Yikes! You just noticed your child has a wart. What should you do? We reached out to Dr. Moise Levy, pediatric dermatologist at Dell Children’s Medical Center and professor at Dell Medical School, for guidance.
To Treat or Not to Treat
“Parents may choose not to treat the wart,” says Dr. Levy. “About 60% of warts go away without treatment within two years or so. The decision of whether to treat or not often depends upon the location of the wart and the child’s age.” Warts can occur in any location and may be seen on the hands, feet, face or around the knees. Some warts can be painful, such as those on the soles of the feet. Warts in other places may get bumped frequently and bleed. Older children and adolescents are more likely to be embarrassed by a wart and want treatment.
Dr. Levy recommends getting medical advice if warts are painful, bleeding or rapidly increasing in size or number. Also talk to your provider if warts are located on the child’s face or genitals or if your child has a weak immune system. Treating warts early – when they’re small – increases the chance of a successful treatment.
Home Treatments for Warts
“There are no defined treatments with a clear success rate,” cautions Dr. Levy. “Parents may want to try daily home treatments for several weeks before considering medical help.” An over-the-counter (OTC) treatment that contains salicylic acid may work. See the sidebar for instructions.
Medical Treatments for Warts
Dr. Levy explains that the best medical treatment depends on the location and size of the wart, as well as the child’s age. Personal preferences are also important factors. “When discussing treatment options with parents, I always involve the child, if practical. Many ‘in-office’ treatments are available, but none are guaranteed to be effective. In fact, your child may need several different types of treatments before the warts go away. It is important to consider the child’s needs and welfare above all else,” says Dr. Levy.
Warts are caused by a virus and are treated by destroying the wart or by immunotherapy. Dr. Levy outlines some of the most common medical treatments:
- Liquid nitrogen. Freezing a wart with liquid nitrogen is the “gold standard” for wart removal. This method can be painful and is not well tolerated by many children. Aggressive freezing near the nail beds may damage nail growth, so dermatologists are careful when treating warts in that area. Freezing may be combined with application of trichloroacetic acid and cantharidin. These chemicals cause irritation and usually aren’t used on a young child’s face.
- Immune boosting injections or topicals. The dermatologist may inject the wart with a substance to try to enhance a local immune response so that the body recognizes the virus and attacks it. Applying a topical “immune-based” source of irritation is another option.
- Cimetidine (Tagamet). Taking cimetidine by mouth is an older treatment option considered when there are multiple warts and the family is motivated. Cimetidine has interactions with many other medicines, including some you can buy without a prescription. So parents must be thorough when listing medicines the child takes or might take. The child will need to take cimetidine every day for a few months for the treatment to be effective.
- Other options. Other options include laser removal or surgery. Surgery carries risk of scarring. “We can often guarantee a scar but can’t guarantee success of permanent wart removal,” says Dr. Levy. Topical options sometimes used are retinoids, 5-fluorouracil or imiquimod.
How to Treat Warts at Home
Select a wart removal product that contains salicylic acid. Liquid, tape or pads are available without a prescription. Don’t treat warts on the face or genital area without talking to the child’s pediatrician first. In addition to the product, you’ll need a small amount of household duct tape or white medical tape and scissors. Follow the steps below before bedtime so the treatment can stay on the wart overnight.
- Soak the wart in warm water for at least five minutes.
- Gently file away any callus on the wart using an emery board or pumice stone.
- Apply the salicylic acid product to the wart. Be careful not to get it on surrounding normal skin. If using a liquid product, let it dry before continuing to step 4.
- Cover the wart with a small piece of duct tape cut to size.
- Leave the treatment on the wart overnight. If possible, leave the tape in place for 24 hours.
- Repeat steps 1-5 every night. Treatment may take several weeks, up to four months.
Adapted from “Warts (verruca vulgaris) and what to do about them,” available from The Society of Pediatric Dermatology website at bit.ly/2HW37pV.
Brenda Schoolfield is a freelance medical writer who splits her time between Austin and Seattle.
