Warts are common, non-cancerous growths caused by certain strains of the human papillomavirus (HPV). The virus enters the skin through tiny cuts, triggering extra cell growth that results in a rough, hard bump. Dermatologists are the primary medical professionals for the diagnosis and removal of warts. They offer a range of treatments far more effective than over-the-counter options, especially for stubborn or widespread lesions.
The Dermatologist’s Role in Diagnosis
The initial consultation with a dermatologist moves beyond simple identification, focusing on accurately diagnosing the lesion. A dermatologist’s expertise is necessary to confirm that the growth is a wart and not a more serious condition, such as a mole, skin tag, or an early form of skin cancer like squamous cell carcinoma. Misdiagnosis can lead to ineffective self-treatment, allowing a potentially harmful condition to progress.
The specialist will carefully examine the lesion, often using a dermatoscope, and may look for classic signs like tiny black dots, which are actually clotted blood vessels. Identifying the specific type of wart, such as common, plantar, flat, or filiform warts, is important because the location and type directly influence the most effective treatment plan. For instance, plantar warts on the sole of the foot grow inward due to pressure and require deeper penetration than a common wart on the hand.
If a growth is rapidly changing, bleeding, or resistant to initial treatment, the dermatologist may perform a skin biopsy. This involves numbing the area and removing a small tissue sample for lab analysis to definitively rule out malignancy or other skin disorders. This ensures the patient receives a precise and tailored approach.
Clinical Wart Removal Procedures
Dermatologists employ several in-office procedures to destroy the wart tissue, which are significantly stronger and more targeted than home remedies. The choice depends on the wart’s size, location, type, and resistance to previous treatments. These interventions are designed to physically remove or chemically destroy the virus-infected cells.
Cryotherapy is one of the most common methods, using liquid nitrogen that boils at -196°C (-320.8°F). The cryogen rapidly freezes the wart tissue, causing ice crystals to form and mechanically rupture the cells. This cellular destruction, combined with subsequent blister formation, causes the wart to scab and fall off, though multiple sessions are often needed for a deep enough freeze.
Electrocautery, frequently paired with curettage, uses a controlled electrical current to generate intense heat, which burns and destroys the wart tissue. After the area is numbed, the dermatologist uses a fine-tipped electrode to cauterize the growth. This process seals blood vessels, minimizing bleeding and reducing the risk of viral spread during the removal of the dead tissue with a curette.
For large, deep-seated, or highly resistant warts, surgical excision may be necessary to ensure complete removal. This procedure involves cutting out the entire wart and a margin of surrounding tissue under local anesthesia. While this method offers a high rate of success in a single session, it does carry a higher risk of scarring compared to less invasive options.
Chemical peels use highly concentrated topical acids, such as trichloroacetic acid (TCA), often in 80% to 90% preparations. These caustic agents destroy the wart by chemically coagulating the proteins and keratinocytes within the infected tissue. The dermatologist carefully applies the acid, which turns the tissue white and causes it to peel away over several treatments.
Immunotherapy is reserved for widespread or highly refractory warts, working by stimulating the body’s immune system to fight the human papillomavirus. This involves injecting an antigen, such as Candida antigen or the Measles-Mumps-Rubella (MMR) vaccine, directly into the wart to provoke a delayed-type hypersensitivity reaction. This localized immune response activates T-cells and natural killer cells, which attack the virus-infected cells, often leading to the clearance of both the treated wart and distant lesions.
When to Seek Professional Treatment
While many warts may resolve on their own, there are several circumstances that warrant a professional evaluation from a dermatologist. If you have attempted consistent over-the-counter treatments, such as salicylic acid applications, for several weeks or months without any noticeable improvement, the wart is likely too deep or stubborn for home care. Professional intervention is also advised if the wart is painful, such as a plantar wart making walking difficult, or if it frequently bleeds.
You should promptly seek a consultation if the warts are rapidly multiplying or spreading, as this indicates an active viral infection. Warts located in sensitive areas, particularly on the face, eyelids, or genitals, require a dermatologist’s precise techniques to avoid scarring or complications. Furthermore, individuals with a compromised immune system or a condition like diabetes should always consult a specialist before attempting any form of wart treatment.