Warts under or around toenails (subungual or periungual warts) are common skin growths. Their location can make them particularly challenging to treat effectively. This article provides guidance on managing these warts, covering both at-home remedies and professional medical interventions.
Understanding Warts Under Toenails
Warts under or around toenails are caused by the human papillomavirus (HPV). Specific HPV types are often responsible. The virus enters the skin through small cuts or breaks, infecting skin cells and forming a wart. Their position beneath the nail plate creates a barrier, making treatment difficult.
The nail also protects the wart, contributing to its persistence and making it more resistant to common therapies. These warts can cause discomfort and pain, especially as they grow and put pressure on the nail bed. Common indications include nail thickening or discoloration (yellow or brown). The skin around the nail might become rough, raised, or develop a cauliflower-like texture, sometimes with tiny black dots.
Home and Over-the-Counter Approaches
Self-treatment often involves salicylic acid, available in liquid, gel, or patch forms. This chemical works by dissolving the affected layers of skin. For application, soak the foot in warm water to soften the skin, then gently file the wart’s surface to remove dead tissue. Apply the salicylic acid product directly to the wart, avoiding healthy surrounding skin.
Consistency is important, often requiring daily application for several weeks to months until the wart fully resolves. Mild burning, redness, or peeling are expected side effects, indicating the treatment is working. Home cryotherapy kits use a freezing agent to destroy wart tissue. These kits involve applying the freezing agent for a short period, which can cause blistering and eventual shedding of the wart.
Duct tape occlusion, an anecdotal method, involves covering the wart with duct tape for several days, then removing it to file down the softened skin.
When to Seek Professional Care
Consult a healthcare professional if a wart causes persistent pain or discomfort that interferes with daily activities. Immediate medical attention is warranted for signs of infection, such as increased redness, swelling, pus, or bleeding around the wart. A professional diagnosis is important if the wart grows rapidly, spreads, or if there is uncertainty about whether the growth is indeed a wart.
Individuals with underlying health conditions, including diabetes, poor circulation, or a compromised immune system, should always seek professional care. These conditions can increase the risk of complications, such as infection or delayed healing. If home treatments have been consistently applied for several weeks without noticeable improvement, consider professional intervention.
Professional Treatment Options
Medical professionals offer various treatments for warts under toenails, often selected based on the wart’s size, location, and resistance. Cryotherapy uses liquid nitrogen to freeze and destroy wart tissue. This procedure typically takes seconds and may require multiple sessions, spaced weeks apart, for complete resolution. Patients may experience stinging or pain during treatment, followed by blistering and eventual shedding.
Laser therapy uses a focused light beam to destroy wart cells. This method is effective for stubborn warts and may require local anesthesia. Surgical removal (excision) involves cutting out the wart. While effective, it carries a risk of nail deformation, especially if the wart is extensively under the nail plate. This approach is often considered for painful or resistant warts.
Cantharidin, a blistering agent, is applied to the wart, causing a blister to form underneath it. The blister lifts the wart from the skin, and the dead tissue is removed after about a week. This method is generally painless during application, though the resulting blister can be painful for a few days.
For resistant cases, immunotherapy stimulates the body’s immune system to fight the HPV infection. This can involve intralesional injections or microwave immunotherapy (e.g., Swift therapy), which uses microwave energy to trigger an immune response. These treatments often require multiple sessions and can lead to high success rates.