Periungual warts are a common skin condition characterized by small, rough growths that develop around or under the fingernails or toenails. These warts are caused by certain strains of the human papillomavirus (HPV), a highly contagious virus that infects skin cells. Periungual warts can range in appearance from tiny, pinhead-sized bumps to larger, cauliflower-like clusters that may be discolored, appearing brown, gray, or black. While often harmless, they can become painful, interfere with nail growth, or cause the surrounding skin to split.
At-Home Removal Methods
Salicylic acid is a common over-the-counter treatment for periungual warts. It works by dissolving affected skin layers, breaking down wart tissue. Available in gels, liquids, and patches, concentrations typically range from 15% to 26%. Before application, soak the wart in warm water for five minutes and gently file down thickened skin.
Apply daily for up to 12 weeks. Covering the treated area with a bandage or duct tape can enhance effectiveness through occlusion. Avoid applying to healthy skin to prevent irritation; discontinue if severe redness, pain, or itching occurs.
Duct tape occlusion therapy involves covering the wart, which may create a moist environment unfavorable for its survival. Some theories suggest the tape’s adhesive or chemicals might also stimulate an immune response. Cut duct tape to cover the wart and leave for six days. Remove, soak the wart in warm water, and gently debride the top layer. Leave off overnight, then reapply, continuing this cycle for several weeks, up to two months.
Exercise caution with home methods; avoid cutting or picking warts. This can cause bleeding, increase infection risk, and spread HPV. While home remedies can be effective, periungual warts are often difficult to treat due to their location, and self-treatment may not always lead to complete resolution.
Professional Medical Treatments
When home treatments are insufficient or for stubborn periungual warts, healthcare professionals offer several effective procedures. Cryotherapy freezes the wart with liquid nitrogen, forming a blister that sheds the tissue. Several treatments, spaced weeks apart, are typically required, with success rates often 50% to 70%.
Cantharidin, derived from blister beetles, is another professional option. It causes a controlled blister to form underneath the wart, leading to detachment and peeling. Application is generally painless, and the blister usually resolves within four to seven days. Often used for common and periungual warts, it can be combined with other agents like salicylic acid for enhanced effect.
Electrosurgery (electrocautery) uses heat from an electrical current to destroy wart tissue. A fine-tipped heated probe burns and removes the wart layer by layer, often under local anesthetic for comfort. Useful for larger or treatment-resistant warts, it effectively eliminates infected cells.
Laser therapy is used for warts unresponsive to other treatments. Pulsed dye lasers (PDL) target wart blood vessels, cutting off supply and causing it to die. Carbon dioxide (CO2) lasers vaporize wart tissue layer by layer. Precise and effective for deep or stubborn warts, it may require local anesthesia and can sometimes lead to scarring.
Surgical excision involves cutting out the wart with a scalpel. Typically reserved for larger or unresponsive warts, it is performed under local anesthetic. While effective, it can result in a wound taking several weeks to heal and potentially leaving a small scar.
Knowing When to Consult a Doctor
Consult a doctor for periungual warts in several situations. If warts cause significant pain, bleeding, or show signs of infection (increased redness, swelling, pus), a doctor should be consulted. Rapidly growing warts, those spreading to other areas, or affecting nail growth and causing disfigurement also warrant evaluation.
Consult a healthcare provider if over-the-counter treatments show no improvement after several weeks or months. This applies if warts persist, spread, or return after home treatment. People with weakened immune systems, such as those with diabetes, should seek medical attention for any warts due to increased susceptibility to complications or persistent infections.
Preventing Future Warts
Preventing periungual warts involves minimizing HPV exposure and practicing good hygiene. Avoid nail biting or picking skin around nails, as this creates breaks for virus entry. Maintain good hand hygiene, including frequent hand washing, to reduce virus spread.
Keeping hands and feet dry can deter the virus, as HPV thrives in warm, moist environments. Wear appropriate footwear like flip-flops or sandals in public areas (locker rooms, swimming pools, communal showers) to reduce contracting the virus from contaminated surfaces. Avoid direct contact with existing warts and do not share personal items (nail clippers, towels, shoes) to prevent virus spread.