A verruca is a curable condition and there are many treatment options, although no methods can provide a 100% guarantee of healing. This is mostly because it is the individual’s immune system that is responsible for combating the virus. This means sometimes it can spontaneously resolve within a few years. It takes up to 8 months from the virus entering into the epidermis to develop the lesions, and as it went in unnoticed, it can resolve itself unnoticed within that time, especially among the young and healthy individuals. Therefore it is not recommended to treat verruca in children until there are issues of pain or self-consciousness. Although verruca is caused by HPV, there is no effective vaccination to prevent plantar warts. The vaccination children receive at school protects them from the different strains of the virus.
Apart from home remedies, some of which may work as a placebo, there are a few clinical home remedies that can work in treating a verruca. The ideal way is to improve the individual’s immune response, manage the patient’s expectations while remembering that no treatment is guaranteed to be a 100% success, and use a painless method without creating scars.
The practitioner has a wide range of treatments to choose from, such as using salicylic acid, Verrutop, cryotherapy, swift and laser (heat therapy), and needling. The aim of all the different treatment methods are to alert the individual’s immune system and activate the natural defence and healing response.
Salicylic acid dries out epidermal moisture and “shrinks back” the verruca. It requires several weeks of daily application to work and may cause damage to healthy tissue.
Verrutop is a nitri-zinc complex solution, which consists of nitric acid, metallic salts (zinc and copper) and organic acids (oxalic acid, lactic acid and acetic acid). Nitric acid reacts with amino acids in the skin and dehydrates proteins and the cellular matrix. During this process xanthochromia occurs (skin is being stained yellow) and a noxious gas is released. This dehydration of the tissues `shrinks` the lesion and breaks down protein bonds in viral-infected keratinocytes. This treatment is widely considered as the most effective and safest form of treatment for verrucas. Verrutop has to be applied by a professional due to the precision needed to avoid damaging surrounding healthy tissue. Effects are usually seen after 4 applications, and the treatment can be applied up to 6 times.
Cryotherapy consists of freezing the lesion with liquid nitrogen. The aim is to damage the affected tissue and cause an anti-inflammatory response. However, this method may leave a scar. It is a very painful method, therefore it is not used on children, as the pain can be unbearable for them.
Laser therapy and microwave therapy both are heat therapies with the aim similar to cryotherapy – damaging the infected tissue. It can cause burns and leave a scar similar to cryotherapy. Swift (microwave) is considered to be safer than laser and seems to be more effective although currently there is not enough research to confirm.
Needling is another way of causing trauma to trigger an immune response. It does not involve chemicals. The needle penetrates the full depth of the verruca and perforates the lesion.
Occlusion therapy is a therapy that covers the lesions with zinc-oxide tape to cause maceration of the skin. The main aim is to induce inflammation and an immune response. This method requires time and consistency.