, making up a “wart bag” for the children can help a lot. Use a small baggie, and put into it some folded up paper towels, toothpicks, duct tape, and the container of wart medicine. That way you don’t have to look around for all the supplies each day when you want to use them.

You can view a printable version for reference offline here: wart instructions.pdf