Wart removal surgery

Warts present as skin-coloured raised growths on the upper skin layer (epidermis) that are non-cancerous. They occur because of infection with certain strains of the human papillomavirus (HPV).

They are not highly contagious but can spread from direct contact from one person to another. While almost all people come into contact with HPV multiple times, only some grow warts for reasons that are not understood. They can develop on any part of the body and could grow bigger, with the risk of spreading to other parts of the body also. Usually harmless, warts can be irritable and may even cause pain depending on their location, for example, the feet.

The following are some of the usual types:

• Common warts: most often feel like rough bumps with dark specks. Mostly found on the hands, elbows and knees – where the skin is broken. Grey to flesh-coloured, these are covered with hornlike projections.
• Plane or flat warts: are smoother and smaller than other warts and tend to grow in large numbers. Typically appear on the face (especially with children), beard area (in men) and lower legs (in women), though it can affect any other body part as well. Yellow to pink in colour.
• Foot warts: also called plantar warts, these appear on the sole of the feet. Grey or brown coloured with tiny, black dots and cause pain while walking – like having pebbles. Due to the weight of the body, usually not raised like other warts. When these appear in clusters, they are also referred to as mosaic warts.
• Filiform warts: these appear like long, thin threads or fingers. Typically affect the area around the mouth, eyelids, armpits or neck. 
• Genital warts: these are sexually transmitted and appear as grey or off-white-coloured bumps in the pubic region. They can cause itching or bleeding from the genitals or the anus.

While they can give cosmetic discomfort, most warts disappear on their own with the passage of time or with home remedies. However, in the following cases, it is advisable to visit a doctor:

• Warts cause pain
• The warts are not cured and continue to recur or spread even after home treatment
• If warts change their shape or colour
• If the wart appears to be red, swollen and warm – this could indicate an infection
• Growths hinder daily activities, like foot warts cause problems while walking
• In the case of adults, if multiple warts start appearing – this indicates problems with the immune system
• For people with deficiency in immune systems
• If you are pregnant
• Genital warts
• Bleeding after a slight brush or bump

(Red more: Home remedies for warts)

For people with some pre-existing health conditions, wart removal may not be advised through certain types of treatments:

• People with allergies
• Those prone to infection
• Warts developing in sensitive areas such as near the eyes
• People with diabetic foot problems
• Peripheral arterial disease

Warts are managed by a general surgeon. The history of warts including number, location, size and other associated factors are asked and noted.

Examination of warts can identify the severity of the disease. It also helps differentiate from other conditions such as corn.

The doctor may also scrape off the top layer of the wart to look for dark pinpoints, which are clotted blood vessels to distinguish warts. In some cases, the doctor may also perform a biopsy using different methods such as:

• Shave biopsy: a small blade is used to remove a thin layer of the wart
• Punch biopsy: this is a more invasive method in which the area around the wart is numbed and a deeper sample is taken.

The extracted tissue is then sent to the laboratory for analysis to discern warts from other types of skin growths.

Once confirmed, the diagnosis the doctor discusses the various treatment options with the patient. The procedures are usually daycare and the patient is discharged by evening.

The patient arrives on the day of the procedure after fasting overnight. Written consent is taken from the patient and relatives after explaining the procedure and associated risks.

Once the patient is cleared for the procedure they are shifted into a minor procedure room. The warts are cleaned and the affected area is draped with a sterile cloth. A monitor is attached to track the patient's vitals. The doctor may treat warts using the following procedures:

• Stronger salicylic or other acids: Prescription-grade salicylic acids are stronger than those available over-the-counter. The doctor may also prescribe trichloroacetic acid, tretinoin or glycolic acid. These are all peeling medicines and work by removing the layers of warts over time.
• Cryotherapy: Also called freezing therapy, this involves the application of liquid nitrogen to warts. The extreme cold causes blister under or around the wart, resulting in the removal of the dead tissue in a week or so. Usually, this treatment is applied once every two to three weeks and is often used in combination with salicylic acid.
• Electrosurgery and curettage: A local anaesthetic is applied. Thereafter, a high-frequency electric current is passed via a needle-shaped electrode. The wart is scraped off using a sharp knife or small, spoon-shaped tool (called a curette) – this may be performed before or after electrosurgery.
• Laser Treatment: For warts that do not respond to other therapies, laser treatment can be used. Local anaesthesia is applied and then the pulse-dye laser is used to cauterize (burn) warts.
• Bleomycin: This is an anti-cancer medicine and is injected into each wart after paring down the wart using a scalpel blade.
• Immunotherapy: This treatment uses the patient’s own immune system to attack warts. Certain chemicals like diphenylcyclopropenone (DCP) and squaric acid dibutyl ester (SADBE) are used to initiate a delayed hypersensitivity response to several antigens and the wart tissue. This results in the production of natural killer cells in the body to get rid of HPV infection, which removes the local as well as distant warts.

Some treatments for wart removal may lead to scarring, which can be permanent. Further, there are also risks of infections in people with pre-existing conditions such as peripheral arterial disease, diabetes and immune deficiencies.

Treatment procedures like cryotherapy and laser treatment necessitate multiple visits to the doctor.

The aftercare and number of follow-up visits depend on the treatment procedure used. Usually, doctors start with the least invasive and painful procedures, and in case those are not successful, proceed with more aggressive procedures.

The doctor specifies the aftercare instructions, which must be followed, such as:

• Using ice packs to address the burning and stinging sensation
• Applying a sterile bandage to keep the area covered
• Using antibiotic cream for reducing the risk of infection
• Taking analgesics (painkillers) for relieving the pain

Post-treatment, the patient should be taken to emergency care in case of any signs of infections, high fever or development of pus.

While the occurrence of warts cannot be entirely avoided, there are steps a person can take to lower their risk of developing and spreading warts:

• Never scratch, bite or pick the wart
• Wearing shoes and not going barefoot
• Hand hygiene and avoiding touching self or others when the hands come in direct contact with the warts
• Keeping towels, socks, footwear and medicines for warts separate and not sharing them
• In case of foot warts, changing socks daily and keeping the bathroom clean after a bath
• Covering warts in case the patient wants to swim

Warts are benign skin growths that occur due to human papillomavirus. The exact mechanism of why warts occur is not known, however, people with immune deficiencies, children and teenagers, and regular exposure to a moist environment result in higher chances of developing warts.

The prognosis for warts removal is good, with most of them disappearing over time without requiring any treatment. There are also home remedies and over-the-counter products that are helpful. In cases where warts are a cosmetic concern, cause pain or do not go away, there are several procedures through which warts can be removed. Despite this, recurrence happens.