Warts: Debunking Myths and Clarifying Treatments

Warts aren't dangerous or life-threatening, but they can be incredibly frustrating for our patients. In primary and urgent care settings, clinicians frequently see patients who've tried every home remedy under the sun — from banana peels to apple cider vinegar — before coming in. Let's clear up the confusion and look at what really works.

What Are Warts, Really?

Warts are benign skin growths caused by the human papillomavirus (HPV). They can appear on the hands, feet, around the nails, or elsewhere. While technically contagious, they typically spread through contact with broken skin or shared surfaces like towels and gym floors. 

Home Remedies: What Do We Know?

Patients are desperate for treatment solutions, but what does the evidence say?

Essential Oils: Popular online, but mostly anecdotal. A 2018 sandalwood oil study showed 80% resolution at 12 weeks, but with only 10 participants and no placebo group (Haque et al.). A single case study noted success with tea tree oil, but this N-of-1 study can't support broader recommendations.

Apple Cider Vinegar: While acidic, like salicylic acid, and shown to have antimicrobial properties, there's no robust evidence that it treats warts effectively. If used, dilute with water to reduce irritation.

Vitamin A (Topical Retinoids): Some case reports and small studies suggest efficacy, particularly in recalcitrant warts. A meta-analysis found a complete response rate of 64% with topical retinoids. Many patients already have Vitamin A-based acne medication at home (like adapalene) and could benefit from this off-label use, although salicylic acid remains superior in terms of evidence and safety.

Castor Oil: Despite demonstrated antiviral properties against some viruses, there is no evidence supporting its use against HPV. Therefore, there is no evidence to recommend it for treating warts.

Duct Tape: A Sticky Situation

Duct tape is one of the most popular home remedies. The theory is that it may cause irritation and stimulate a local immune response. A 2002 randomized controlled trial by Focht et al. found that 85% of patients using silver duct tape daily for two months experienced complete resolution, compared to 60% of those receiving cryotherapy, suggesting superior efficacy.

However, subsequent studies have had mixed results. A 2007 study using clear duct tape found no significant difference compared to placebo, suggesting that the adhesive composition might influence effectiveness. In 2020, a study in the Journal of Dermatological Treatment concluded that silver duct tape might be a practical alternative for plantar warts in adults, particularly when cryotherapy is unavailable or not tolerated.

• Duck Tape Technique: A small piece of silver duct tape is applied to the wart, left in place for 4-7 days, then removed. The area is cleaned, and dead skin is filed down. The tape is reapplied and the cycle repeated for 4-6 weeks

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Evidence-Based Treatments

1. Salicylic Acid: This keratolytic agent has the strongest evidence base. It destroys HPV-infected epidermis and may also provoke an immune response. With proper use, cure rates approach 73%, significantly better than placebo (Mulhem & Pinelis). It is safe, inexpensive, and available in various formulations.

- Education is key with this one. Instruct patients to:

• Soak the wart  in warm water for 5 minutes

• Filed down thick skin with a pumice stone or an emery board

• Apply salicylic acid

• Repeat daily with liquid or gel preparations, or every other day with the patch

• Do for max 12 weeks or until the wart resolves

2. Cryotherapy: Freezing the wart with liquid nitrogen is effective, with cure rates between 50-70% after multiple treatments. It is often used in conjunction with salicylic acid. Multiple treatments may be needed

Patient Talking Points

Warts may be benign, but the confusion around how to treat them is anything but. With a little patient education, you can dispel common myths, set realistic expectations, and guide families toward treatments that are safe. Salicylic acid remains the best-supported option, cryotherapy is a reliable next step, and duct tape may help in select cases — though the evidence varies. Most importantly, reassuring patients that warts are common, manageable, and often slow to resolve can go a long way in easing frustration.